Includes bibliographical references. / Children often present to the Emergency Centre (EC) with painful injuries, or conditions which require painful or upsetting interventions to diagnose or treat. Procedural sedation and analgesia (PSA) refers to the pharmacologic technique of managing the child’s pain and anxiety. The appropriate management of pain and anxiety in the EC is a significant facet of emergency care for all patients, especially in paediatric patients.1 This is achieved partly by the administration of sedative, dissociative, or analgesic drugs which alter awareness, completely sedate the patient, reduce or eliminate pain.2,3,4 PSA is an essential component of Emergency Medicine practice and is a core skill acquired in Emergency Medicine training programs. There is good evidence that proactively addressing pain and anxiety may improve quality of care and patient satisfaction by facilitating interventional procedures and minimizing patient suffering.5

Background Saudi Arabia has suffered from disasters commonly in the last decade. The Saudi military medical services play a major role in confronting these events, but there are anecdotal challenges with their planning and response systems. Currently, disaster planning in Saudi Arabia appears to be undertaken in some detail, but the medical response to disasters is fragmented. This study aimed to review and assess the standard operating procedures for disaster response in the Saudi Arabian military health services. Methods We undertook a prospective, survey-based assessment of disaster response. We sought all disaster plans and Standard Operating Procedures from management and emergency department leadership at each of the 13 Military hospitals. We used a standardised survey tool to evaluate facility disaster planning. This tool gathers quantitative data using close-ended questions and open-ended commentary surrounding a hospital’s disaster response operating procedures. Results There was wide variability in the hospitals across the 20 themes in the survey. While most hospitals have a disaster plan, an up to date version was not always available. Key issues were identified in: management of contaminated patients; coordination of visitors, volunteers and extra staff; media management, and collaboration with other agencies. Conclusion The study highlighted a number of strengths in facility disaster preparedness, and a number of aspects where concerted efforts are required to improve the situation. In general, most hospitals had reasonable disaster plans in place, although none covered all the recommended areas in sufficient detail.

Includes abstract. / Includes bibliographical references (leaves 65-73). / To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area. The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times, relating to the obstetric and neonatal incidents was analysed for 2005 and 2008.

Includes abstract. / Includes bibliographical references (leaves 44-58). / Thirty years ago, oral rehydration therapy (ORT) was hailed as potentially the most significant medical advance of the century. Dehydration from diarrhoea killed approximately 5 million children per year in the late 1970's. ORT is a simple and inexpensive means of treating diarrhoeal dehydration. Today 25% of the world's children have access to ORT, and it is estimated that every year it saves 500,000 lives (Drucker 1988).

Includes bibliographical references (leaves 58-61). / Aims: To assess the level of knowledge and use of capnography among medical personnel in emergency departments in the Western Cape; To assess the cost effectiveness of capnography in emergency departments; To make recommendations to emergency departments in the Western Cape on capnography.

Background. Attrition of registrars impedes the development of Emergency Medicine (EM) in South Africa and Africa, which negatively affects health systems strengthening. Factors relating to attrition of registrars in the EM training program in the Western Cape had not previously been explored. Understanding these factors will enable the development of a framework to be used to conduct formal exit interviews. This exit interview will allow the Division to continually document and address factors related to attrition. Objectives. To explore the factors contributing towards attrition amongst EM Registrars in the Western Cape, to enable a framework for a formal exit interview to be developed. Methods. An explorative qualitative study was conducted using semi-structured interviews. Data was analysed using NVivo software and thematic qualitative analysis. Results. Seven participants were interviewed (5 female and 2 male; ages 28-33). They joined the EM training program at different times (2005-2013) and their time spent in the program varied (8 months to 20 months). Despite their diverse histories, they voiced similar concerns regarding the training program (i.e. lack of support, unsociable hours), regarding relationships (i.e. motherhood, family time), and also with regards to self (i.e. burnout, work-life balance). Conclusion. This study highlights the need for a formal exit interview to address attrition in the Division of EM. The framework for the exit interview should encompass factors related to self, relationships and the training program.

Background There is a growing need for Emergency Medical Services (EMS) globally and in Africa, as health services develop. The establishment and continued operation of volunteer ambulance services might assist with this need. This study provides a comprehensive overview of the operational activities of a volunteer ambulance service and forms a first step for further studies of this and other volunteer ambulance services. Objectives This study describes and quantifies the operational activities of Hout Bay Volunteer Emergency Medical Service (Hout Bay EMS) a volunteer ambulance service in Cape Town, South Africa for a one year period from 1 January to 31 December 2016. Methods This retrospective study describes call-outs, shifts and service demographics of Hout Bay EMS for 2016, using Provincial EMS dispatch data and shift records from Hout Bay EMS. Performance comparisons are drawn between Hout Bay EMS and Provincial EMS. Outcomes In the study period, there were 682 call-outs involving Hout Bay EMS, a total mission time of 951 hours worked over 119 shifts by 31 active members in 2016. Assault was the leading call-out type (18.40%); 58.24% of call-outs were Priority 2 (less urgent), and 39.30% of call-outs ended in no patient transport. Response times to Priority 1 call-outs were generally shorter for Hout Bay EMS than those of Provincial EMS within the Hout Bay area. Members largely preferred night shift to day shift by a factor of 4:1; the majority of shifts were worked by Basic Life Support (28.57%) and Intermediate Life Support (57.98%) qualified members compared to the relatively few shifts (13.44%) worked by Advanced Life Support members. This study shows that a small volunteer ambulance service mostly active on weekends can successfully complement the efforts of the larger, full-time provincial ambulance service it is dispatched by. This model could be replicated elsewhere to meet the growing need for emergency medical services.

