Introduction The benefits of family presence during adult resuscitation (FPDR) are well documented in the literature. However, despite apparent value, FPDR is not always practised. The purpose of this study was to evaluate the perceptions of Emergency Medicine physicians and specialist trainees regarding FPDR in South African public sector Emergency Centres. Method A descriptive study was undertaken, using an electronic survey which consisted of both open and closed-end questions. The Survey was distributed via email to 157 Emergency Medicine physicians and specialist trainees in South Africa. The data was collected and subjected to descriptive statistical analysis. Results Most South African Emergency Medicine physicians and trainees did not feel that FPDR interrupted patient care; did not feel it hindered the teams’ productivity; and did not believe it increases complaints about the quality of patient care. Despite this, practice of FPDR was found to be uncommon. Knowledge regarding FPDR guidelines was poor. Discussion The views of South African Emergency Medicine physicians and specialist trainees regarding FPDR is in keeping with other pro-FPDR countries. However, these views do not seem to translate into practice. FPDR education and development of local guidelines are recommended.

Background: Calling an ambulance is the first line for citizens in dealing with many healthcare emergencies. It is crucial for the caller to convey correct information regarding the patient’s emergency and on-scene location to the emergency services, resulting in prompt dispatch of correct emergency resources to the exact location. Although there is a good deal of focus on emergency medicine time parameters and outcomes, little is known about the experiences, perceptions and satisfaction level from those who have accessed pre-hospital Emergency Medical Services. Methods: A telephonic survey was conducted on individuals who had recently called for an ambulance, from the urban township of Langa, Cape Town. Surveys were conducted in the caller’s home language, using a standardized tool for collecting quantitative data around the call process, caller satisfaction, outcomes of the call, and issues experienced. Results: During June 2018, 50 callers completed the survey (69% response rate). Most callers (88%) used a personal mobile phone, and 83% called predominantly for medical problems in the daytime. Callers accessed the service by dialling a variety of emergency phone numbers. Callers were largely satisfied with the call (66%), and there were fewer language mismatches than expected. A need for better communication regarding ambulance status and over the phone medical advice was identified. A substantial number of inconsistencies were reported between callers’ outcomes and those from emergency communication centre which require further analysis. These inconsistencies, pointed into gaps within the emergency communication centre’s collecting and database system Conclusion: The study provided the first insight into pre-hospital emergency caller experiences and perceptions, highlighting important aspects perhaps not revealed through other metrics. Measurement of caller satisfaction can be a useful quality improvement tool, and would seem feasible without substantial resources. Further investigation into data capturing system and identification of call outcomes are recommended.

Introduction: Emergency medical services (EMS) who attend to natural disasters are at a high risk of experiencing numerous psychological and physical conditions that adversely affect their health and safety as well as their ability to serve their purpose. This study aimed to identify factors that affect EMS responders' health and safety in natural disasters and provide information to mitigate harm in future natural disasters. Methods: A scoping review was conducted to identify literature published between 2000 and 2020 relating to EMS responder safety in natural disasters according to a predetermined search strategy. Titles and abstracts were first screened, whereafter full texts were reviewed and extracted. Results: In total, 49 articles were identified and 22 articles were ultimately included. The findings from the research identified numerous factors and outcomes that affect the health and safety of responders attending to disasters. These could be categorised into mental and psychological issues (PTSD, suicidal ideation, depression) and physical issues (environmental, infectious, and traumatic conditions). Conclusion: Numerous health and safety hazards befall responders attending to natural disasters and the variability of their incidence commands case-specific prevention and mitigation strategies. There is poor monitoring of factors affecting the health and safety of responders as well as their consequences, making current mitigation and prevention strategies ineffective. Enhanced surveillance and reporting systems should be developed and implemented to inform and improve mitigation strategies.

