Includes abstract. / Includes abstract. / Outcomes of cardiac arrest and cardiopulmonary resuscitation (CPR) are poorly monitored or evaluated in our hospitals in South Africa. CPR plays a significant role in emergency medicine, and regardless of poor outcomes internationally, efforts should continuously be made to improve these outcomes. In this study we set out to establish the outcomes of CPR performed on all cardiac arrest patients in two hospitals in the Cape Metropole region.

Includes bibliographical references. / Data regarding health literacy in South Africa is limited, yet health literacy is critical to consider when addressing the needs of a population that is underserved by the medical community. An increase in health literacy can have a dramatic impact upon community members’ quality of life, life expectancy, and patient outcomes, as well as the successful advancement of the country. Townships and informal settlements surrounding Cape Town have limited access to timely health services, including life-saving emergency care. In recent years a community-based emergency first aid responder (EFAR) program has been created to address this need. EFARs have expressed interest in participating in other health related projects, and have the potential to help address health literacy needs in the Cape Town area. The aim of this study was to validate the use of the HLQ (Health Literacy Questionnaire) in South Africa and use it to develop a framework for EFARs to measure and respond to health literacy needs. After some revision, a validated combined Afrikaans/English HLQ was created for use in South Africa.

Background: Unintentional injury remains one of the leading causes of morbidity and mortality among children worldwide. The aim of this study will be to ascertain if teachers and teacher's assistants in early childhood development facilities have training in first aid or emergency care, what their attitudes towards first aid are and how competent they feel to manage emergencies. Methods: A cross-sectional survey will be carried out among early childhood development (ECD) practitioners who are studying at the Goodwood campus of Northlink College in the Western Cape. The survey will be optional and anonymous. A standardised collection of demographics will be performed and participants will be given a questionnaire that assesses the participant's knowledge and attitudes towards first aid and basic life support.

Includes abstract. Includes bibliographical references.

The aim of this study is to determine the current door to needle time for administration of fibrinolytics in acute myocardial infarction in Emergency Centres in the Cape Metropole. This study will also aim to identify the factors contributing to the delay.

Paediatric resuscitation can be a stressful event for many clinicians. It is compounded by the need to calculate accurate drug dosages and equipment sizes for many interventions. These calculations are most often based on weight, which is a difficult parameter to obtain. It is rare that one is able to weigh a child before a resuscitation. There are many different methods available for weight estimation. Most of these are formulae based on age but length based tools are often used. Most of these formulae were derived in developed world populations and have become inaccurate due to the changing weights and heights of children. The aim of this study was to evaluate 4 weight estimation methods (APLS, Luscombe and Owens, Best Guess and Broselow® Tape) to determine which are accurate for weight estimation in South African Children. These 4 formulae were also used to calculate the doses of adrenaline (0.1 m/kg of 1: 10000), Fluid bolus (20ml/kg) and First Shock defibrillation dose (2J/Kg) to determine which were clinically useful. A database of 3233 children between 1 and 12 years seen at Red Cross Hospital· Trauma Unit in Cape Town during 2002 was used. Measured weight was compared to estimated weights from all 4 methods and Intervention doses calculated from measured weight was compared to doses from weight estimation methods. APLS formula and the Broselow® Tape showed the best correlation with measured weight. Mean percent error- 6.4% for APLS for 1-10 year olds and -10% error for Broselow® tape in children <145cm length. Both the Best Guess and Luscombe and Owens formulae tended to overestimate weight (+13.4% and +17.6 % respectively). The Broselow tape was most accurate for dosages of all interventions but little difference existed between methods. The APLS and Broselow® tape are most accurate in estimating weight in the South African population, even though they have a tendency to underestimate weight.

Introduction: Low and middle-income countries account for over 90% of worldwide morbidity and mortality associated with injuries. While insufficient resources preclude appropriate care, suboptimal clinical skills, are a universal setback. Major curricula gaps have been identified as underlying this situation. In Africa, most training efforts are targeted at postgraduate level, relegating undergraduate Emergency Medicine (EM) education to a less formal undertaking. This study set out to delineate a list of locally appropriate undergraduate EM procedural core competencies for the University of Zimbabwe College of Health Sciences (UZCHS), through a consensus building process. Methods: A three-stage modified online Delphi survey was used to gain consensus among expert medical trainers at UZCHS, between July and August 2017. Opinion was sought on a five-point Likert scale, regarding agreement with items for inclusion on the procedural core competency list. The original survey list of 105 competencies was generated from literature. The second round included suggestions from panelists. The study was ethically cleared by the University of Cape Town, UZCHS and the Medical Research council of Zimbabwe. Results: 19 expert medical teachers, representing seven clinical departments responded to the survey, with 15 completing all rounds. 79% had more than 5 years’ experience in teaching and assessment of emergency procedures. Of these, 50% had at least 10 years’ experience. The experts reached consensus (75% selecting agree or strongly agree) on 64 competencies (61%), on the first round. The second round yielded consensus on a further 33 items. Only one additional item reached consensus in the final round. A final list of 98 core procedural competencies was generated by three Delphi rounds. Qualitative comments are summarised per emerging themes. Conclusions: A locally appropriate list of undergraduate procedural core competencies, was established. This process can serve as guidance for curriculum projects in Zimbabwe and similar settings.

