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van Rensburg L, Majiet N, Geldenhuys A, King LL, Stassen W. A resuscitation systems analysis for South Africa: A narrative review. Resusc Plus 2024; 18:100655. [PMID: 38770395 PMCID: PMC11103484 DOI: 10.1016/j.resplu.2024.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
With a growing incidence in cardiovascular diseases in Africa, including South Africa, and with it a greater incidence of out-of-hospital cardiac arrest (OHCA) there is a need to understand the readiness of these emergency care systems to support a response. Yet, OHCA is expensive and requires comprehensive development across an entire chain of survival in order to gain any benefit in mortality or morbidity. In this narrative review, we provide a resuscitation systems analysis using the Global Resuscitation Alliance's Frame of Survival. We provide evidence or commentary on the elements of the outer frame and inner frame, and make an assessment of the South African system's readiness to support OHCA care, and provide suggestions for priority areas that need to be developed. The South African resuscitation system demonstrates reasonable readiness to respond to OHCA but is characterised by considerable variation and fragmentation. Given the cost ineffectiveness of many interventions and the anticipated rise in OHCA incidence, there is a pressing need for context-specific strategies in South Africa. These strategies should focus on enhancing both outcomes and resource efficiency, while respecting community ethics and sociocultural dynamics.
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Affiliation(s)
| | - Naqeeb Majiet
- Division of Emergency Medicine, University of Cape Town, South Africa
- Emergency Medical Services, Western Cape Department of Health & Wellness, South Africa
| | | | - Lauren Lai King
- Division of Emergency Medicine, University of Cape Town, South Africa
- African Federation for Emergency Medicine, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
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2
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Miri K, Sabbaghi M, Mazlum SR, Namazinia M. The trend of change in the role of pre-hospital emergency medical services in Iran's healthcare system: a situational analysis. BMC Emerg Med 2023; 23:99. [PMID: 37648986 PMCID: PMC10468862 DOI: 10.1186/s12873-023-00861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Following the significant changes in healthcare systems over the last century, the role of pre-hospital emergency medical services (EMS) has been drawn against numerous challenges. In view of this, the present study aims to reflect on the trend of change in the role of pre-hospital EMS to meet new situations and needs, thereby providing a clear picture of this process. METHODS Respecting the intricate concept of development and the major changes in Iran's healthcare system, this study was fulfilled using situational analysis (SA), developed by Clarke (2018), in Iran within 2022-2023. For this purpose, the data were collected through semi-structured, in-depth individual interviews with four faculty members, two managers involved in EMS, and six highly skilled EMS personnel in various positions. Moreover, the relevant articles published from 1950 to 2023 were reviewed. The data analysis was then performed via SA in the form of open coding as well as simultaneous analysis through three types of maps, viz., situational, social worlds/arenas, and positional maps, along with constant comparative analysis. RESULTS Pre-hospital EMS in Iran has thus far had two turning points from 1970 to 2023, wherein academic components, need for equipment and resources, in conjunction with basic needs in the modern society, have been the main propellers. As well, the complexity of care for non-communicable diseases (NCDs), demand for managed care, and technological advancement has gradually resulted in further development in EMS. This trend describes the EMS situation in Iran from 1973 to 2023, as well as the EMS emergence stages, quantitative growth and infrastructure, and clinical education development in 2002-2023, indicating the lack of funding and inadequate scientific infrastructure in proportion to the population receiving such services. CONCLUSION Considering the trend of change in the approaches adopted by healthcare systems across the world, and given the breakthroughs in nursing and medicine, along the education of professionals during the last thirty years, the descriptions of duties and performance in EMS have moved from primary care and patient transfer to specialized services and outpatient care. In addition, the cultural context specific to Iran, the challenges of women working in EMS centers, the disconnection of service providers, namely, the Iranian Red Crescent Society (IRCS) Relief and Rescue Organization (R&RO), Iran's National Police Force (INPF), and Iran's National Medical Emergency Organization (INMEO), as well as lack of resources and equipment, and the geographical distribution of human resources (HRs) based on population dispersion, are thus among the significant issues facing pre-hospital EMS in this country.
