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Introduction: Out of Hospital Cardiac Arrest (OHCA) is a time-sensitive emergency which requires prompt identification and emergency care in order to reduce morbidity and mortality. The first step in recognising OHCA is rapid identification by the emergency dispatch centre. Identification of such patients remains challenging in South Africa due to multiple languages and widely differing levels of education. This study aimed to identify the key descriptors (words and phrases) of OHCA used by callers speaking Afrikaans when contacting the emergency dispatch centre of the Western Cape Provincial Emergency Medical Services (WC-EMS). Methodology: Computer-aided dispatch (CAD) data with a corresponding “patient unresponsive” incident type were drawn for a 12 month period (January – December 2018). Corresponding patient care records were extracted to verify OHCA. The original voice recordings between the caller and emergency call taker at the time of the emergency were extracted and transcribed verbatim. Transcriptions were subjected to inductive, qualitative content analysis to the manifest level. Descriptors of OHCA in Afrikaans calls were coded, categorised and quantified. Results: A total of 729 confirmed OHCA cases were identified, of which 36 (5%) were in Afrikaans and eligible for analysis. Following content analysis, 83 distinct codes in six categories were identified. The most prevalent categories were descriptors related to Respiratory Effort (apnoea and difficulty in breathing; 30.1%) (30.1%), Clinical Features (related to the eyes, mouth and body temperature; 20.4%) and Cardiac Activity (pulselessness; 16.8%). Conclusion Afrikaans Callers within the Western Cape province of South Africa use consistent descriptors when requesting and ambulance for OHCA. Future studies should focus on describing descriptors for other languages commonly spoken in the province, and to develop and validate telephonic OHCA recognition algorithms.

MSc, Nursing, Faculty of Health Sciences, University of the Witwatersrand / Handover is an internationally recognised formal procedure, which has become a ritual in daily nursing practice. A structured handover plays an important role in verbal as well as written interdisciplinary communication, decision making and patient treatment, thus ensuring patient safety and maintaining the continuity of care. The purpose of this study was to determine and describe the handover practices as reported by registered nurses working in emergency care units in private sector hospitals. The objectives determined the information content in current handover practices of registered nurses, including the view or opinions of these nurses regarding handover practices. Furthermore, this study indicated were there are differences in handover practices between specialists versus non – specialist nurses. A descriptive, prospective research design was used to collect data from registered nurses working in emergency care units at private sector hospitals (n = 8). All registered nurses (N = 142) who met the inclusion criteria, were invited to participate in the study. Registered nurses who returned completed questionnaires constituted the final sample (n = 117). Data on handover practices were collected by means of a 96 item (17 question / 5 page) self administered questionnaire. This data were analysed using descriptive statistics, Chi2, Bartlett’s test for equal variances, Spearman’s test, Pearson’s r, Fisher’s exact, student T-Test and Cronbach’s Alpha. The level of significance was set at p ≤ 0.05. Epi-Info and STATA version 10 statistical computer packages were used for data analysis. Results indicated that 10.26% of registered nurses working in emergency care units had received formal training regarding handover practices and procedures. In order to solve lack of formal handover training problem, the researcher has established an acronym by using the word “HANDOVER”©, which may aid registered nurses with the handover practices and procedures. Thus, offering the handover structure and more user-friendly format. Use of a handover acronym pocket card was suggested for future formal training purposes.

MSc (Med) Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand / Adequate exposure to paediatric pre-hospital emergency cases for students undertaking clinical learning is a key component of preparation for independent practise. Both clinical reasoning and psychomotor skills require practise in a realistic environment in order to best equip the qualifying practitioner for demands of the real world of pre-hospital emergency care. The aim of this study was to retrospectively describe the exposure of pre-hospital emergency care students in the University of Johannesburg‟s National Diploma in Emergency Medical Care programme to emergencies involving paediatric patients in the Greater Johannesburg Metropolitan area over a continuous eight year period, between 1 January 2001 and 31 December 2008. Patient care records contained in an electronic clinical learning management information system entered over the eight-year study period were analysed in order to characterise the exposure of students to paediatric emergency cases in general, and clinical skills performed during this exposure. Results showed that, with the exception of infants and children seen by first year students, median exposure to paediatric emergency cases for students in all academic years was below 50%. Exposure to emergencies involving younger patients was generally lower than that for older patients, however the acuity of patients increased with decreasing age. Exposure to most clinical skills also decreased with decreasing patient age. Opportunities for students to practise critical or invasive skills were relatively rare. Suggestions for the improvement of student exposure to paediatric emergency cases and clinical skills include a period of internship and greater utilisation of hospital-based clinical skills exposure and practice.

