Includes bibliographical references (leaves 68-73).

Introduction Maintaining the airway is an essential element in the care of any ill or injured patient. Inadequate management of the airway may lead to hypoxia and hypercarbia with subsequent secondary brain injury, cardiopulmonary arrest, and ultimately death. The aim of the study was to identify which airway devices are available in public emergency centres of referral hospitals in Namibia and to determine the perceived level of knowledge of use regarding these devices. Methods A cross-sectional study was conducted in four emergency centres of referral hospitals in Namibia. Data regarding the availability of airway devices were collected on a standardised data sheet by means of a site inspection. A questionnaire was also distributed to emergency centre doctors to assess their perceived knowledge of use of airway devices. Descriptive statistics of all variables are reported. Results Twenty-two different airway devices were documented at study hospitals. All centres had some form of basic airway devices. Only one (25%) had venturi-masks. Two centres (50%) had one type of introducer (Gum elastic bougie) whilst none of the centres had video laryngoscopes, surgical airway devices or laryngeal tubes. Twelve participants (32.4%) had received formal training on airway devices (senior clinicians n=6, junior clinicians n=6), and 25 (67.6%) had no formal training (senior clinicians n=11, junior clinicians n=12). Majority of the clinicians lacked perceived knowledge in the use of alternative airway devices which were not available in their respective emergency centres, with a frequency of 81.4%. Conclusion The study indicates that basic airway devices are available in referral emergency centres in Namibia, however most of the alternative airway devices are not adequately stocked in the sampled emergency centres. Furthermore, a large number of clinicians had perceived knowledge of the basic airway devices. However, the perceived level of knowledge of use in alternative airway devices was inadequate.

Background Simulation learning is an educational strategy that has been used in South African Emergency Care Practitioner training for at least a decade. No authors had previously measured the satisfaction of South African ECP students with simulation learning. Objective The objectives of this study were to explore the simulation satisfaction of students from two universities in South Africa, and to describe the simulation satisfaction using descriptive statistics. Methods This cross-sectional, descriptive, quantitative study used an English, electronic version of the SSES with one item from the tool deleted. Results A total of 81 students participated in the study - 32 from Nelson Mandela University (NMU) (39.5%) and 49 (60.5%) from the University of Johannesburg (UJ). Statistically significant differences were noted between the two groups in all three factors between the students from NMU and UJ: debriefing and reflection (median = 3.5 vs median = 4.2; p = 0.000; r = 0.5), clinical reasoning (median = 3.6 vs median = 4.0; p=0.002; r = 0.3.) and clinical learning (median = 3.7 vs median = 4.0; p=0.005; r = 0.3). Conclusions Students from both universities have had an overall positive experience of simulation learning, the students from UJ reported higher levels of satisfaction with simulation. These data provide important information for ECP student educators and highlight areas of satisfaction as well as dissatisfaction with simulation learning. This study also indicates that further research is required into the ECP student experiences of simulation learning in South Africa.

Background: Tuberculosis (TB) is a major healthcare problem worldwide and is endemic to Cape Town, South Africa. Health Care Workers in Emergency Centers (ECs) are at high risk of nosocomial TB infection. The aim of this study was to determine whether the isolation rooms (IRs)in emergency centers, for patients with diagnosed or suspected TB, comply with set National Core Standards. Methods: This was a cross-sectional descriptive study of ECs in the Cape Town Metropolitan area. .The characteristics of IRs with regards to air changes per hour (ACH), negative pressure ventilation with relation to the surrounding areas and appropriate discharge of air outdoors or via filters before recirculation was measured using standard objective engineering methods. Results: 19 IRs in 8 ECs were evaluated, none of which complied with the National Core Standard's ideal requirements for IRs. Five complied with minimal requirements . Eleven (57,9%) IRs were designed to have negative pressure; and 8 (42,1%) rooms were not designed for isolation purposes, . IR volumes ranged from 15,5 m³ to 67,2 m³ (median 35,6 m³). Five (26,3%) IRs were under negative pressure; 7 (36,8%) had erratic air flow; and 7 (36,8%) showed positive airflow from the IR into adjacent clinical areas. Fifteen (78,9%) IRs had central provision of air via a ventilation system; 6 (31,6%) had central air extraction; 6 (31,6%) had local extraction; and 7 (36,8%) used natural ventilation only. Four local extraction units had zero flow rate. Airflow in naturally ventilated IRs was significantly lower than flow with other systems (p = 0,0002). The ACH ranged from 0 (n=4) to 112.37 (median 11,9); and was significantly greater in rooms ventilated with central extraction compared to other systems (p = 0,00002). Discussion: The ventilation aspects of airborne infectious disease control are generally poorly implemented. This may contribute to, and fail to mitigate, the high risk of nosocomial transmission of airborne infectious diseases to staff and other patients utilising emergency facilities in the TB endemic areas of Cape Town. Conclusion: Existing ECs should improve adherence to standards of airborne infectious disease transmission prevention in order to protect patients and staff from nosocomial airborne transmitted diseases, such as TB. New Hospitals should place a high priority on the amount, positioning and maintenance of IRs when planning their facility.