Background: The objective of this study is to evaluate the emergency and disaster preparedness of military hospital emergency services, and to further, identify strategies for improvement in disaster preparedness and response. Saudi Arabia is prone to various man-made and natural disasters. Among these is the event of the annual pilgrimage termed Hajj, which annually presents the risk of overcrowding. Many of these disasters have resulted in mass casualties. Consequently, there has been increased emphasis on planning by disaster experts to establish and maintain an organized preparation for a wide range of emergencies. Emergency Medical Services (EMS) play a vital role in disaster management. Both pre-hospital EMS and in hospital emergency services are considered inefficient and inadequately prepared in disaster response and management. Most importantly, there is limited data on emergency care (EMS and hospital-based) disaster preparedness and responses in Saudi Arabia. Methods: We undertook a prospective cross-sectional, descriptive survey-based assessment of disaster preparedness. The research focused on collecting and analysing data through quantitative methods. To review the standard operating procedures (SOP), we sought all disaster plans and SOPs from management and emergency unit leadership at each of the 3 Medical Services Directorate (MSD) hospitals. We then undertook a questionnaire assessment, gathering quantitative data using close-ended questions and open-ended commentary surrounding a hospital's disaster response operating procedures. Results: We found a wide variability in the hospitals across the 22 themes in the survey. Most hospital emergency units have a good to excellent disaster plan. There were, however, concerns with the departmental standards with Radiology, Occupational Health, Critical Care, Respiratory Therapy, Pastoral Counselling, and provision made for the preservation of forensic evidence. Internal traffic flow and control issues presented relate to elevators manned and its prioritized usage. It is found that the area demarcated for media liaison needs improvement. Reception of casualties also needs attention and finally, relocation of patients and staff needs prioritisation. Conclusion: The study has highlighted several strengths in facility disaster preparedness and further shared the need for rigorous efforts required to improve the situation at some facilities. In general, most hospitals were found to have a good disaster management plan in place, however, a few covered all the recommended areas in sufficient detail.

Background Psychiatric boarding in Emergency Departments is a global challenge. Patients with mental and behavioural disturbances are disproportionally affected with boarding times up to three times longer than other patients. This retrospective cross-sectional study investigated the impact of an initiative to reduce psychiatric boarding on length of stay and readmission rate, as well as exploring the relationship between boarding times and length of stay. Methods All adult patients referred over a 24-month period (June 2017 – May 2019) for psychiatric admission from the Emergency Department of a Cape Town district hospital were included. This included a 9-month period prior to the initiative, after which inpatient capacity was increased, and inpatient hallway boarding was implemented. Data relating to admission processes and outcomes were extracted from electronic registries. Results In total, 2607 patients were referred for psychiatric admission (2.7% of all Emergency Department patients). The initiative was associated with a decrease of 95% (56 vs 3 hours, p24-hour boarding category (351 vs 360 hours, p=0.047). The readmission rate increased from 12% to 18% post intervention. Conclusion A significant improvement in hospital length of stay and psychiatric boarding times occurred after the initiative was implemented. The benefits should be weighed up against a subsequent higher readmission rate. From a lean- and economical perspective, the results of this study suggest that psychiatric boarding equates to waste as it is independent of ward length of stay. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended.

Introduction:Evidence based medicine is the standard of modern health care practices. Ongoing biomedical research is needed to expand existing knowledge and improve quality of care, but it needs to reach clinicians to drive change. Journal articles and conference presentations are dissemination tools. The aim of the study was to establish the publication rate of scientific abstracts presented at the first and second African Conference of Emergency Medicine. The secondary objectives were establishing nonpublication dissemination and the factors associated with publication and non-publication. Determining non-publication dissemination patterns and the factors associated with reasons for publishing or non-publication were also investigated. Methods:Presenters of the 129 scientific abstracts from the first and second African Conference of Emergency Medicine were invited to participate in an online survey. The survey was followed by a manual literature search to identify published manuscripts of authors that did not complete the survey, to determine the most accurate publication rate. Results:Thirty-one presenters responded (24%), of which 18 published in a peer-reviewed journal. An additional 25 publications were identified by the literature search. The overall publication rate was 33.3% (26.9% from 2012 and 40.3% from 2014). Oral presentations were more likely to be published (p=0.09). Sixteen manuscripts (37.2%) were published in the African Journal of Emergency Medicine. Presentations at local academic meetings were the most used platform beyond publication (43%). The main reason to publish was to add to the body of knowledge (100%), while lack of time (57%) was the major obstacle for not publishing.Conclusion:The overall publication rate for the first and second Africa Conferences of Emergency Medicine iscomparable to other non-African Emergency Medicine conferences. The increasing publication trendbetween conferences might reflect the development of regional research capacity. EmergencyMedicine providers in Africa need to be encouraged to participate in high quality, locally relevant research and to distribute those findings through accessible formats.

