Browsing by Subject "Emergency Medical Services"

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    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.
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    Open Access
    A retrospective study of the prehospital burden of trauma managed by the Western Cape Government emergency medical service
    (2019) Abdullah, Mohammed Naseef; Saunders, Colleen; McCaul, Michael; Nyasulu, Peter
    Introduction: Trauma is one of the leading causes of premature death and disability in South Africa. There is a paucity of data describing the prehospital trauma burden in sub-Saharan Africa. The aim of this study was to describe the epidemiology and common trauma emergencies managed by the Western Cape Government emergency medical service (WCG EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this was the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these cases, 168 980 (34.3%) or 25.9 per 1000 population were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were males and between the socio-economically active ages of 21-40 years old (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS case load managed. The patient acuity was categorised as being urgent for 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report of the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the WHO or any other LMIC. It also provides the foundation for further research towards understanding the emergency care needs in South Africa and to support Afrocentric health care solutions to decrease this public health crisis.
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    Open Access
    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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    An agent-based model of the emergency medical services system in Nelson Mandela Bay municipality
    (2024) Cope, Sky; Silal, Sheetal
    Inefficient EMS systems can lead to delays in accessing urgent medical care and increased mortality for critically ill or injured patients. In the Nelson Mandela Bay district of South Africa's Eastern Cape province, the public EMS system struggles to meet its own response time targets. In addition to long response times, staff and vehicles are not always allocated efficiently, as highly-skilled personnel and specialised vehicles are frequently used for responding to low priority or planned patient transport calls. This decreases the quality of medical care provided to the most critically ill patients. The aim of this research is to improve patient outcomes in Nelson Mandela Bay's under resourced public EMS system, which serves the majority of the local population, including those who are unable to afford private EMS. It therefore has the potential to improve access to EMS for the most underprivileged communities, and enhance healthcare equity in the re gion. To achieve this, the research provides decision-makers in the Eastern Cape Department of Health (ECDoH) with a set of evidence-based recommendations for reducing response times, and improving the efficiency of staff and vehicle allocations. These recommendations are sen sitive to the resource-limited nature of the setting, and prioritises interventions that do not require additional staff or vehicles. The EMS system was modelled using an agent-based simulation model, which enables multiple sources of variation in the system to be explicitly accounted for, and nuanced scenarios to be investigated. The model was built and validated using anonymised EMS call data, a smaller dataset of precise response times, and travel time estimates from Google Maps. A key finding of this research is that the median response time of Priority 1 calls can be reduced to below the 30 minute target by implementing changes to dispatching, rerouting and prioritisation behaviour alone, and without increasing resources. These improvements come at the expense of substantial increases in median response times for lower priority calls, but these increases can be counteracted by moderately scaling up the number of staff employed. Improving the accuracy of dispatchers in triaging calls was identified as a particularly effective method of reducing response times, without considerable increases to response times for other call types. A number of policy recommendations were formulated based on these results. These will be presented to management in the Eastern Cape Department of Health, aiming to guide policy interventions for Nelson Mandela Bay's EMS system.
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    Open Access
    Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN)
    (2022-03-05) Nutbeam, Tim; Kehoe, Anthony; Fenwick, Rob; Smith, Jason; Bouamra, Omar; Wallis, Lee; Stassen, Willem
    Background: Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups. Methods This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16–59, 60–69, 70–79 and 80+  years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality. Results 70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p < 0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p < 0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8–46), not trapped 24.2 (20.1–29.2). Conclusions Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time.
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    Emergency care in 59 low- and middle-income countries: a systematic review
    (2015) Obermeyer, Ziad; Abujaber, Samer; Makar, Maggie; Stoll, Samantha; Kayden, Stephanie R; Wallis, Lee A; Reynolds, Teri A
    AbstractObjectiveTo conduct a systematic review of emergency care in low- and middle-income countries (LMICs).MethodsWe searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards.FindingsWe identified 195 reports concerning 192 facilities in 59countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000per year (IQR: 10 296–60 000), most of whom were young (median age: 35years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care.ConclusionAvailable data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.
