Patients present daily to the emergency department of Ceza hospital, Kwazulu Natal for medical treatment. Some of these patients are self-referral or referred by other health care workers. Analysis of demography of patients presenting to the emergency department from 1st January to 31st December 2010 was conducted to provide a general overview and characteristics of the studied population. It was a retrospective, transverse and descriptive study that involved patients’ records reviewed from a hospital register. The results showed that the commonest primary diagnosis was assault with a patient population of 81 (16.9%) followed by gastroenteritis (12.3%) and soft tissue injuries (8.5%) respectively. Most patients were single (94.6%), black (100%) and mostly males (57.7%). The highest number of the patient population seen at the emergency department was in February (14.8%) and the patients seen were mostly in the age range of 21 to 30 years. Most cases that presented to the emergency department were non-emergencies that constituted 67.2% of the cases seen and the emergency cases were only 32.8%. The highest patient population at the emergency department of Ceza hospital was 34.83% in summer with presentation peaking from 8.00 am until 11.59 am. The highest proportion of patients’ presentation was found to be during the weekends.

Helicopter EMS (HEMS) is a critical tool in the safety net for medical emergencies around the world. It incorporates a team working in precise unison to both safely operate the aircraft and provide high quality and state of the art care to critically ill and injured patients. Crew Resource Management (CRM), the planning and implementation of allocating flight resources, has been recognized by the HEMS industry to be a critical factor in the safety of HEMS operations. There is no question that there is a risk associated with every flight and as studies have shown, the danger of an accident has not decreased but increased dramatically over the past ten years. The HEMS community is working diligently to surmount obstacles in the path of change to making HEMS operations safer while continuing the research and advancement of medical care. Change is on the horizon for HEMS and there is no better time than now to find and fix the flaws in our system. The leaders in the HEMS community are researching and investigating how and where these changes must be made, but their reviews and evaluations are being done exclusively here in the United States. In attempts to approach this issue at a different angle, a project was initiated at the University of Pittsburgh through the Center for Emergency Medicine of Western Pennsylvania (CEM) and the University of Pittsburgh Honors College (UHC). This project attempts to examine the variance in CRM methods employed by HEMS programs outside the United States, the efficacy of implementing those methods, and some of the best practices applied by these programs. By looking at the techniques, methods, and cultures of these services selected, we may expand our understanding of CRM and our own safety culture in Helicopter EMS to advance the industry to a new standard.

Thesis (M.P.H.)--University of Hong Kong, 2008. / Includes bibliographical references.

The World Health Organisation (WHO) defines palliative care as 'an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.' 1 This includes a wide variety of situations such as chronic illness and end-of-life care. 2 Palliative care is usually performed in-hospital. However, emergency medical services (EMS) often encounter patients requiring palliative care as these patients may have acute exacerbations of illness, progress towards end-of-life or require transport to a medical facility. 3-9 Thus, there is a role for palliative care in the pre-hospital setting. EMS providers are uniquely positioned to deliver this care in the pre-hospital setting as they are often the first point of medical contact. 10 This has great potential benefit for patient comfort, early identification and relief of suffering and earlier referral to hospice care. 10, 11 Despite this unique position there is an overall lack of guidance within EMS systems to manage palliative patients. 5, 6, 10 In the United States of America (USA), for example, only 5-6% of EMS systems have protocols for palliative care. 6, 10 In addition, there is no specific pre-hospital emergency care curricula on the subject, resulting in a lack of education and training for EMS providers. 3-5, 12, 13 This may stem from the historical focus of EMS training which primarily involves immediate measures to preserve life or limb until definitive care is reached. 11 This focus has resulted in an EMS ethos of 'saving lives.' 5, 12 Palliative care, on the other hand, is not focussed on 'saving lives', but rather the prevention and relief of suffering. 1 Therefore, palliative care may seem to conflict with emergency care, placing EMS providers in difficult situations when confronted with palliative care patients. 8, 12, 14 South Africa itself faces what has been termed a “quadruple burden of disease” due to communicable diseases such as HIV/AIDS, high maternal and paediatric mortality rates, non-communicable disease as well as injury. 15 The large number of patients suffering from these diseases and the life-limiting complications thereof, results in increased need for palliative care in the country as noted by the South African Minister of Health. 16 Access to health care for patients suffering from these diseases is a further challenge in the Sub-Saharan African setting. 17, 18, 19 In South Africa, EMS are often contacted 3 by those without access to transport to provide this service. 20 Thus, South African EMS providers may frequently encounter not only high acuity emergency patients, but many ill HIV/AIDS, cancer and other chronically ill patients requiring palliative care who are unable to access healthcare via alternative means. 21 European studies have found that approximately 3-5% of all pre-hospital calls involve palliative care situations. 2, 22, 23 With the quadruple burden of disease and limited access in the South African setting, this percentage is likely higher as these factors result in increased frequency of contact between EMS providers and patients requiring palliative care. Although EMS providers in South Africa manage palliative patients in the prehospital setting, to our knowledge, no research has been produced in the (South) African setting regarding prehospital palliative care. Outside of Africa literature has been produced but is limited. This literature review discusses paramedic perceptions of prehospital palliative care, prehospital palliative care patient management and legislation concerning prehospital palliative care. Finally, expert opinion pieces and recommendations are reviewed.

