Background Seizures are considered one of the most common time-sensitive and potentially life-threatening medical emergencies presenting to emergency centres and attended to by prehospital emergency care practitioners. These require a rapid response, prompt identification and appropriate management. There is a paucity of information describing the demographics and prehospital management of patients presenting with seizures in South Africa. Objectives The aim of this study was to describe the demographics and prehospital management of patients presenting with a chief complaint of seizures and/or convulsions to prehospital emergency care practitioners within the Western Cape Government Emergency Medical Services. Methods This retrospective study included all Western Cape Government Emergency Medical Services calls indicating a chief complaint of seizures and/or convulsions between August 2017 and July 2018. Descriptive statistics were performed to describe basic demographics in this population. A sample of emergency calls originating within the City of Cape Town was selected for a clinical chart review to describe on-scene clinical presentation and vitals, response times, and prehospital treatment provided. Results A total of 24 746 seizure and/or convulsion cases were recorded during the study period. The highest frequency of patients was in the 21 - 40 year age group (31%), and 57% of patients were male. The subsample (n=3 075) yielded 1 571 cases with completed electronic patient care records. The mean dispatch and response times were 20 (±36) and 14 (±10) minutes respectively with a mean on-scene time of 25 (±13) minutes. No on-scene vital signs were recorded in 11.3% of patients. Recorded on-scene vitals indicated that 36% of patients presented with a tachycardia, 14% had an oxygen saturation of < 95%. Airway manoeuvres were performed in 30% of cases, and 50% of patients presenting with a SpO2 < 95% received supplemental oxygen. The benzodiazepine Diazepam was the most common medication administered, and 83% of medications were administer through the intravenous route. Conclusions Seizures are a recognised time-sensitive emergency, however in this sample of patients we observed a longer than expected dispatch time. Although the importance of recording baseline vital signs is recognised, there was a large proportion of undocumented vital signs 35 within the sample. Despite consensus recommendations that intramuscular midazolam are the preferred medication and route, IV diazepam was the most frequently administered. Seizures are an under-recognised burden on Emergency Medical Services within the Western Cape. This study provides an initial description of the epidemiology within this population, allowing for optimization of recognition and management in these patients.

Kenya and Zambia face an increasing burden of emergent disease, with a high incidence of communicable diseases, increasing prevalence of non-communicable diseases and traumatic injuries. However, neither country has an integrated emergency care system that provides community access to high-quality emergency services. There has been recent interest in strengthening the emergency care systems in these countries, but before any interventions are implemented, an assessment of the current need for emergency care must be conducted, as the burden of acute disease and barriers to accessing emergency care in Zambia and Kenya remain largely undocumented. Aims and Objectives: The aim of this project was to ascertain community-based perceptions of the critical interventions necessary to improve access to emergency care in Zambia and Kenya, with the following objectives: 1. Determine the current pattern of out-of-hospital emergency care delivery at the community level. 2. Identify the communities’ experiences with emergency conditions and the barriers they face when trying to access care. 3. Discover community-generated solutions to the paucity of emergency care in urban and rural settings. Methods: Semi-structured focus groups were piloted in Zambia with 200 participants. Results were analysed with subsequent tool refinement for Kenya. Data were collected via focus groups with 600 urban and rural community members in cities and rural villages in the 8 Kenyan provinces. Thematic analysis of community member focus groups identified frequency of emergencies, perceptions of emergency care, perceived barriers to emergency care, and ideas for potential interventions. Results: Analysis of the focus group data identified several common themes. Community members in Zambia and Kenya experience a wide range of medical emergencies, and they rely on family members, neighbours, and Good Samaritans for assistance. These community members frequently provide assistance with transportation to medical facilities, and also attempt some basic first aid. These communities are already assisting one another during emergencies, and are willing to help in the future. Participants in this study also identified several barriers to emergency care : a lack of community education, absent or non-functional communication systems, insufficient transportation, no triage system, a lack of healthcare providers trained in emergency care, and inadequate equipment and supplies. Conclusions: Community members in Zambia and Kenya experience a wide range of medical emergencies. There is substantial reliance on family members and neighbours for assistance, commonly with transportation. Creating community education initiatives, identifying novel transportation solutions, implementing triage in healthcare facilities, and improving receiving facility care were community-identified solutions to barriers to emergency care.