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Affiliation(s)
- Kheizaran Miri
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammadreza Sabbaghi
- Department of Medical Emergency, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Seyyed Reza Mazlum
- Department of Medical - Surgical Nursing, School of Nursing and Midwifery, Mashhad University Medical of Medical Sciences, Mashhad, Iran
| | - Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
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International Perspectives of Prehospital and Hospital Trauma Services: A Literature Review. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence suggests that reductions in the incidence in trauma observed in some countries are related to interventions including legislation around road and vehicle safety measures, public behaviour change campaigns, and changes in trauma response systems. This study aims to briefly review recent refereed and grey literature about prehospital and hospital trauma care services in different regions around the world and describe similarities and differences in identified systems to demonstrate the diversity of characteristics present. Methods: Articles published between 2000 and 2020 were retrieved from MEDLINE and EMBASE. Since detailed comparable information was lacking in the published literature, prehospital emergency service providers’ annual performance reports from selected example countries or regions were reviewed to obtain additional information about the performance of prehospital care. Results: The review retained 34 studies from refereed literature related to trauma systems in different regions. In the U.S. and Canada, the trauma care facilities consisted of five different levels of trauma centres ranging from Level I to Level IV and Level I to Level V, respectively. Hospital care and organisation in Japan is different from the U.S. model, with no dedicated trauma centres; however, patients with severe injury are transported to university hospitals’ emergency departments. Other similarities and differences in regional examples were observed. Conclusions: The refereed literature was dominated by research from developed countries such as Australia, Canada, and the U.S., which all have organised trauma systems. Many European countries have implemented trauma systems between the 1990s and 2000s; however, some countries, such as France and Greece, are still forming an integrated system. This review aims to encourage countries with immature trauma systems to consider the similarities and differences in approaches of other countries to implementing a trauma system.
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Pine H, Eisner ZJ, Delaney PG, Ogana SO, Okwiri DA, Raghavendran K. Prehospital Airway Management for Trauma Patients by First Responders in Six Sub-Saharan African Countries and Five Other Low- and Middle-Income Countries: A Scoping Review. World J Surg 2022; 46:1396-1407. [PMID: 35217888 DOI: 10.1007/s00268-022-06481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
The global injury burden disproportionately affecting low- and middle-income countries (LMICs) is exacerbated by a lack of robust emergency medical services. Though airway management (AM) is an essential component of prehospital emergency care, the current standard of prehospital AM training and resources for first responders in LMICs is unknown. This scoping review includes articles published between January 2000 and June 2021, identified using PMC, MEDLINE, and SCOPUS databases, following PRISMA-ScR guidelines. Inclusion criteria spanned programs training formal or informal prehospital first responders. Included articles were assessed for quality using the Newcastle-Ottawa scale. Relevant characteristics were extracted by multiple authors to assess prehospital AM training. Of the initial 713 articles, 17 met inclusion criteria, representing 11 countries. Basic AM curricula were found in 11 studies and advanced AM curricula were found in nine studies. 35.3% (n = 6) of first responder programs provided no equipment to basic life support (BLS) AM training participants, reporting a median cost of $7.00USD per responder trained. Median frequency of prehospital AM intervention was reported in 31.0% (IQR: 6.0, 50.0) of patient encounters (advanced life support trainees: 12.1%, BLS trainees: 32.0%). In three studies, adverse event frequencies during intubation occurred with a median frequency of 22.0% (IQR: 21.0, 22.0). The training deficit in advanced AM interventions in LMICs suggests BLS AM courses should be prioritized, especially in sub-Saharan Africa. Prehospital AM resources are sparse and should be a priority for future development.
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Affiliation(s)
- Haleigh Pine
- Washington University in St. Louis McKelvey School of Engineering, 1 Brookings Drive, St. Louis, MO, 63130, USA. .,LFR International, Los Angeles, CA, USA.