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Includes abstract. Includes bibliographical references (leaves 51-58).

Includes bibliographical references.

Background: The City of Cape Town, South Africa, has a large youth violence problem with the highest percentage of non-natural deaths per age group in Cape Town occurring between 15 and 24 years of age. Many authorities suggest that youth violence is preventable and there is a fast growing international knowledge base on how emergency centres (ECs) and EC personnel can contribute to youth violence prevention (YVP). In order to utilise this opportunity most effectively, it is important to understand the challenges faced by EC staff, their perceptions of youth violence, and their willingness to engage in YVP interventions in the EC. There is currently no known EC-based YVP intervention in South Africa. Objectives: This study explored the perceptions and attitudes of Cape Town emergency medicine doctors on youth violence, their role in YVP and how it applies to their practice in the EC. Methods: Semi-structured focus groups, each with 3-5 Cape Town emergency medicine (EM) registrars, were conducted, using five basis questions for discussion to elicit participants' perceptions of and attitudes towards YVP. Data saturation was reached after three focus groups. Thematic analysis as described by Braun and Clarke was carried out on the focus group data sets. Results: The three focus groups were all diverse in terms of race, gender, and level of training. In terms of the "Extent of the problem" themes around acceptability and increased burden were explored."Youth Violence Prevention in the EC" focused on the need for a champion, role of the emergency doctor vs. other stakeholders and sustainability issues. Conclusions: EM registrars in Cape Town have a very limited knowledge of YVP in general and specific to the EC. They are faced with immense challenges that relate to patient load, violence directed to EC personnel, and a sense of despair or despondence in terms of ability to effect change. Concerns about the possible implementation of YVP interventions were sustained funding and sustainability in general. These and other factors influenced attitudes towards EC initiated YVP. Notwithstanding challenges, this study has shown an overwhelmingly positive attitude of EM registrars towards the concept of YVP intervention in the EC, and them being the champion or co-champion of it. Recommendations: It is recommended that EM registrars in their training time should receive theoretical and practical training on YVP which can lead to increased awareness of YVP issue, the need to know resources in the community, and in the future will make it easier to implement a pilot intervention project in a selected EC. Further research is needed on a relevant screening tool to identify high risk patients in local ECs.

Objectives: To determine the case mix and workload of patients presenting to three private emergency centres in Cape Town Design: A Prospective cross sectional observational study was undertaken Setting and subjects: A convenience sample of all prospective patients that presented to three private emergency centres namely Melomed Gatesville, Melomed Bellville and Melomed Mitchell's plain during the month of September 2013 The outcome measures included the following:- ● Determining basic metrics across all three units over study time ● Determining the triage parameters for patients sampled across three units ● Direct time study of patients through unit ● Determining Doctor to patient workloads ● Determining Nurse to patient workloads ● Determining average number of patients receiving special investigations Results: Third party funding was responsible for 91 % of patients seen. The patient profiles consisted primarily of lower acuity presentations. There were clear peaks of attendance with lower acuity presentations decreasing after 10 pm. The majority of patients were discharged and very few required specialist follow up. Conclusions: This study provides valuable information with regards to private emergency centres in the predominantly low income and low socio economic sectors of the Western Cape, Cape town thus allowing a greater focus on the operational aspects of Emergency Centres In these areas and to assist with future planning of the management and running of similar Emergency Centres.

Background Uganda lacks formal emergency care training programs to address its high burden of acute illness and injury. The Ugandan Ministry of Health (MoH) rolled out the World Health Organization’s (WHO) Basic Emergency Care (BEC) course, the first openaccess short course to provide comprehensive basic emergency training for health workers in low-resource settings. The BEC and its new online cases both require further evaluation. Aim and Objectives The study aimed to assess the BEC course and online cases’ impact with the following objectives: 1. Determine participants’ knowledge acquisition and self-efficacy in emergency care. 2. Evaluate BEC participants’ perceptions of the course and online cases. 3. Assess the online cases’ impact on participants’ knowledge and self-efficacy in emergency care. Methods Mixed methods design explored the BEC’s impact. MCQs and Likert scales assessed knowledge and self-efficacy, respectively, among 137 participants pre-BEC, post-BEC and six-months post-BEC using mixed model analysis of variance (ANOVA). FGDs assessed perceptions of the course and online cases post-BEC and six-months postBEC among 74 participants using thematic content analysis. Results Participants gained and maintained significant increases in MCQ averages and Likert scores. The pre-course cases group scored significantly higher on the pre-test MCQ than controls (p=0.004) and found cases most useful pre-BEC. Nurses experienced more significant initial gains and long-term decays in MCQ and self-rated knowledge than doctors (p=0.009, p< 0.05). Providers valued the ABCDE approach and reported improved emergency care management post-BEC. Resource constraints, untrained colleagues and knowledge decay limited the course’s utility. Conclusions Basic emergency care courses for low-resource settings can increase frontline providers’ long-term knowledge and self-efficacy in emergency care. Nurses experience greater initial gains and long-term losses in knowledge than doctors. Online adjuncts can enhance health professional education in LMICs. Future efforts should focus on increasing trainings and determining the need for re-training.