Triage, which means "to sort", determine the priority of the patients need of care. The aim of the present study was to describe nurses’ perception of triage at a pediatric emergency department. A questionnaire with open- and closed-ended questions were distributed to all 25 nurses that worked at a pediatric emergency department. The answer frequency was 48 % (n=12). Open-ended questions were analyzed by qualitative content analysis and the closed-ended questions with descriptive statistics after which statistical correlations and differences were calculated. The nurses’ perception of triage was that this first assessment and prioritization of the patients’ need of care increased safety and control and that to refer patients to another level of care may reduce the waiting time however, were time consuming for the nurse. The perception of interception factors for referring patients to another level of care were lack of availability and negative reactions from parents and patients. To perform triage and at the same time be responsible for other patients was perceived as a difficult. As a support in the performance of triage a triage-system, easy to interpret, was needed. Any significant differences or association could not be detected regarding level of education or work experiences. The nurses perceived that a correct triage gave the patient correct care at right level. / Utifrån triagebedömning, där triage betyder "att sortera", prioriteras patientens behov av vård. Syftet med denna studie var att beskriva sjuksköterskors uppfattning om triagebedömning på en barnakutmottagning. En frågenkät med öppna och slutna frågor delades ut till samtliga 25 tjänstgörande sjuksköterskor vid barnakutmottagningen. Svarsfrekvensen var 48 % (n=12). De öppna frågorna analyserades med kvalitativ innehållsanalys och de slutna frågorna bearbetades med deskriptiv statistik därefter beräknades statistiska samband och skillnader. Sjuksköterskors uppfattning om triage var att denna första bedömning och prioritering av patientens vårdbehov gav en ökad säkerhet och kontroll samt att hänvisning av patienter till annan vårdnivå kunde minska väntetider men krävde stor tidsåtgång. Brist på tillgänglighet till primärvården och negativa reaktioner från föräldrar och patienter uppfattades som en hindrande faktor vid hänvisning. Sjuksköterskorna uppfattade att det var en svår arbetsuppgift att utföra triagebedömning samtidigt som man ansvarade för andra patienter. Som stöd i triagebedömningen önskades triagemallar som var lätta att tyda. Inga signifikanta skillnader eller samband kunde identifieras vad gäller graden av utbildning eller antal yrkesverksamma år. Sjuksköterskorna uppfattade att rätt utförd triage gav patienten rätt vård på rätt vårdnivå.

La médecine d'urgence, discipline de structuration récente, a un rôle majeur dans le maillage sanitaire français. Par ses missions primordiales, ni son rôle, ni sa place ne sauraient être aujourd’hui remis en cause. Toutefois, nombre de contingences interfèrent avec la pratique, modifiant voire perturbant l’exercice. Aussi les compétences des soignants doivent-elles être adaptées aux demandes, et adaptables, tant les conditions d’exercice s’avèrent variables. Aller à la rencontre de la personne à soigner est à la fois indispensable et aléatoire, comme soumise au hasard, semblant parfois échapper. Le fait de rencontrer l’autre relèverait-il de l’illusion, de l’irruption fortuite, ou devrait-il s’intégrer comme une mission, voire une responsabilité à part entière de cette médecine à la temporalité brève ? Le questionnement éthique ainsi dégagé, l’expérience personnelle en tant qu’urgentiste a constitué le socle de cette recherche. Au cours de notre réflexion, des sources philosophiques, sociologiques, romanesques nous ont permis de soutenir et d’illustrer le propos. L’analyse concrète et factuelle des paramètres généraux de la médecine d’urgence intra-hospitalière s’est avérée incontournable, afin d’en percevoir l’impact potentiel sur ce que nous appelons la rencontre. Au fil de cette étude, la perspective de la rencontre ne pouvait s’envisager que dans une autre voie : s’extraire du fatalisme inhérent aux conditions de l’exercice d’urgentiste, s’écarter du déroulé des soins.Ce basculement éthique s’est imposé ayant pour effet de se réapproprier le soin à l’autre et ainsi de replacer la question de la véritable rencontre dans une perspective éthique. L’intersubjectivité entre le malade et le soignant, en urgence et aux urgences, oblige le soignant à se questionner sur sa propre fonction. Dans ce cadre, la dimension de l’utile devient un possible vecteur de la rencontre, comme support éthique à part entière. Le soignant serait-il utile du seul fait de son métier, de son action et/ou en lui-même ? Enfin, le mouvement irréfragable vers l’autre en tant que personne à soigner, impose une sorte de transcendance que concrétise la promesse. Au-delà du contrat initial qu’est la promesse des meilleurs soins, une sorte de nouvelle promesse a fait jour : se promettre avant tout d’aller à la rencontre de l’autre comme premier mouvement. Cet engagement émerge comme la condition première, même et surtout en urgence, permettant de se réaliser comme soignant et d’être au cœur de sa fonction. / Although a relatively new medical specialty, Emergency Medicine has become an established and indispensable discipline within the French health care system given that its role and play are no longer questionable. However, many contingencies interfere with the practice, modifying or even disturbing healthcare results and impact. Therefore, the role of the emergency medicine physician is evolving based upon expectations of the health care system and individual patients.As it also depends on chance, the individual patient encounter in this context is mostly unpredictable and may be chaotic, and sometimes seems almost impossible to achieve. How can the physician render order out of chaos such that a high quality of care can be delivered despite chaotic work conditions? Is patient encounter a delusion, an unpredictable opportunity, or should it be anticipated as in a working plan, and even, should it be considered the full responsibility for this short-reaction-time medicine? The ethical questioning thus identified, using my experience as an emergency physician to better define the physician’s role in the emergency department has constituted the mainstay of this research project. During our reflection, diverse philosophical, sociological, and fictional sources have allowed us to support and convey our point. Realistic and factual analysis of the main features of in-hospital emergency medicine has proved to be a critical step in order to unveil the impact of this specific environment where the patient encounter takes place. Throughout the dissertation, we attempt to envision the patient’s encounter from another perspective: standing aside the course of care for questioning the caregiver's attitude, which is usually fatalistic in the practice of emergency medicine. Indeed, in emergencies and the emergency room, patient and caregiver intersubjectivity mandate the caregiver to explore his/her mission.This ethical shift facilitates a qualitative analysis of physician-patient interactions to define better the scope of the emergency physician’s role and the variables that define physician resiliency. Within this framework, the dimension of utility becomes a potential carrier of the encounter, like full ethical support. Indeed, would caregiver's utility be supported by his/her mission, his/her actions or by him/herself? Lastly, the irrepressible move toward the patient requires a transcendental approach to fulfill the commitment. Then it appears that beyond the initial contract, which is the promise of the best care, a new commitment arises: first and foremost, seeking out the encounter with the patient. Even and especially in emergencies, this commitment is critical as it permits the healthcare professional to emerge at the very heart of his/her mission.