Introduction: The skill of endotracheal intubation to achieve a definitive airway for critically ill and injured patients in the prehospital setting is frequently performed by advanced life support providers. Several methods may be utilised, including intubation without the use of medication, the use of sedatives or a rapid sequence intubation. There is a paucity of data available that assesses prehospital advanced airway intubation practices in South Africa. The aim of this study is to describe the advanced airway management practices of advanced life support providers across South Africa. Methods: A retrospective, observational study method was used (chart review). Electronic patient care records were sourced from private and public emergency medical services companies and collated accordingly. Results: A total of 704 cases were included. Intubation during cardiac arrest was the most common approach to airway management (n=280, 40%) followed by rapid sequence intubation (n=202, 28%), medication-facilitated intubations (n=152, 22%) and a nomedication approach (n=70, 10%). Successful intubation using an endotracheal tube was reported in 197 (98%) of rapid sequence intubation cases, 134 (88%) of the medication facilitated cases, 61 (87%) of no-medication cases and 228 (81%) of cardiac arrest cases. A first-pass success rate was described in 260 (79%) cases, with the cardiac arrest group having a first-pass success of 85%, followed by the rapid sequence intubation group (83%), the nomedication group (71%) and the medication facilitated group (61%). Hypotension and cardiac arrest were the most common adverse events. A total of 496 (70%) patients were alive at hospital handover. The average scene time and transportation time was 42 minutes and 24 minutes respectively for the rapid sequence intubation group, 42min and 27min for the medication facilitated group, 44min and 25min for the no-medication group and 57min and 16min for the cardiac arrest group. Discussion: The study described the prehospital airway management practices by advanced life support providers in South Africa. Rapid sequence intubation had the highest endotracheal intubation success rate overall and the lowest prevalence of adverse events. There was no statistical difference in survival between the rapid sequence intubation, medication facilitated and no-medication group. Due to a lack in standardised treatment guidelines, differences in fluid administration, post-intubation care, confirmation of placement and ventilation were noted. No standard approach to record keeping was found, with the quality of patient care records being variable. A standardised advanced airway management report would be beneficial as it would improve the quality of data recorded and allow for better comparisons to be made.

Background Communication is vital to patient-doctor interactions especially in emergency centres (EC). It is evident from international and South African studies that language barriers result in suboptimal clinical outcomes, increased use of already limited resources and poor patient satisfaction. In the Western Cape, initiatives such as community trained interpreters, telephonic services and multilingual language policies have been implemented to improve communication between doctors and patients. Objectives This study was done to ascertain to what extent language barriers are perceived to still exist by doctors in emergency centres in secondary public hospitals in Cape Town. Methods A quantitative on-line survey of full time doctors in the ECs of six urban secondary public hospitals in Cape Town was conducted in October 2019. Data was collected over a 5 week period and covered demographics, languages spoken, (self-reported) fluency of languages spoken, languages encountered, perceived occurrence of language barriers, perceived impact of language barriers and strategies currently implemented to overcome these barriers. Results Of the 119 doctors invited to complete the survey, 74 eligible responses were received. Language barriers still exist in secondary public hospitals in the Western Cape. The majority of doctors spoke Afrikaans and no isiXhosa speaking doctors took part in the survey. Half of the doctors surveyed stated they would not be able to take a history in isiXhosa without an interpreter. Most (97%) of doctors had not heard of community trained interpreters and only 23% had ever used the telephone interpretation service available. Perceived consequences of language barriers include: inability or longer duration to get a history, increased use of resources, and patients returning because they did not fully understand the treatment plan. Informal interpreters such as nursing staff and family members were used most often to overcome language barriers. No official interpreters were available to assist in person and doctors are either unaware of telephonic interpreting services or woefully under-using this service. Due to language barriers, doctors are left feeling frustrated with themselves or sad for the patients that they are meant to be helping due to language barriers. Conclusion Reintroduction of community based interpreters, teaching doctors more languages and investment into technologyaided translation services are possibilities that have been suggested by doctors and could be researched further to help improve the current situation.