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    Meeting national response time targets for priority 1 incidents in an urban emergency medical services system in South Africa: More ambulances won’t help
    (2015) Stein, Christopher; Wallis, Lee; Adetunji, Olufemi
    BACKGROUND: Response time is viewed as a key performance indicator in most emergency medical services (EMS) systems. OBJECTIVE: To determine the effect of increased emergency vehicle numbers on response time performance for priority 1 incidents in an urban EMS system in Cape Town, South Africa, using discrete-event computer simulation. METHOD: A simulation model was created, based on input data from part of the EMS operations. Two different versions of the model were used, one with primary response vehicles and ambulances and one with only ambulances. In both cases the models were run in seven different scenarios. The first scenario used the actual number of emergency vehicles in the real system, and in each subsequent scenario vehicle numbers were increased by adding the baseline number to the cumulative total. RESULTS: The model using only ambulances had shorter response times and a greater number of responses meeting national response time targets than models using primary response vehicles and ambulances. In both cases an improvement in response times and the number of responses meeting national response time targets was observed with the first incremental addition of vehicles. After this the improvements rapidly diminished and eventually became negligible with each successive increase in vehicle numbers. The national response time target for urban areas was never met, even with a seven-fold increase in vehicle numbers. CONCLUSION: The addition of emergency vehicles to an urban EMS system improves response times in priority 1 incidents, but alone is not capable of the magnitude of response time improvement needed to meet the national response time targets.
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    Reasons why patients with primary health care problems access a secondary hospital emergency centre
    (2012) Becker, Juanita; Dell, Angela; Jenkins, Louis; Sayed, Rauf
    BACKGROUND: Many patients present to an emergency centre (EC) with problems that could be managed at primary healthcare (PHC) level. This has been noted at George Provincial Hospital in the Western Cape province of South Africa. AIM: In order to improve service delivery, we aimed to determine the patient-specific reasons for accessing the hospital EC with PHC problems. METHODS: A descriptive study using a validated questionnaire to determine reasons for accessing the EC was conducted among 277 patients who were triaged as green (routine care), using the South African Triage Score. The duration of the complaint, referral source and appropriateness of referral were recorded. RESULTS: Of the cases 88.2% were self-referred and 30.2% had complaints persisting for more than a month. Only 4.7% of self-referred green cases were appropriate for the EC. The three most common reasons for attending the EC were that the clinic medicine was not helping (27.5%), a perception that the treatment at the hospital is superior (23.7%), and that there was no PHC service after-hours (22%). CONCLUSIONS: Increased acceptability of the PHC services is needed. The current triage system must be adapted to allow channelling of PHC patients to the appropriate level of care. Strict referral guidelines are needed.
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    The development of integrated palliative care and emergency medical services in South Africa
    (2025) Gage, Caleb; Stassen, Willem; Gwyther Elizabeth
    Background The role of Emergency Medical Services in out-of-hospital patient management has evolved rapidly in recent years to include more intricate and integrated forms of healthcare beyond emergency care. For example, there has recently been recognition of the role Emergency Medical Services play in the provision of palliative care. The developing body of literature on this topic has recommended Emergency Medical Services and palliative care systems should integrate to improve palliative situation management in the out-of-hospital setting. In South Africa, however, these systems remain segregated. As a result, palliative situations are managed poorly by Emergency Medical Services providers due to disregard of patient autonomy and performance of aggressive, futile interventions. Potential benefits of integration between these systems include delivery of early palliative care, provision of home-based care, respect of patient autonomy, improved patient/family quality of life, increased patient and family satisfaction and confidence, decreased health care costs and appropriate trajectories of care. A further benefit in the low-to-middle income context of South Africa would be efficient use of limited resources. Aim and Objectives To develop a framework for the integration of palliative care and Emergency Medical Services systems in South Africa. The research aim was pursued through the following objectives, each of which represented a study within the thesis: Study 1: To review existing literature concerning the intersection of palliative care and Emergency Medical Services. Study 2: To examine Emergency Medical Services use for palliative situations in South Africa. Study 3: To gather the perspectives of palliative care providers on Emergency Medical Services use in palliative care in South Africa. Study 4: To gather perspectives of South African patients and family members with palliative needs concerning Emergency Medical Services use in their care. Study 5: To develop and prioritise approaches facilitating Emergency Medical Services and palliative care system integration within South Africa. Methods Study 1 was a scoping literature review performed with an a priori search strategy inclusive of grey literature. Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included. Extracted data underwent descriptive content analysis. Study 2 was an observational, descriptive, retrospective patient record review employed at two hospitals with palliative care services in the Western Cape of South Africa. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. Summary descriptive statistics (medians, ranges) were used to describe the numerical data (such as patient age). Clinical variables (such as patient chief complaint) were analysed as categorical data. Emergency Medical Services intersection with palliative situations according to time of day, working hours, day of week, and month of year were subjected to Chi-squared testing for temporal analysis. Geospatial data were investigated using cluster and proximity analyses. Spatio-temporal and clinical analyses were reported in separate articles. Study 3 employed a qualitative design using individual semi-structured interviews with doctors and nurses holding post-graduate palliative medicine qualifications. Verbatim transcriptions of interviews were subjected to content analysis using an inductive-dominant approach to develop codes and categories. Study 4 employed a qualitative design using individual semi-structured interviews with patients and family members with palliative needs. Verbatim transcriptions of interviews were subjected to thematic analysis using an inductive-dominant approach to develop categories and themes. Study 5 was a nominal group technique, involving experts from both Emergency Medical Services and palliative care, who answered the question “what do you think should be done to most effectively integrate Emergency Medical Services and palliative care services in South Africa?” Answers were sorted into categories, awarded scores by participants, and ranked according to their impact and feasibility within SA. Interviews with Emergency Medical Services providers were performed previously and are not repeated in this thesis. However, findings from this previous study are incorporated. Results Study 1 included 56 articles for review. Overall, these articles noted that EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. This study identified knowledge gaps and provided overall context for the thesis and subsequent studies. In Study 2, 1 207 unique patients received palliative care services during the study period. Of these, 395 (33%) made use of Emergency Medical Services for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20-93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the most common chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). Most Emergency Medical Services transports occurred from peri-urban areas (78%, n=385), during the daytime (52%, n=257), out-of-office hours (53%, n=261), and weekdays (76%, n=375). Statistically significant variation in distribution was found according to time of day (p=<0.001), with 38% (n=188) of cases occurring between 13h00 and 19h00, and month of year (p=<0.001), with 36% (n=177) occurring in June, August and October. Proximity analysis revealed a mean driving time of 6.69min and distance of 3.65km to palliative care facilities. This study provided quantitative evidence of Emergency Medical Services intersection with palliative situations in South Africa as well as insight into palliative care access. Study 3 found that palliative care providers maintained an overall positive view of integration with Emergency Medical Services, noting their beneficial impact and suggesting various methods of integration, while also highlighting challenges and concerns. In Study 4 patients and family members with palliative care needs described a loss of previous control they held over their lives and a subsequent longing to maintain what control remained. Emergency Medical Services care was viewed positively when this longing was satisfied and negatively when further control was seized. These studies allowed for the incorporation of primary stakeholder perspectives on the integration of Emergency Medical Services and palliative care. In Study 5, fifty-two methods of Emergency Medical Services and palliative care integration were generated and ranked by the expert panel. These methods formed the following categories (listed in rank order from highest to lowest): Awareness, Education, Community Engagement, Communication and Information Sharing, Stakeholder Collaborations, Alternative Pathways and Approaches, Research, Funding, Policy Development, Governance. Conclusions This thesis identified and filled knowledge gaps concerning Emergency Medical Services and palliative care integration in the South African setting through review of contemporary literature, retrospective analysis of palliative situations involving Emergency Medical Services, gathering of primary stakeholder views, and expert panel development of integrative methods. While previously assumed, substantial intersection between Emergency Medical Services and palliative situations in South Africa has now been demonstrated, highlighting the significance of this topic within the country. Primary stakeholder perspectives offered support for Emergency Medical Services and palliative care integration, and novel insights into patient and family member experiences, necessitating a person-centred approach to care, have been provided. Guidance for the implementation of such integration, provided by experts from both Emergency Medical Services and palliative care systems, has been developed. Based on this evidence, a conceptual framework for Emergency Medical Services and palliative care integration in South Africa was produced alongside guidance for practical use. The implementation of this framework will assist in the efficient use of limited healthcare resources in the country while simultaneously improving access to and quality of palliative care for those in need. Though the framework presented here was developed for the South African context, it contains elements from the international literature as well as World Health Organization and health system integration frameworks. Thus, this framework may have applications outside of South Africa, particularly in other low-to-middle income countries with similar resource constraints. Future research should monitor the safety and efficacy of framework implementation, investigate the economic impact of EMS and palliative care integration through cost effectiveness studies, develop curriculum for EMS education in palliative care, and involve pilot studies.