| | - Zachary J Eisner
- LFR International, Los Angeles, CA, USA.,University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA.,Michigan Center for Global Surgery, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Peter G Delaney
- LFR International, Los Angeles, CA, USA.,University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA.,Michigan Center for Global Surgery, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Simon Ochieng Ogana
- Masinde Muliro University of Science and Technology, Kakamega Webuye Highway, P.O. Box 190-50100, Kakamega, Kenya
| | - Dinnah Akosa Okwiri
- Masinde Muliro University of Science and Technology, Kakamega Webuye Highway, P.O. Box 190-50100, Kakamega, Kenya
| | - Krishnan Raghavendran
- Michigan Center for Global Surgery, 1301 Catherine St, Ann Arbor, MI, 48109, USA.,University of Michigan Medicine Department of Surgery, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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Vlok N, van der Berg J. Helicopter Emergency Medical Services Response to a Major Incident. Air Med J 2020; 39:506-508. [PMID: 33228904 DOI: 10.1016/j.amj.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
Major incidents account for a vast number of consequences, whether it be individual morbidity and mortality or economic disruption and expense. Because of the infrequent nature, it poses a variety of unique risks and challenges for individual emergency medical services systems. Air ambulances are usually dispatched based on the clinical presentation of an individual patient who needs emergent critical care intervention. The response to a major incident is unusual and infrequent, but the benefit of tasking air ambulances to such incidents has been described by various authors. Here, such a response is described in a low- to middle-income country that saw the immediate tasking of 2 separate air ambulances to a single, multivehicle collision with multiple injured patients that occurred near a small, rural hospital not capable of treating critically ill patients. The benefits of tasking of the air ambulance in the sense of additional expertise as well as potential other nonclinical benefits are discussed and described here.
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Affiliation(s)
- Neville Vlok
- HALO Aviation, Johannesburg, Gauteng, South Africa.
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Lindquist BD, Koval KW, Acker PC, Bills CB, Khan A, Zachariah S, Newberry JA, Rao GVR, Mahadevan SV, Strehlow MC. Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept. Open Access Emerg Med 2020; 12:201-210. [PMID: 32982494 PMCID: PMC7505709 DOI: 10.2147/oaem.s249447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India. METHODS From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide). LESSONS LEARNED During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials. CONCLUSION These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.
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Affiliation(s)
- Benjamin D Lindquist
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Kathryn W Koval
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC29425, USA
| | - Peter C Acker
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Corey B Bills
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
- University of California San Francisco, San Francisco, CA94143, USA
| | - Ayesha Khan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Sybil Zachariah
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - G V Ramana Rao
- GVK Emergency Management and Research Institute, Secunderabad, Telangana500078, India
| | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA94304, USA
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Glomb NW, Shah MI, Kosoko AA, Doughty CB, Galapi C, Laba B, Rus MC. Educational impact of a pilot paediatric simulation-based training course in Botswana. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:279-283. [DOI: 10.1136/bmjstel-2019-000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/04/2022]
Abstract
BackgroundAs emergency medical services (EMS) systems develop globally in resource-limited settings, equipping providers with paediatric training is essential. Low-fidelity simulation-based training is an effective modality for training healthcare workers, though limited data exist on the impact of such training programmes. The objective of this study was to evaluate the paediatric portion of a simulation-based curriculum for prehospital providers in Botswana.MethodsThis was a prospective cohort study of EMS providers from more populated regions of Botswana, who attended a 2-day training that included didactic lectures, hands-on skills stations and low-fidelity simulation training. We collected data on participant self-efficacy with paediatric knowledge and skills and performance on both written and simulation-based tests. Self-efficacy and test data were analysed, and qualitative course feedback was summarised.ResultsThirty-one EMS providers participated in the training. Median self-efficacy levels increased for 13/15 (87%) variables queried. The most notable improvements were observed in airway management, newborn resuscitation and weight estimation. Mean written test scores increased by 10.6%, while mean simulation test scores increased by 21.5% (p<0.0001). One hundred per cent of the participants rated the course as extremely useful or very useful.Discussion/ConclusionWe have demonstrated that a low-fidelity simulation-based training course based on a rigorous needs assessment may enhance short-term paediatric knowledge and skills for providers in a developing EMS system in a limited-resource setting. Future studies should focus on studying larger groups of learners in similar settings, especially with respect to the impact of educational programmes like these on real-world patient outcomes.