Introduction Triage allows prioritisation of the most severely ill in emergency centres that face a complex and growing burden of disease. The presenting symptom is an independent variable that informs acuity and directs resource allocation. This study describes the most common presenting complaints and linked diagnoses, in total and for each category of the South African Triage Scale (SATS) at Mitchell’s Plain Emergency Centre Methods A retrospective, cross-sectional, chart review was used. The sample consisted of patients who presented to Mitchell’s Plain EC in January and June 2015. Charts were reviewed via the Electronic Content Management system. Data were collected on demographic profile, triage priority, presenting symptoms at triage, and ICD-10 diagnosis on EC disposition. Results 3434 of 4335 charts that were reviewed were suitable for inclusion. Triage acuity was 13.8% (n=475) green, 41.0% (n=1409) yellow, 32.5% (n=1116) orange and 4.3% (n=148) red. Trauma (9.7%) and abdominal pain (8.6%) were the most common presenting complaints- the majority of these were triaged as yellow cases. The most common diagnosis made was pneumonia (3.4%) – most frequently presenting as shortness of breath (14.4%). High acuity complaints were predominantly medical. Triage and clinicians report of the main complaint correlated in 74.3% of cases (r=0.7). The majority of patients and highest proportion of high priority patients presented on Mondays and Saturdays. Conclusion Mitchell’s Plain EC has complex caseload with a significant burden of trauma presentations related to interpersonal violence and penetrating assault. Respiratory and gastrointestinal symptoms due to infections were common across triage acuities, and cardiac or neuropsychiatric complications of chronic diseases presented frequently in high priority categories. Describing these presentations and their linked characteristic diagnoses will allow for further research into clinical flow pathways between arrival and disposition. Staffing requirements may be determined by linking these pathways to reality based time frames.

Background: Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system, but health workers must understand it, and it must be used routinely. Whereas efforts have been made to introduce paediatric triage in Uganda, such as Emergency Triage Assessment and Treatment Plus (ETAT+), there is no unified adult triage system being used in Uganda, and it is not clear if hospitals have local protocols being used in each setting. There are limited data on adult triage systems in Uganda. This study aimed at determining how adult hospital-based triage is performed in hospitals in northern Uganda. Methodology: This was a descriptive study. Allocating numbers to the three sub-regions in the northern region, and using a random number generator, we randomly selected the Acholi sub-region for the study. The study was conducted in 6 of the 7 hospitals in the region - one hospital declined to grant permission for the research. It was a written questionnaire survey under supervision of the investigator. In each hospital, at least one representative of nurses in various duty shifts (night, morning and evening shifts), the nursing in-charge/leader, at least one doctor (head of department or any doctor on duty, if available) and a clinical officer (physician assistant, if available), making a minimum of 5-6 study participants who were health professional staff working in emergency receiving areas from each hospital consented and participated in the study. Results: Thirty-three participants from 6 hospitals including 5 doctors, 4 physician assistants, 11 registered nurses, 9 enrolled nurses and 4 nursing assistants consented and participated in the study. Experience of staff working in emergency receiving areas varied with 15(45.5%) greater than 2 years, 7(21.2%) 1-2 years, 5(15.2%) 6 - <12 months and 6(18.2%) for less than 6 months. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal adult hospital-based triage protocol in place. The triage guide/protocol/charts were kept in drawers, had 3 colours - red, yellow and green. Staff rated it as "good", and all staff acknowledged the need to improve it. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from Out Patient Department (OPD) and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improving/developing formal triage in all these hospitals. Conclusion: Formal adult, hospital-based triage is widely lacking in northern Uganda, and staff do perform subjective "eyeball" judgments to make triage decisions. Most hospitals do not have specifically allocated emergency department which risks disorganization in the flow of patients, crowding and consequently worse patient outcomes.

Emergency care is an integral part of an effective healthcare system. However, emergency care systems remain largely underdeveloped in low- and middle-income countries, particularly in Sub-Saharan Africa. Somalia is in the horn of Africa. Decades of civil war, political instability, and terrorism insurgency have greatly hampered healthcare in the country, and the country does not have a formal emergency care system. The aim of the study was to assess the current provision of emergency care in healthcare facilities in northern Somalia, namely Somaliland and Puntland. This was a cross-sectional descriptive study carried out in all emergency units in Hargeisa and Garowe, the capital cities of Somaliland and Puntland respectively. A standardised WHO emergency care assessment tool was used to assess the performance of emergency care procedures in the emergency units. Simple descriptive statistics were used to analyse the data. Six facilities - two in Puntland, and four in Somaliland - participated in the study. Two of these were regional referral public facilities, while the rest were private. The performance of sixty emergency care procedures was assessed. Absent equipment was the main reason (47%, n=60 for the non-performance of these emergency care procedures. Lack of training (29%), stock out of supplies (13%), and lack of skilled personnel (10%) were the other reasons for the non-performance of these emergency care procedures. The findings of this study underscore the need for more resource allocation with a focus on equipping emergency units and having adequate supplies. The study also highlights the need for training of healthcare providers who routinely provide care in emergency units.