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    The development of integrated palliative care and emergency medical services in South Africa
    (2025) Gage, Caleb; Stassen, Willem; Gwyther Elizabeth
    Background The role of Emergency Medical Services in out-of-hospital patient management has evolved rapidly in recent years to include more intricate and integrated forms of healthcare beyond emergency care. For example, there has recently been recognition of the role Emergency Medical Services play in the provision of palliative care. The developing body of literature on this topic has recommended Emergency Medical Services and palliative care systems should integrate to improve palliative situation management in the out-of-hospital setting. In South Africa, however, these systems remain segregated. As a result, palliative situations are managed poorly by Emergency Medical Services providers due to disregard of patient autonomy and performance of aggressive, futile interventions. Potential benefits of integration between these systems include delivery of early palliative care, provision of home-based care, respect of patient autonomy, improved patient/family quality of life, increased patient and family satisfaction and confidence, decreased health care costs and appropriate trajectories of care. A further benefit in the low-to-middle income context of South Africa would be efficient use of limited resources. Aim and Objectives To develop a framework for the integration of palliative care and Emergency Medical Services systems in South Africa. The research aim was pursued through the following objectives, each of which represented a study within the thesis: Study 1: To review existing literature concerning the intersection of palliative care and Emergency Medical Services. Study 2: To examine Emergency Medical Services use for palliative situations in South Africa. Study 3: To gather the perspectives of palliative care providers on Emergency Medical Services use in palliative care in South Africa. Study 4: To gather perspectives of South African patients and family members with palliative needs concerning Emergency Medical Services use in their care. Study 5: To develop and prioritise approaches facilitating Emergency Medical Services and palliative care system integration within South Africa. Methods Study 1 was a scoping literature review performed with an a priori search strategy inclusive of grey literature. Empirical, English studies involving human populations published between 1 January 2000 and 24 November 2022 concerning EMS and palliative care were included. Extracted data underwent descriptive content analysis. Study 2 was an observational, descriptive, retrospective patient record review employed at two hospitals with palliative care services in the Western Cape of South Africa. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. Summary descriptive statistics (medians, ranges) were used to describe the numerical data (such as patient age). Clinical variables (such as patient chief complaint) were analysed as categorical data. Emergency Medical Services intersection with palliative situations according to time of day, working hours, day of week, and month of year were subjected to Chi-squared testing for temporal analysis. Geospatial data were investigated using cluster and proximity analyses. Spatio-temporal and clinical analyses were reported in separate articles. Study 3 employed a qualitative design using individual semi-structured interviews with doctors and nurses holding post-graduate palliative medicine qualifications. Verbatim transcriptions of interviews were subjected to content analysis using an inductive-dominant approach to develop codes and categories. Study 4 employed a qualitative design using individual semi-structured interviews with patients and family members with palliative needs. Verbatim transcriptions of interviews were subjected to thematic analysis using an inductive-dominant approach to develop categories and themes. Study 5 was a nominal group technique, involving experts from both Emergency Medical Services and palliative care, who answered the question “what do you think should be done to most effectively integrate Emergency Medical Services and palliative care services in South Africa?” Answers were sorted into categories, awarded scores by participants, and ranked according to their impact and feasibility within SA. Interviews with Emergency Medical Services providers were performed previously and are not repeated in this thesis. However, findings from this previous study are incorporated. Results Study 1 included 56 articles for review. Overall, these articles noted that EMS have a role to play in out-of-hospital palliative care, however, many challenges must be overcome. This study identified knowledge gaps and provided overall context for the thesis and subsequent studies. In Study 2, 1 207 unique patients received palliative care services during the study period. Of these, 395 (33%) made use of Emergency Medical Services for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20-93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the most common chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). Most Emergency Medical Services transports occurred from peri-urban areas (78%, n=385), during the daytime (52%, n=257), out-of-office hours (53%, n=261), and weekdays (76%, n=375). Statistically significant variation in distribution