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Howard I, Cameron P, Wallis L, Castrén M, Lindström V. Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study. BMJ Open Qual 2020; 9:bmjoq-2020-000946. [PMID: 32439739 PMCID: PMC7247383 DOI: 10.1136/bmjoq-2020-000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction In South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development. Methods A multiple exploratory case study design was used that employed the Institute for Healthcare Improvement’s 18-point Quality Program Assessment Tool as both a formative assessment and semistructured interview guide using four provincial government EMS and one national private service. Results Services generally scored higher for structure and planning. Measurement and improvement were found to be more dependent on utilisation and perceived mandate. There was a relatively strong focus on clinical quality assessment within the private service, whereas in the provincial systems, measures were exclusively restricted to call times with little focus on clinical care. Staff engagement and programme evaluation were generally among the lowest scores. A multitude of contextual factors were identified that affected the effectiveness of quality systems, centred around leadership, vision and mission, and quality system infrastructure and capacity, guided by the need for comprehensive yet pragmatic strategic policies and standards. Conclusion Understanding and accounting for these factors will be key to ensuring both successful implementation and ongoing utilisation of healthcare quality systems in emergency care. The result will not only provide a more efficient and effective service, but also positively impact patient safety and quality of care of the services delivered.
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Affiliation(s)
- Ian Howard
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden .,Division of Emergency Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Peter Cameron
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee Wallis
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa.,Division of Emergency Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Fraser A, Newberry Le Vay J, Byass P, Tollman S, Kahn K, D'Ambruoso L, Davies JI. Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa. BMJ Glob Health 2020; 5:e002289. [PMID: 32377406 PMCID: PMC7199706 DOI: 10.1136/bmjgh-2020-002289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background Time-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records. Aim To use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death. Methodology Deaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare. Results Of 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis. Conclusion TCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.
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Affiliation(s)
- Andrew Fraser
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Peter Byass
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia D'Ambruoso
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Justine I Davies
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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D’Ambruoso L, van der Merwe M, Wariri O, Byass P, Goosen G, Kahn K, Masinga S, Mokoena V, Spies B, Tollman S, Witter S, Twine R. Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa. Health Policy Plan 2019; 34:418-429. [PMID: 31243457 PMCID: PMC6736195 DOI: 10.1093/heapol/czz047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2019] [Indexed: 01/08/2023] Open
Abstract
Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating 'in the dark' in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.
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Affiliation(s)
- Lucia D’Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Maria van der Merwe
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Oghenebrume Wariri
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Medical Research Council (MRC) Unit, The Gambia at London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Peter Byass
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Gerhard Goosen
- Mpumalanga Department of Health, Nelspruit, South Africa
| | - Kathleen Kahn
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | | | | | - Barry Spies
- Mpumalanga Department of Health, Nelspruit, South Africa
| | - Stephen Tollman
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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11
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Dippenaar E, Wallis L. Pre-hospital intercostal chest drains in South Africa: A modified Delphi study. Afr J Emerg Med 2019; 9:91-95. [PMID: 31193823 PMCID: PMC6543074 DOI: 10.1016/j.afjem.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/24/2018] [Accepted: 01/04/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Trauma is one of the most common causes of death in low- and middle-income countries, with thoracic injury accounting for 20-25% of these deaths worldwide. The current management of a life-threatening pre-hospital pneumothorax is with a needle chest decompression, however, definitive care for a pneumothorax and/or haemothorax is still the insertion of an intercostal chest drain. The aim of this study was to seek expert opinion and consensus on the placement of ICDs in the pre-hospital emergency care setting in South Africa. METHODS A three-round modified Delphi study was undertaken with an expert panel drawn from local emergency care experts consisting of physicians and emergency medical service practitioners. Participants supplied opinion statements in round 1 under headings derived from common emerging themes found in the literature. During round 2 participants used a 9-point Likert scale to rate their consensus on each statement and in round 3 they were able to change their position based on the earlier panel distributions. A consensus percentage of 60% was set within a narrow margin of 'strongly agree' or 'strongly disagree'. RESULTS A total of 22 experts took part as panel members. There were 123 opinion statements produced from round 1, of which 21 (17%) reached consensus in round 2. At the end of round 3 another four statements reached consensus, bringing the total up to 25 (20%). CONCLUSION Definitive care of a life-threating pneumothorax and/or haemothorax must be sought emergently. The insertion of an ICD, under select conditions, may be required in the pre-hospital setting in South Africa.