Background To date, health facilities in Sub-Saharan Africa have not had an objective measurement tool for evaluating comprehensive emergency service provision. One major obstacle is the lack of consensus on a standardised evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine (AFEM) developed an assessment tool specifically for these settings - the Emergency Care Assessment Tool (ECAT) - that assesses provision of key medical interventions. These interventions are referred to as signal functions for the six sentinel conditions that occur prior to death: respiratory failure, shock, altered mental status, severe pain/trauma, and dangerous fever. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. Previous studies aimed at the refinement and context modification of the ECAT have already been performed in multiple African countries. We undertook a validation study to help determine the applicability of the tool in assessment of emergency services throughout the continent. Aims and Objectives The aim of this study was to determine the content, construct, and face validity of the AFEM Emergency Care Assessment Tool in Cameroon. To achieve this, the study had the following objectives: (1) Employ the ECAT in district, regional, and central hospitals in Cameroon. (2) Use direct observation to determine whether the signal functions can be performed in these facilities. Methods This was an observational study at a convenience sample of five hospitals in Cameroon: three district, one regional, and one central. The goal of this study was to validate the instrument, not the facility, and so the sample size was related to the number of signal functions witnessed rather than the number of facilities visited. The tool was administered with the Head of Emergency at each facility. This completed ECAT was then compared with direct observations of the signal functions, a process which was conducted by the partner local emergency care specialists accompanied by the ECAT researcher. Results In general, the higher the level of facility, the greater the emergency care capacity and the greater the number of signal functions that could be performed correctly and consistently. Discrepancies in funding, supplies, resource allocation, and care delivery ability were apparent through ECAT results, expounding on barriers to care delivery, and direct observation. McNemar tests on the ECAT results versus direct observation at each facility yielded statistically significant support for tool validation at the national level emergency unit as well as two of the district level emergency units. Concordance between reported and observed signal functions could not be achieved at the regional facility and one of the district facilities. Conclusions The ECAT has good potential for facility level assessment of emergency care provision, and collects meaningful information that can guide effective improvements in the delivery of emergency care.

Author Assist is an initiative of the African Journal of Emergency Medicine (AfJEM) that pairs an experienced researcher with an author recently rejected for publication to assist with revision of the rejected article. This study explores the factors of the assistance process within partnerships that have achieved successful publication after resubmission and blind peer-review. It aims to improve Author Assist's ability to facilitate successful publication by identifying potential areas of focus that impact individual researcher development. A grounded theory, qualitative approach first looks at the assistance process for seven individuals via semi-structured interview. Structured surveys with a wider sample size of authors then provide feedback on specific components of the process and inform recommendations for improvements to the programme. Interviews are analysed by deductive placement of themes into inductively-developed categories. Participant stories within the African acute care context tend to be consistent with available literature describing current global challenges in overcoming barriers to scientific research and publication. Recounts of the Author Assist process are overwhelmingly positive, and frame the programme as a worthwhile, albeit time consuming, initiative that makes a substantial difference in the professional development of individuals, their ability to take on mentorship roles themselves, and their future success in scientific publication. Inductive build-up from interviews of effective components of the process, and suggestions for progression of the programme are confirmed by responses from other past participants. Common themes arising from author feedback include perceived pressure by assistants to complete work on time amidst other career demands; the effectiveness of the partnerships in addressing issues of language, structure, and submission requirements; and the desire for the programme to encompass the full research process. Assistant themes tend to mirror those of the authors. In addition, assistants suggest a more involved manuscript assessment by the journal, prior to commissioning a partnership. Also suggested is a redesign of the assistant database to categorise by type of assistance offered, rather than by topic expertise. The findings from this study confirm Author Assist's unique niche within emergency care development, and its effectiveness in supporting individual research careers. A number of reasonable and low cost improvements to the programme have been put forward for AfJEM to improve ability to facilitate successful publication.

Background: Prehospital emergency care providers in South Africa are regularly called to assist with the management of mental healthcare users. The Mental Health Care Act no 17 of 2002 regulates mental healthcare in South Africa but makes no reference to the roles and responsibilities of prehospital emergency care providers in the provision of mental healthcare, rather giving the South African Police Services authority over the wellbeing of a mental healthcare user outside the hospital setting. Aims: To investigate what prehospital emergency care providers understand their responsibilities are towards a mental healthcare user and the community during the management of a behavioural emergency. Setting: Prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria. Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care; Basic Life Support, Intermediate Life Support and Advanced Life Support. Data from each focus group was collected through audio recordings, transcribed and analysed using a framework approach. Results: A total of 19 prehospital emergency care providers from all three main levels of care participated in the focus group discussions (4 BLS, 6 ILS and 9 ALS). Four main themes were identified: Perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion: Participants placed high value on their moral and medical responsibilities towards a mental healthcare user and would like to have the backing of legislation to fulfil their role. There is a desire for better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.