was found according to time of day (p=<0.001), with 38% (n=188) of cases occurring between 13h00 and 19h00, and month of year (p=<0.001), with 36% (n=177) occurring in June, August and October. Proximity analysis revealed a mean driving time of 6.69min and distance of 3.65km to palliative care facilities. This study provided quantitative evidence of Emergency Medical Services intersection with palliative situations in South Africa as well as insight into palliative care access. Study 3 found that palliative care providers maintained an overall positive view of integration with Emergency Medical Services, noting their beneficial impact and suggesting various methods of integration, while also highlighting challenges and concerns. In Study 4 patients and family members with palliative care needs described a loss of previous control they held over their lives and a subsequent longing to maintain what control remained. Emergency Medical Services care was viewed positively when this longing was satisfied and negatively when further control was seized. These studies allowed for the incorporation of primary stakeholder perspectives on the integration of Emergency Medical Services and palliative care. In Study 5, fifty-two methods of Emergency Medical Services and palliative care integration were generated and ranked by the expert panel. These methods formed the following categories (listed in rank order from highest to lowest): Awareness, Education, Community Engagement, Communication and Information Sharing, Stakeholder Collaborations, Alternative Pathways and Approaches, Research, Funding, Policy Development, Governance. Conclusions This thesis identified and filled knowledge gaps concerning Emergency Medical Services and palliative care integration in the South African setting through review of contemporary literature, retrospective analysis of palliative situations involving Emergency Medical Services, gathering of primary stakeholder views, and expert panel development of integrative methods. While previously assumed, substantial intersection between Emergency Medical Services and palliative situations in South Africa has now been demonstrated, highlighting the significance of this topic within the country. Primary stakeholder perspectives offered support for Emergency Medical Services and palliative care integration, and novel insights into patient and family member experiences, necessitating a person-centred approach to care, have been provided. Guidance for the implementation of such integration, provided by experts from both Emergency Medical Services and palliative care systems, has been developed. Based on this evidence, a conceptual framework for Emergency Medical Services and palliative care integration in South Africa was produced alongside guidance for practical use. The implementation of this framework will assist in the efficient use of limited healthcare resources in the country while simultaneously improving access to and quality of palliative care for those in need. Though the framework presented here was developed for the South African context, it contains elements from the international literature as well as World Health Organization and health system integration frameworks. Thus, this framework may have applications outside of South Africa, particularly in other low-to-middle income countries with similar resource constraints. Future research should monitor the safety and efficacy of framework implementation, investigate the economic impact of EMS and palliative care integration through cost effectiveness studies, develop curriculum for EMS education in palliative care, and involve pilot studies.
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    The prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review
    (2014) Stassen, W; Welzel, T
    BACKGROUND: Each year, ~89 000 (180/100 000) new cases of head injury are reported in South Africa (SA), with the majority of patients being in the economically active population. Hypotension and hypoxaemia significantly increase the morbidity and mortality in patients who have suffered a traumatic brain injury (TBI). Cerebral tissue is particularly vulnerable to these secondary insults in the period immediately following a TBI, emphasising the importance of prehospital care in TBI. OBJECTIVE: To establish the prevalence of prehospital hypotension and hypoxaemia in moderate to severe blunt TBI in greater Johannesburg, Gauteng, SA. METHODS: The records of adult patients who sustained a moderate to severe TBI between 1 January and 31 December 2011 were retrospectively reviewed for hypotension (systolic blood pressure <90 mmHg) and hypoxaemia (oxygen saturation <90%) during their prehospital phase of care. These results were subject to descriptive analysis. RESULTS: A total of 299 records were identified, 66 of which met the inclusion criteria. The prevalence of prehospital hypotension and hypoxaemia were 33.3% (n=22) and 37.9% (n=25), respectively, while 21.2% (n=14) of patients suffered double insults of hypotension and hypoxaemia. Hypotension and hypoxaemia were associated with haemorrhage (p=0.011) and chest injuries (p=0.001), respectively. CONCLUSION: The prevalence of hypotension in this study was similar to that observed in international studies, but the prevalence of hypoxaemia was much higher. There is a need for local guidelines to be developed to inform the quality of TBI care in the context of the developing world.