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Jasper AO, Jasper GC, Edah IO, Edah CA. Pre-hospital care of road traffic accident victims in the Niger Delta: a private initiative and experience. Open Access Emerg Med 2019; 11:51-56. [PMID: 30881153 PMCID: PMC6419604 DOI: 10.2147/oaem.s178384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This is a review of pre-hospital care of road traffic accident (RTA) victims in the Niger Delta covering the highway linking Benin to Warri in Delta State, Nigeria, from January to December (2017). The non-availability of these services in the South South Nigeria prompted this initiative. Ambulance services with technicians and doctors attended the patients when accidents occurred. This was done in collaboration with the Nigeria Red Cross, Police, Army, and Road safety patrol teams. The information from the patrol team through dedicated lines initiated the emergency response. Response time was an average of 10-30 minutes. A major benefit of this initiative is early commencement of resuscitation and prevention of secondary injuries. A total of 70 RTA victims were salvaged from the accident scene by the Red Cross Society in 2017. A total of 29 RTA patients were salvaged through this initiative in 2017, in Delta State, Nigeria. The main challenges of this effort were delayed communication, insufficient ambulance manpower, and limited funding. Government involvement in public enlightenment, training paramedics, and provision of ambulance services to reduce deaths on our highways is needed.
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Affiliation(s)
- Abiodun Oyinpreye Jasper
- Department of Anaesthesia, Faculty of Clinical Medicine, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria,
| | - Gladys Chidinma Jasper
- Department of Anaesthesia and Intensive Care, Treasurehold Specialist Hospital, Sapele, Delta State, Nigeria
| | - Irene Oghenerukevwe Edah
- Department of Anaesthesia and Intensive Care, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Courage Akpesiri Edah
- Department of Anaesthesia and Intensive Care, Treasurehold Specialist Hospital, Sapele, Delta State, Nigeria
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Mehmood A, Rowther AA, Kobusingye O, Hyder AA. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med 2018; 11:53. [PMID: 31179939 PMCID: PMC6326122 DOI: 10.1186/s12245-018-0207-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Armaan Ahmed Rowther
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Tansley G, Stewart B, Zakariah A, Boateng E, Achena C, Lewis D, Mock C. Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana. PREHOSP EMERG CARE 2016; 20:768-775. [PMID: 27074588 PMCID: PMC5153373 DOI: 10.3109/10903127.2016.1164775] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/15/2016] [Accepted: 03/08/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion. METHODS Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 and 60 minutes of each of the 128 ambulance stations in Ghana. With network analysis methods, a two-step floating catchment area model was created to identify district-level variability in access. Districts without NAS stations within their catchment areas were identified as candidates for an additional NAS station. Additionally, five candidate stations for capacity expansion (e.g., addition of an ambulance) were then identified through iterative simulations that were designed to identify the stations that had the greatest influence on the access scores of the ten lowest access districts. RESULTS Following NAS inception, the proportion of Ghana's landmass serviceable within 60 minutes of a station increased from 8.7 to 59.4% from 2004 to 2014, respectively. Over the same time period, the proportion of the population with access to the NAS within 60-minutes increased from 48% to 79%. The two-step floating catchment area model identified considerable variation in district-level access scores, which ranged from 0.05 to 2.43 ambulances per 100,000 persons (median 0.45; interquartile range 0.23-0.63). Seven candidate districts for NAS station addition and five candidate NAS stations for capacity expansion were identified. The addition of one ambulance to each of the five candidate stations improved access scores in the ten lowest access districts by a total 0.22 ambulances per 100,000 persons. CONCLUSIONS The NAS in Ghana has expanded its population-level spatial access to the majority of the population; however, access inequality exists in both rural and urban areas that can be improved by increasing station capacity or adding additional stations. Geospatial methods to identify access inequities and inform service expansion might serve as a model for other LMICs attempting to understand and improve formal prehospital care services.