Background: Burn care in resource-constrained settings represents a significant challenge. Mobile health (mHealth) could have useful advantages by providing timely expert advice. As part of a larger study on teleconsultation in burn care, a mobile application – the Vula App – was developed and tested in the Western Cape. This study gauges healthcare providers' intention to use this mHealth technology and factors influencing its adoption. Methods: 48 healthcare providers working in Emergency Centres of three health facilities answered a questionnaire immediately after being trained in the use of the app. The survey was based on the Technology Acceptance Model of Davis and included the constructs of ease of use, usefulness, design quality, impact on care, compatibility, and behavioural intention to adopt. Descriptive statistics were used for data analysis. Results: The mean age of participants was 29.5 years old and the male-to-female ratio was 1:2. 73.9% of respondents were doctors and the remainder nurses. 93.4% of them already owned and used smartphones, with 76% using them in medical practice. 93% of respondents thought the app was easy to use and 91.3% found it useful. 17.8% found it incompatible with their routine work. 84.8% of participants expressed their intention to adopt and use the system. 4.3% of participants rejected it and 10.9%remained undecided. Conclusion: The majority of participants already used smartphones and found the Vula app useful, easy to use, well designed, beneficial in burn care and compatible with their routine work. These factors led them to express the intention to use the app. This significantly predicts actual future use and is essential to the successful implementation of mHealth.

Background and Objectives: While trauma is currently the second leading cause of death in Saudi Arabia, little statistical information is available about injury rates and related patient outcomes. There is a need to understand trauma epidemiology to determine strategies that can be put in place to prevent and treat such trauma. We aimed to describe trauma rates, types of injuries, demographic distribution of injury and body regions affected by trauma in King Fahad Hospital in the city of Medina. Methods: The study was undertaken in King Fahad Hospital, the first multi-speciality reference hospital in the Medina region and the only trauma centre in the city. We collected retrospective data on all the trauma victims who visited the Emergency Department from 1st January to 31st December 2018. Simple descriptive statistics were calculated. Trauma mortality was compared with trauma scores with Receiver Operator Curves. Results: During the study period, 8793 patients were evaluated, 5846 (66.5%) males. The mean age was 27.5 years. 5608 (64%) were admitted in one of the in-hospital departments and rest were referred to OPD. Traffic-related injuries (4086; 46.5%) and falls (2993; 34%) were the most common causes of injury. Extremities injury (5929; 67.5%) was recorded as the most common body part. From the in-hospital patients, 5077 (90.5%) were discharged home and 167 (3%) died. Considering the mortality prediction accuracy of RTS and NTS. The RTS score of ≤9 had sensitivity and specificity of 90.2% and 90.4%, respectively, in predicting mortality in >5-year-old patients. NTS score of ≤13 had 90% sensitivity and 97.3% specificity in predicting mortality in the age group of 0-5 year-old. Conclusion: This descriptive study is a crucial step in addressing the burden of trauma in Saudi Arabia. Information related to the characteristics of injuries and relevant patient 2 outcomes may assist in further research into possible causal factors. It may contribute to the creation of new protocols in preventing and managing injuries more efficiently.

Background: Despite practicing resuscitation skills in a simulation environment, medical students often express anxiety about having to participate in patient resuscitation in the clinical environment. This fear can lead to an unwillingness to initiate or participate in resuscitations, and a decreased confidence in their skills. Exploring the perceptions of final year medical students can provide valuable insight for improving the current simulation programme at the University of Cape Town. Aim: The aim of the study is to explore 6th year medical students' perceptions and self-reported competence for clinical practice after receiving Resuscitation-Based Simulation training.