Background Pneumonia, diarrhoea and perinatal factors are the foremost killers of South African children as in other low- and middle-income countries. Poverty, poor access to care and pre-hospital care are reported major pre-hospital factors and lack of triage, poor skills, delays, poor adherence to treatment protocols and inadequate emergency care determining mortality have been reported to increase in-hospital mortality. Objectives To describe the clinical presentation and management of children admitted via the medical emergency unit (MEU) of the Red Cross War Memorial Children's Hospital (RCWMCH) who subsequently died. Methods We did a retrospective study undertaking a cross-sectional review of children who died following admission via RCWMCH MEU in 2008. Demographic information, clinical data, time factors and mortality data were reviewed and summarised by descriptive and inferential statistics. The unit utilised the WHO Emergency Triage Assessment and Treatment (ETAT) triage tool, categorising children into Red (emergency), orange (priority) and Green (non-urgent). Patient management was assessed by means of ETAT and the Integrated Management of Childhood Illness (IMCI) tools, which is used to identify severity of illness and strategize treatment plans accordingly. Results A total of 135 children met the inclusion criteria. The crude mortality rate was of 6.25 per 1000 admissions. Of the 135 children who died, 119 (88%) were under five years of age, 33(24%) were HIV-infected, of whom (88%) were under 5 years old. In 67 (50%), a chronic medical condition could be identified while 67 (50 %) were moderately or severely malnourished. There were 29 (22%) deaths within 24 hours of arrival at the MEU. Fifty-five (41%) presented after hours. Community health centres referred 65 (48%) patients, general practitioners referred 20 (15%) and 38 (28%) were self-referred. Ambulance services provided pre-hospital transport to 69 (51%). The two top presenting illnesses in 88 (65%) of the children were acute respiratory illness and acute gastroenteritis. Prior to referral, oxygen was not provided in 57 (59%) children, 35 (71%) with suspected sepsis did not receive antibiotics and glucose was not checked in 39 (80%) with depressed level of consciousness. The median time to ward transfer was 3.23 (IQR: 2.12-4.92) hours. Twelve deaths (9%) occurred in the MEU, 57 (42%) in PICU, 56 (42%) in medical wards and 10 (7%) in specialist wards. The five most common causes of death were acute respiratory infections in 45 (33%), acute gastroenteritis in 27 (20%), septicaemia 22 (16%), meningitis in 13 (10%) and cardiac conditions in 12 (9%) children. Conclusion The top causes of mortality in this hospital cohort in 2008 were pneumonia, acute gastroenteritis, and septicaemia. Using the IMCI and ETAT standard of care, suboptimal management was identified in pre-hospital management, as well as MEU management. Appropriate training and protocol implementation to improve morbidity and mortality should be undertaken.