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Getachew S, Ali E, Tayler-Smith K, Hedt-Gauthier B, Silkondez W, Abebe D, Deressa W, Enquessilase F, Edwards JK. The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia. Public Health Action 2016; 6:66-71. [PMID: 27358798 DOI: 10.5588/pha.15.0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
Abstract
SETTING The emergency department (ED) of Zewditu Memorial Hospital, Addis Ababa, Ethiopia. OBJECTIVE To document the proportion, trend, characteristics and outcomes of road traffic injury (RTI) related ED admissions (⩾15 years) between 2014 and 2015. DESIGN A retrospective, cross-sectional study using routinely collected ED data. RESULTS Of 10 007 ED admissions, 779 (8%) were RTI cases; this proportion peaked in the month of January (11%). Medical records were available for 522 (67%) of these RTI cases. The median age was 28 years and 69% were males. The majority were pedestrians (69%) injured by an automobile (78%). On triage, 32% were classified as needing urgent/immediate intervention. Head injuries (20%) were the second most common injury after lower limb injuries (36%). ED outcomes were as follows: discharged (68%), hospitalised (17%), referred (17%) and died (1%). Among the 78 hospitalised cases, respectively 62% and 16% were admitted to the surgical and orthopaedic departments. Of 146 RTI cases with head injuries, 25% were hospitalised, of whom 82% were admitted to the surgical department. CONCLUSION Our findings can guide policy makers in referral hospitals in improving the planning of hospital resources and the prioritisation of public health needs linked to further urban development. A comprehensive plan to prevent RTIs, particularly among pedestrians in Addis Ababa, is urgently needed.
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Affiliation(s)
- S Getachew
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - E Ali
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - K Tayler-Smith
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - B Hedt-Gauthier
- Partners in Health/Inshuti Mu Buzima, Butaro, Burera District, Rwanda ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - W Silkondez
- National Tuberculosis Control Programme, Ministry of Health, Mbabane, Swaziland
| | - D Abebe
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - W Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - F Enquessilase
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - J K Edwards
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg ; School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Munyewende PO, Rispel LC. Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces. Glob Health Action 2014; 7:25323. [PMID: 25537937 PMCID: PMC4275646 DOI: 10.3402/gha.v7.25323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms. Objective The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.
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Affiliation(s)
- Pascalia O Munyewende
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
| | - Laetitia C Rispel
- Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Suriyawongpaisal P, Aekplakorn W, Tansirisithikul R. A Thailand case study based on quantitative assessment: does a national lead agency make a difference in pre-hospital care development in middle income countries? Scand J Trauma Resusc Emerg Med 2014; 22:75. [PMID: 25496537 PMCID: PMC4273444 DOI: 10.1186/s13049-014-0075-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency Medical Institute of Thailand (EMIT) has been established as a national lead agency to improve emergency medical service systems since December 2008. However up to now, there has not been any published systematic assessment of its performance to guide further policy decisions. METHODS This study assesses the 4-year pre-hospital care coverage and performance in Thailand after EMIT establishment. The assessment makes use of 1,171,564 records from a national data set for pre-hospital care i.e., Information Technology for Emergency Medical Service System (ITEMS) in 2012. RESULTS Comparing with historical data, we found evidence indicating the national lead agency making differences in two basic requirements of pre-hospital care i.e., the coverage was increased by at least 1.4 times higher than the majority reported figures among 11 out of the total 13 regions of the country at baseline; and mean total response time for critical-coded patients, the longest in our study, is 1.6 times shorter than previously reported figure in 2008 (48.46 minutes). Analysis of the national data set also revealed quite substantial missing values indicating a need for further improvement. When historical data was not available, we compared our findings with international figures. Over triage rate of 28.4% for advanced life support (ALS) ambulance was found which is roughly a third of that reported in Taiwan. Almost all patients were stabilized and/or treated regardless of being transferred to hospitals in contrast to the scenarios in the U.S. systems which may probably be due to different payment mechanism. Relying on circumstantial evidences, we identified probable stagnation in pre-hospital care coverage for patients visiting emergency department after the establishment of the lead agency. CONCLUSIONS This national data assessment shows progression in certain basic pre-hospital care requirements in Thailand. However, it needs regular systematic evaluation and there is still room for improvement of pre-hospital care systems such as increasing coverage, more equitable distribution of the coverage, faster response times, especially for patients with critical code, information system, cost-effectiveness study as well as further specific qualitative researches to guide further development of policy and intervention.