Includes abstract. / Includes bibliograpical references. / Hospitals across South Africa are inundated with patients suffering from conditions associated with substance abuse. It is inevitable that contact with health services be made through an emergency centre (EC) at some point. This study aims to assess the exposure and attitudes of emergency physicians to substance abuse and addiction in major South African academic ECs. A prospective survey based on the Substance Abuse Attitude Survey (SAAS) was conducted in a convenience sample of eighty five emergency physician registrars and junior consultants in Cape Town, Gauteng, Limpopo and KwaZulu Natal. Respondents were targeted during academic meetings and by post.

Background Helicopter Emergency Medical Services (HEMS) are an expensive resource that should be utilised efficiently to optimise the cost-benefit ratio. This is especially true in resource-limited settings, such as South Africa. This may be achieved by implementing call-out criteria that are most appropriate to the healthcare system in which HEMS operate. Currently, there are no published evidence-based HEMS callout criteria developed for South Africa. By identifying patients that are most likely to benefit from HEMS, their utilisation can be enhanced and adjusted to ensure optimal patient outcome. Aim To systematically utilise expert opinions to reach consensus on HEMS call-out criteria that are contextual to the South African setting. Methods A modified Delphi technique was used to develop call-out criteria, using current literature as the basis of the study. Purposive, snowball sampling was employed to identify a sample of 118 participants locally and internationally, of which 42 participated for all three rounds. Using an online survey platform, binary agreement/disagreement with each criterion was sought. Acceptable consensus was set at 75%. Statements were sent out in the third round ascertaining whether participants agreed with the analysis of the first two rounds. Results After two rounds, consensus was obtained for 63% (36/57) of criteria, while 64% of generated statements received consensus in the third round. Results emphasised the opinion that HEMS dispatch criteria relating to patient condition and incident locations were preferential to a comprehensive list. We present these criteria in a collated format, favouring further inquiry on a case-by-case basis. Participants suggested the use of a screening tool, which can guide dispatch decision-making. Conclusion The combination of existing literature and participant opinions, established that callout criteria are most efficient when based on clinical parameters and geographic considerations, as opposed to a specified list of criteria. This could improve resource allocation, specifically in a low to middle income country such as South Africa.

Introduction: The diagnosis of Pulmonary Embolism (PE) is challenging to make and is often missed in the Emergency Centre. The true incidence of PE in South Africa is unknown. The diagnostic work-up of PE has been improved by the use of Clinical decision rules (CDRs) and CT Pulmonary Angiography (CTPA) in high-income countries. Currently used CDRs have not been validated in the South African environment, where HIV and TB are highly prevalent. Both conditions are known to induce a hyper-coagulable state. Methods: This study was a retrospective chart review of patients with suspected PE that had CTPAs performed from October 2013 to October 2015 at Mitchell’s Plain Hospital in South Africa. Data was collected on demographics, presenting symptoms and signs, vitals, bedside investigations, HIV and TB status, use of CDRs and CTPA result. A Revised Geneva Score was calculated retrospectively and compared to the CTPA result. Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%), followed by cough and chest pain. 29% of patients also had clinical features of DVT. No sign or symptom was seen to be markedly different in those with confirmed PE compared to those without. Among patients with confirmed PE, 37% were HIV positive and 52% had current TB. The retrospective revised Geneva Scores compared poorly with the CTPA results. Discussion: PE remains a diagnostic challenge. Worldwide, the use of CDRs has shown to improve the utilization of CTPA. In our study, the retrospectively calculated CDR was not predictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious when making a clinical probability assessment of PE in this setting. However, further studies are needed to determine whether HIV and TB could be independent risk factors for PE.

No description available.

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.