In sub-Saharan Africa, the shift in disease burden from infections to non-communicable disease and injury highlights the need for effective and efficient emergency care. Despite this, emergency care is a neglected sector of the health system in most low and middle-income countries. Funding and resource allocations are often small and have little impact on the development of emergency care systems, and provision of emergency care is therefore frequently left to under-trained and/or under-prepared nurses or clinical officers. In order to develop effective emergency care systems, one must first identify strengths and challenges in existing systems. The aim of this study was to determine facility-based emergency care capacity in public hospitals in Zambia. This descriptive cross-sectional study comprised of a total of 23 facilities: seven districts, 12 general and four central hospitals. Data were collected using a standardised Emergency Care Assessment Tool (ECAT); developed in 2013 by AFEM to ascertain facilities' strengths and weaknesses in the delivery of the emergency care services for five sentinel conditions and maternal health. The ECAT was administered through one-on-one interviews with designated personnel working in emergency receiving areas. The assessment tool consists of six main themes relating to the ability to provide care for patients suffering from respiratory failure, shock, altered mental status, severe pain, trauma and maternal health. The majority of facilities were able to perform almost all the procedures across all themes. However, some procedures, which were highly technical and required personnel with specialist training or specialised equipment, were not performed at all facilities. The level of the facility also dictated whether a procedure could be performed where higher-level health facilities like central hospitals were able to perform more procedures than lower-level facilities due to higher numbers of trained personnel, more equipment and supplies, and better infrastructure. Maternal health was covered in almost all (>90%) hospitals. Across all themes, the most frequent reasons for not performing procedures were lack of supplies (n=137) followed by no training (n=136), no infrastructure (n=35) and no human resources (n=34). At the central level, the most frequent reason for not performing procedures was no supplies (n=16), whereas at district and general levels the most frequent reason was no training. Overall, most facilities were able to offer basic emergency care services. However, there is limited capacity of training and supplies across all facilities, as well as a lack of infrastructure and policies for emergency care in lower-level facilities. Zambian hospitals can provide basic emergency care, but there is need to enhance training and improve on provision of supplies to enable facilities to provide emergency care. Focus must also be on development of policies relating to emergency care to guide and standardise procedures. Capacity building should be more focused at district and general hospitals to improve emergency care across all levels of health facilities, as it will reduce the burden at central level and improve patient outcomes since these are first-line access points for patients.

Disaster scholarship and recent disaster policy in the United States have suggested that coordination of efforts in the disaster recovery process will allow impacted jurisdictions to maximize positive recovery outcomes. Yet it remains unclear exactly who should be, or is, coordinating disaster recovery at the local level. This study explored the role of county elected officials in disaster recovery in an attempt to understand what role these elected officials currently play in the recovery process—particularly as related to the coordination of recovery efforts. During the initial data collection process, the researcher discovered that the role of county elected officials in disaster recovery appears to be consistent with their routine, day-to-day role in county government. No one person within the impacted counties was charged with a coordinator role in recovery. The researcher expanded the focus of the study to explore whether there were disaster conditions that necessitate overall coordination in order to best negotiate the recovery process and, if so, who was fulfilling that overall coordination role and what were they doing as part of it. Data was initially collected through 20 in-depth, telephone interviews with county elected officials in twelve states. Grounded theory was used to conceptualize the overall research design and analyze the data. Based on theoretical sampling, an additional 22 in-depth, telephone interviews were completed with a combination of county elected officials, emergency managers, designated recovery coordinators, and municipal mayors. The data showed that overall coordination in disaster recovery as implied by the literature and supported in federal policy did not appear to be currently happening—at least not at the county level. Coordination—to the extent that it was occurring in most jurisdictions—could best be described as in pockets and ad hoc. However, the study was unable to determine the extent to which this absence of coordination represents a problem in recovery. Based on the findings of this research, it would seem that there is a discrepancy between the literature-based idealization of coordination in recovery and the ad hoc coordination materializing in practice that needs to be addressed by both researchers and practitioners.

Recent disasters have demonstrated the importance of mitigating their potential impact to not only protect human lives, but to also reduce the seemingly unending cycle of repeated damages. The Disaster Mitigation Act of 2000 requires state, local, and tribal governments to have FEMA-approved Hazard Mitigation Plans in order to qualify for certain types of Federal funding. However, even with these mandates in place, there are a number of local governments that have yet to adopt a FEMA-approved multi-hazard mitigation plan. Although multi-hazard mitigation plans seem rational for reducing the impact of hazards, efforts to prepare plans and implement mitigation-related activities are oftentimes met with resistance at the local jurisdictional level. The purpose of this qualitative study is to inductively examine the social, financial, and political conditions and forces that contribute to the decision to adopt or not adopt a hazard mitigation plan in the Red River Valley.