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Affiliation(s)
- Paibul Suriyawongpaisal
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
| | - Rassamee Tansirisithikul
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
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Metelmann C, Metelmann B, Wendt M, Meissner K, von der Heyden M. LiveCity. INTERNATIONAL JOURNAL OF ELECTRONIC GOVERNMENT RESEARCH 2014. [DOI: 10.4018/ijegr.2014070104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of emergency medicine is to treat time-critical diseases and conditions to reduce morbidity and mortality. The improvement of emergency medicine is an important topic for governments worldwide. A common problem is the inevitable lack of support by emergency doctors, when paramedics need their assistance at the emergency site but are without an emergency doctor. Video-communication in real time from the emergency site to an emergency doctor, offers an opportunity to enhance the quality of emergency medicine. The core piece of this study is a video camera system called “LiveCity camera”, enabling real-time high quality video connection of paramedics and emergency doctors. The impact of video communication on emergency medicine is clearly appreciated among providers, based upon the extent of agreement that has been stated in this study´s questionnaire by doctors and paramedics. This study is part of the FP7-European Union funded research project “LiveCity” (Grant Agreement No. 297291).
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Affiliation(s)
- Camilla Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bibiana Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Michael Wendt
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Konrad Meissner
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Martin von der Heyden
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Sun JH, Shing R, Twomey M, Wallis LA. A strategy to implement and support pre-hospital emergency medical systems in developing, resource-constrained areas of South Africa. Injury 2014; 45:31-8. [PMID: 22917929 DOI: 10.1016/j.injury.2012.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/31/2012] [Indexed: 02/02/2023]
Abstract
Resource-constrained countries are in extreme need of pre-hospital emergency care systems. However, current popular strategies to provide pre-hospital emergency care are inappropriate for and beyond the means of a resource-constrained country, and so new ones are needed-ones that can both function in an under-developed area's particular context and be done with the area's limited resources. In this study, we used a two-location pilot and consensus approach to develop a strategy to implement and support pre-hospital emergency care in one such developing, resource-constrained area: the Western Cape province of South Africa. Local community members are trained to be emergency first aid responders who can provide immediate, on-scene care until a Transporter can take the patient to the hospital. Management of the system is done through local Community Based Organizations, which can adapt the model to their communities as needed to ensure local appropriateness and feasibility. Within a community, the system is implemented in a graduated manner based on available resources, and is designed to not rely on the whole system being implemented first to provide partial function. The University of Cape Town's Division of Emergency Medicine and the Western Cape's provincial METRO EMS intend to follow this model, along with sharing it with other South African provinces.
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Affiliation(s)
- Jared H Sun
- Yale School of Medicine, 367 Cedar St, New Haven, CT 06510, USA.
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Hardcastle TC, Finlayson M, van Heerden M, Johnson B, Samuel C, Muckart DJJ. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. World J Surg 2012. [DOI: 10.1007/s00268-012-1852-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Williams A. Emotion work in paramedic practice: the implications for nurse educators. NURSE EDUCATION TODAY 2012; 32:368-372. [PMID: 21640449 DOI: 10.1016/j.nedt.2011.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 05/06/2011] [Accepted: 05/11/2011] [Indexed: 05/30/2023]
Abstract
Contemporary paramedic practice involves the emergency assessment, management, treatment and transport of the public with minor and major; potentially life threatening conditions (Caroline, 2008). Paramedics are exposed to a myriad of human emotions related to suffering, pain, devastating trauma and death. Managing their own and others emotions appears to be a crucial component of their work, however there is a paucity of evidence relating to this aspect of the role. The movement of preregistration paramedic education into higher education has impacted on nurse educators in some settings, who are undertaking key administrative, managerial, teaching and personal tutoring roles. This is a valuable opportunity for nurse educators to contribute to the education of student paramedics in the crucial area of emotion work as part of interprofessional health care education. This paper examines emotional labour in health care, historical influences on paramedic education, the limited empirical research and the impact of gender, which provide insights into this profession crucial for nurse educators. The implications of emotion work for the educational curriculum and the support of student paramedics are discussed and strategies such as counselling, reflection and personal tutoring are suggested. Mentorship selection and preparation are highlighted and the need for a cultural change in attitude towards emotion work.
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Affiliation(s)
- Angela Williams
- School of Health Science, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP, United Kingdom.
