Although there is extensive literature regarding out-of-hospital use of capnography, the willingness and knowledge of South African paramedics where capnography is available for routine use is poorly understood. From informal reviews, it would appear that even when capnography is available the practitioners decided to not use the tool. Aim: To determine the knowledge of prehospital providers with respect to the use of capnography to guide decision making in the treatment of patients. Methods: A cross-sectional research-generated survey of 80 out-of-hospital advanced life support paramedic providers in South Africa working in the private industry where capnography is available. Participants will be recruited with the assistance of the company's research committee using an email platform, and consent process. The questionnaire will establish the knowledge, ability and willingness of advanced life support paramedics to identify and use capnography as part of their clinical decision making process. Descriptive statistics will be used to interpret and report the data. The study should be concluded within 6 months of receiving ethical approval from Human Research Ethics Committee of the University of Cape Town. Discussion: The findings of the study will describe a cohort of out-of-hospital practitioners' knowledge and willingness to use capnography in an environment where it is routinely available. Recommendations will be made regarding the need for further policy development and change management for the implementation of best practice.

Introduction Acute Myocardial Infarction (AMI) is a time sensitive emergency. In resource limited settings such as South Africa, prompt identification and management of these patients in the pre-hospital setting may minimise the negative consequences of an overburdened emergency medical and hospital service. Expedited care thus, in part, relies on the dispatch of appropriate pre-hospital medical providers by emergency medical dispatchers. Identification of these patients in the call centre is challenging due to a highly diverse South African society, with multiple languages, cultures, and levels of education. The aim of this study was therefore, to describe the terms used by members of the South African public when calling for an ambulance for patients suffering an AMI. Methodology In this qualitative study, we performed content analysis to identify keywords and phrases that callers used to describe patients who were experiencing an AMI. Using the patient report form number of randomly selected paramedic- diagnosed AMI cases, original voice recordings between the caller and call centre operators at the time of the emergency were extracted and transcribed verbatim. Descriptors of AMI were identified, coded and categorised using content analysis, and quantified. Results Of the 50 randomly selected calls analysed, 5 were not conducted in English. The descriptors (meaning units) used by callers were and found to fall into three categories; Pain: Thorax, No pain: Thorax and Ill- health. The code that occurred most often was no pain, heart related (n=16; 23.2%), followed by the code describing pain in the chest (n=15; 21.7%). Conclusion South African callers use a consistent set of descriptors when requesting an ambulance for a patient experiencing an AMI. The most common of these are non- pain descriptors related to the heart (“heart attack”). These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time- critical patients and prevent the dispatching of resource limited advanced life support paramedics to inappropriate cases.

Background and aim Inefficient storage and sourcing of routinely required consumables located on procedure trolleys results in time wasted when preparing for common procedures in Emergency Centres, contributing to poor efficiency and quality of care. We designed a novel purpose-orientated procedure trolley, and evaluated its impact on time spent on procedure preparation and efficiency. Methods In an urban emergency centre, eight participants were measured each day over 24 days, once using the contemporary setup and once using the modified procedure setup. During each simulation, efficiency markers were assessed (time spent on procedure preparation, steps taken, stops made, and amount of time participants had to open a drawer to locate required items). Results The mean time required to collect the required items for IV cannulation and blood sampling from the purpose-orientated trolley was 22.7 seconds(s) (SD = 3.66) compared to 49.2 s (SD = 15.45) using the contemporary trolley. There was a significant difference in mean collection time between the two trolleys (p < 0.0005). There was a significant difference (p-value < 0.0005) in all the other categories: steps taken, stops made, and drawer opening. Conclusion In our setting, stocking procedure trolleys in a purpose-orientated manner has the potential to improve efficiency by reducing time spent on procedure preparation.

Includes abstract. / Includes bibliographical references (leaves 35-37). / The aim of this study is to assess whether ECG interpretation improves with advancing years of Emergency Medicine training in South Africa, and to compare the results with similar international studies. A prospective cross-sectional study of Emergency Medicine registrars and recently qualified emergency physicians was conducted between August 2008 and February 2009 during training sessions at various universities through South Africa. Subjects completed a survey about level of training and experience, previous ECG training and their impression of the current training program and how it could be improved. They were then asked to interpret 10 clinically important ECGs. The trainees in their first and second years of emergency medicine training were compared to their more senior counterparts (third to fifth years).

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.