Includes bibliographical references / To date, health facilities in Africa have not had an objective measurement tool for evaluating essential emergency service provision. One major obstacle is the lack of consensus on a standardized evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine has developed an assessment tool, specifically for low- and middle-income countries, via consensus process that assesses provision of key medical interventions. These interventions are referred to as essential emergency signal functions. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. These are evaluated for the six specific clinical syndromes, regardless of aetiology, that occur prior to death: respiratory failure, shock, altered mental status, severe pain, trauma, and maternal health. These clinical syndromes are referred to as sentinel conditions. This study used the items deemed "essential", developed by consensus of 130 experts at the African Federation for Emergency Medicine Consensus Conference 2013, to develop a tool, the Emergency Care Assessment Tool (ECAT), incorporating these using signal functions for the specific emergency sentinel conditions. The tool was administered in a variety of settings to allow for the necessary refinement and context modifications before and after administering in each country. Four countries were chosen: Cameroon, Uganda, Egypt, and Botswana, to represent West/Central, East, North, and Southern Africa respectively. To enhance effectiveness, ECAT was used in varying facility levels with different health care providers in each country. This pilot precedes validation studies and future expansive roll out throughout the region.

Prolonged seizures are a medical emergency and require immediate treatment to prevent complications. Benzodiazepines (BDZ's) are integral to acute seizure management. The most commonly used BDZs are Lorazepam, Diazepam and Midazolam. Lorazepam is often perceived as the superior choice but recent studies have challenged this but results appear inconclusive and contradictory. This study aims to consolidate the available literature and formulate recommendations for the use of BDZs in the emergency setting for children. Methods A rapid review methodology with a tiered approach was used. This approach uses high quality guidelines as the first tier, review of reviews (second tier) then systematic reviews and the fourth and final tier uses randomized control trials as primary data. The Australian National Health Medical Research Council's matrix for grading and developing guidelines was used to grade quality of recommendations.

Introduction - Helicopter search and rescue in Africa is conducted primarily by military organizations. Since 2002 the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial and aquatic rescue. This is the first description of the operations of an African helicopter rescue service. Objective - To describe the terrestrial and aquatic helicopter rescue activity of a civilian operated HEMS in the Western Cape, South Africa from 1 January 2012 – 31 December 2016. Methods - A five-year retrospective review was conducted using data from the organization's operational database, aviation documents, rescue reports and patient care records. Patient demographics and activity at time of rescue, temporal and geographical distribution, crewing compositions, patient injury, triage, clinical interventions and rescue techniques were analysed. Results – A total of 581 search and rescue missions were conducted, of which 451 were terrestrial and 130 aquatic rescues. The highest volume of rescues was conducted within the urban Cape Peninsula. Hoisting using a rescue harness was the most common rescue technique used. 644 patients were rescued. Uninjured or minorly injured persons represented 79% of the sample. Trauma (33%, 196/644) was the most common medical reason for rescue, with lower limb trauma predominant (15%, 90/644). The most common clinical interventions performed were intravenous access (108, 24%), spinal immobilization (92, 21%), splinting (76, 17%) and analgesia administration (58, 13%). Conclusions - The patient demographics and rescue activity described are similar to those described in high-income settings.

Introduction Adverse Events (AEs) in Helicopter Emergency Medical Services (HEMS) remains poorly reported, despite the potential for harm to occur. The Trigger Tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their Proximal Causes (PCs) in Qatar HEMS. Methods Using the Pittsburgh Adverse Event Tool (PittAETool) to identify AEs in HEMS, we retrospectively analyzed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for Triggers, AEs, and Harm per 100 patient encounters, plotted measures on Statistical Process Control (SPC) charts, and conducted a multivariate analysis to report harm associations. Results We identified 883 Triggers in 536 patients, with a rate of 1.1 Triggers per Patient Encounter, where 81.2% had Documentation Errors (n=436). An AE and Harm rate of 27.7% and 3.5% respectively was realized. The leading PC was Actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the Intervention and Medication triggers (n=16), where Deviation from Standard of Care was common (37.9%; n=11). Age and diagnosis adjusted odds was significant in the Patient Condition (6.50; 95% CI, 1.71-24.67; P= 0.01) and Interventional (11.85; 95% CI, 1.36-102.92; P= 0.03) trigger groupings, while age and diagnosis had no effect on Harm. Conclusion The TT methodology is a robust, reliable, and valid means of AE detection in the HEMS domain. Whilst an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and Documentation errors should also be addressed in future research.