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Prehospital ultrasound as the evolution of the Franco-German model of prehospital EMS. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0077-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPurposeTo evaluate, throughout model analysis and evaluation of existing literature and personal experience, which can be the benefits of routine performance of prehospital ultrasound in the different models of prehospital emergency medical service.MethodsThe existing literature was reviewed.ConclusionsThe ultrasound can be a very valuable asset in both the Anglo-American and the Franco-German models. In the latter, however, its role is further emphasized since US-enhanced on-spot early diagnosis performed by the physician can be beneficial to the whole system and not just the single patient.
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Slabbert J, Smith W. Patient transport from rural to tertiary healthcare centres in the Western Cape: Is there room for improvement? Afr J Emerg Med 2011. [DOI: 10.1016/j.afjem.2011.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hanewinckel R, Jongman HP, Wallis LA, Mulligan TM. Emergency medicine in Paarl, South Africa: a cross-sectional descriptive study. Int J Emerg Med 2010; 3:143-50. [PMID: 21031037 PMCID: PMC2926869 DOI: 10.1007/s12245-010-0185-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 04/19/2010] [Indexed: 11/27/2022] Open
Abstract
Background Emergency Medicine (EM) in South Africa is in its earliest stages of development. There is a paucity of data about emergency department (ED) patient demographics, epidemiology, consultation and admission criteria and other characteristics. Aims This information is absolutely necessary to properly guide the development of EM and appropriate emergency care systems. In order to provide this information, we performed a study in a rural hospital in Paarl, 60 km outside Cape Town. Methods All patients who were seen in the ED between 1 January 2008 and 31 May 2008 were eligible for our research. We designed a cross-sectional descriptive study and retrieved information from a randomized sample of all consecutive patient charts seen during this period using a 40-point questionnaire (see Appendix 1). Results We investigated 2,446 charts, of which 2,134 were suitable for our research The majority (88.2%) of these patients were self-referred. In our sample, 24.1% were children under 12 years old. Almost 20% of patients had a serious pathological condition or were physiologically unstable; 36.0% of all presentations were trauma related. Besides trauma-related problems, gastrointestinal- (21.9%) and respiratory tract- (12.4%) related problems were most common in the ED; 16.5% of the patients were admitted to a ward. Conclusion This descriptive epidemiological study provides necessary data that will be used for further needs assessments and for future EM development in Paarl, and can be used as a template in other EDs and hospitals to provide similar data necessary for initial EM development strategy.
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Affiliation(s)
| | | | - Lee A. Wallis
- Emergency Medicine, University of Cape Town & Stellenbosch University, Cape Town, South Africa
| | - Terrence M. Mulligan
- Emergency Department and Emergency Medicine Residency, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Lockey D. International EMS systems: Geographical lottery and diversity but many common challenges. Resuscitation 2009; 80:722. [PMID: 19427091 DOI: 10.1016/j.resuscitation.2009.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2009] [Indexed: 10/20/2022]
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Cox M, Shao J. Emergency medicine in a developing country: experience from Kilimanjaro Christian Medical Centre, Tanzania, East Africa. Emerg Med Australas 2008; 19:470-5. [PMID: 17919221 DOI: 10.1111/j.1742-6723.2007.01012.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tanzania in East Africa has a population of over 36 million and is one of the poorest countries in the world. Life expectancy has declined and infant mortality rates are increasing. Four consultant specialist hospitals and 17 regional hospitals service the mainland. Kilimanjaro Christian Medical Centre is a major specialist teaching hospital with 500 beds, serving the entire north-west of the country. There is a small 'casualty' ward with three cubicles and one resuscitation room. Malaria, HIV, respiratory infections and gastroenteritis are the chief causes of death in children. Changing lifestyle and Western influences have increased diabetes and vascular disease in adults, and large numbers of trauma deaths are increasingly encountered. Kilimanjaro Christian Medical Centre 'Casualty' admission data are presented, as well as an insight into the challenges of emergency medicine in this country.
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Affiliation(s)
- Megan Cox
- St George Hospital, Kogarah, New South Wales, Australia.
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In this issue. Resuscitation 2005. [DOI: 10.1016/j.resuscitation.2005.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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