Yes / The aim of this study is to determine emergency nurses’ knowledge about, and perceived ability to support, people who are suicidal. A questionnaire consisting of 34 questions was sent out to 113 adult emergency nurses employed in two emergency departments. A total of 38 responded. Findings highlight differences in attitudes and show a correlation between suicide prevention training and nurses’ perceived competence to triage people who are suicidal. The article makes recommendations for future research, as well as nurse education and training on suicide prevention, to improve attitudes and increase emergency nurses’ ability to respond effectively to people who are suicidal.

Antalet besökare på akutmottagningar ökar runt om i landet och arbetsförhållandena för vårdpersonalen blir allt sämre. Triagesystemet används för att kunna sortera och prioritera akut sjuka patienter som är i behov av att omedelbart träffa läkare för bedömning. Den stora majoriteten av patienter som söker vård på en akutmottagning har dock inte livshotande tillstånd. De har således en lägre prioritering och står på så sätt inför en komplicerad situation med bristande information, okunskap och långa väntetider. Syftet med studien är att beskriva hur patienten upplever vården på en akutmottagning. Metoden författarna har valt att använda är litteraturstudie enligt Axelsons modell. Studien behandlar nio artiklar. De valda artiklarnas resultat sammanställs och bildar tillsammans teman och subteman i syfte att skapa en ny helhetsbild. I Resultat framkommer det att patienter upplever triageringen som positiv men att den efterföljande vården, med bland annat långa väntetider, bristande information och avsaknad av delaktighet, bidrar till en otrygg och frustrerande upplevelse för patienter av vården på en akutmottagning. Diskussionen belyser patientens upplevelse av triageringen och hur det kommer sig att just detta möte beskrivs som positivt av patienter. Vidare diskuteras den bristande informationen patienter upplever på akutmottagningar och hur detta påverkar patienten.

Student Number : 9512861R - MA research report - School of Psychology - Faculty of Humanities / The present study served to investigate the way in which continuous exposure to potentially traumatic incidents impacts on the South African Emergency Care Practitioner (ECP). The study sought to investigate the presence of symptoms of posttraumatic stress (PTS) in the sample and the events which appear to pose the greatest threat to these ECPs’ mental health. The notion that individuals exposed to the same traumatic stressors can present with very different posttraumatic responses has led to the acknowledgement that the relationship between exposure and PTS is a complex one. Studies have examined a multitude of variables believed to impact in some way on this relationship, with particular emphasis on individual appraisals and coping styles. Less attention has been afforded the role of social phenomena in the development of posttraumatic stress disorder (PTSD). The attention that has been afforded these phenomena has tended to examine social support as a unidimensional construct, and studies have often measured different social support conceptualisations. Utilising a recognised psychosocial framework, the present study sought to investigate the impact of social support in the relationship between exposure and PTS. It sought to examine three distinct facets of social support, namely: the appraisal of being supported, the perception of available supportive behaviours from family and friends, and an individual’s orientation towards utilising support. The study used a cross-sectional, correlational design to investigate the relationships between exposure, PTSD symptoms and social support. The procedure involved the anonymous completion of several standardised self-report measures by 107 ECPs from Netcare 911, a private South African emergency care organisation. These measures included a revised version of the Paramedic Work Exposure Checklist (PWEC), the Revised Impact of Event Scale (RIES), the Social Support Appraisals Scale (SS-A), the Social Support Behaviours Scale (SS-B) and the Network Orientation Scale (NOS). The events that tended to be rated as having the most negative emotional impact among respondents involved assisting abused or injured children, witnessing the death or injury of a coworker, assisting victims of sexual assault, dealing with equipment failure or the incompetence of others and receiving inadequate or incorrect information when dispatched on a call. The correlational analyses revealed that exposure to events rated as having a negative emotional impact was significantly and positively associated with symptoms of PTSD in the sample. Correlational analyses also revealed that each of the facets of social support measured was significantly negatively associated with symptoms of PTSD. The results indicate that the mode and source of support most significantly associated with symptoms of PTSD in the sample was the perception of available emotional support from friends. In spite of the direct relationships observed between symptoms of PTSD and the facets of social support examined, none of the social support facets investigated emerged as a significant buffer in the relationship between exposure and PTSD. The study highlights the need for additional research, including longitudinal investigation, into the role of multiple facets of social support in the relationship between exposure and PTSD. Some suggestions for future research and the practical application of the findings of the research are offered.