ES consolidation propose significant net gains for the Marine Corps.

Study objective: The aim of this study was to describe and analyse the success of endotracheal tube (ETT) placement when performed by paramedics in the out-of-hospital setting in Johannesburg, South Africa. Design: A prospective, observational study design with a consecutive convenience sample was used to analyse the prevalence of unrecognised mal-positioned ETTs by ALS paramedics. Setting: The ETT position was evaluated by the receiving medical practitioner in patients arriving at eight different urban, public and private, Johannesburg emergency departments (EDs) after being intubated by paramedics from multiple, both public and private – emergency medical services (EMS) agencies out-of-hospital. The study is set in a developing context where EMS systems vary considerably in terms of clinical governance, paramedic experience and qualification, and resources. Patients: All patients who arrived at Johannesburg EDs who had been intubated by paramedics out-of-hospital regardless of indication, aetiology or age, were included in the convenience sample. Methods: The main outcome measure was the unrecognized misplaced intubation rate which was recorded via routine methods by the receiving medical practitioner immediately upon arrival of the intubated patient at the ED. Findings were compared with international values. The use of endotracheal intubation confirmatory devices, both by paramedics and ED medical practitioners, was also reported. Main results: Of the 100 patients who were intubated out-of-hospital, 2 (2%; 95 CI 0.4% – 7.7%, p < 0.0001) arrived with unrecognised oesophageal ETT misplacements, and the ETT cuff was found to be in the pharynx, above the vocal cords in 1% of the sample. Thus, unrecognised mal-positioned intubations were detected in a total of 3 of 100 cases (3%; 95 CI 0.8% – 9.2%, p < 0.0001). Right main bronchus positioning occurred in 9 (9%) of cases. Paramedics reported the use of auscultation of the chest and stomach in 98% of the sample to confirm ETT placement, direct laryngoscopy in 22%, end-tidal carbon dioxide detection (ETCO2) in 19%, and pulse oximetry in 12% of patients. None of the misplaced ETTs had ETCO2 verification used out-of-hospital. ETT confirmation strategies by ED medical practitioners included auscultation of the chest and stomach in 97% of cases, direct laryngoscopy in 33%, and use of capnography to detect ETCO2 in only 4% of out-of-hospital intubated patients. Conclusions: This, the first known study to evaluate endotracheal intubation placement by EMS personnel in South Africa, found an overall 3% rate of misplaced ETTs (2 oesophageal and 1 hypopharyngeal), similar to several previous investigations, and much less than earlier studies. The findings of this study have important implications for South African EMS policy and practice. Based on the findings of this study, it seems reasonable to recommend that in a resource-limited, developing country where expensive ETCO2 is not readily available, the out-of-hospital ETT position should, at very least, be confirmed via auscultation, direct laryngoscopy and subjective clinical methods. Despite showing a statistically significant reduction in ETT misplacement rates when compared to international studies in similar settings, the results of this Johannesburg study are alarming and cause for concern, since any misplacement of an ETT in a critically ill or injured patient is calamitous with the potential for increased morbidity and mortality.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in the field of Emergency Medicine Johannesburg 2011 / The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) has a trauma unit which consists of the emergency treatment / resuscitation area, an Intensive Care unit (ICU) and a trauma ward. For non-trauma surgical admissions, a different management system is in place. There is a general medical emergency area where surgical patients are triaged and assessed then sent on for admission to the wards and / or operation as required. Currently the structures described necessitate a total of at least 4 medical officers and 2 registrars on duty in the hospital in addition to consultants and other staff on call from home. The potential exists for the unacceptably frequent rostering of doctors on call and therefore in terms of total hours worked by each. With a view to optimising the existing human resources and improving the quality of patient care by reducing the number of working hours of the doctors, an audit of the surgical workload inclusive of trauma at CMJAH was undertaken. The number of admissions and operations, both elective and emergency, were captured, for the trauma unit and three surgical wards at CMJAH for the 2009 calendar year. Total emergency admissions to all four wards combined were 13032 of which 86.1% were trauma admissions. An average of 15 patients per week (sometimes many more) were operated in the trauma unit. The burden of trauma is extremely heavy compared to that of the other surgical units. An important suggestion would be to look at restructuring the existing resources into a more organised system of practice such as an Acute Care Surgery Unit thus optimising both emergency and non-emergency care of surgical patients.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg In partial fulfillment the requirements for the degree of Master of Science in Nursing Johannesburg, 2017 / Background: Continuity of quality care and patient safety depends mainly on the effective handover. Gaps in communication might lead to omissions of vital information affecting continuity and safety of care and leading to negative consequences and sentinel events. Purpose: The aim of this study was to describe the opinions of nurses regarding the effectiveness of handover practices between nurses in the Emergency Departments and Intensive Care Units in an academic hospital in Johannesburg using a handover rating tool. The recommendations for clinical practice and education were provided thereafter. Method: A descriptive quantitative cross sectional survey was used. Convenience sampling was used. A sample size of hundred and eleven handovers (n=111) was used. Data was collected using a 16 item handover evaluation tool developed by Manser et al. (2010). The handover rating tool is divided into two sections. The first section was the demographic data, the second section asks about the information transfer, shared understanding, working atmosphere, overall handover assessment and circumstances of handover. Data analysis was done by means of descriptive and non parametric statistics using graphs, frequency distributions, medians and interquartile ranges, Wilcoxon rank sum and logistic regression. Testing was done at the 0.05 level of significance. Results: A higher level of qualification and years of experience in trauma and Intensive Care Unit were significant factors related to information transfer, shared understanding and overall handover quality. Univariate ordinal model showed statistical that respondents handing over were more likely to agree with information transfer, shared understanding, working atmosphere, overall handover quality and circumstances of handover compared with those receiving. Univariate ordinal model showed statistical difference that non specialist handing over were likely to agree to overall handover quality whereas multivariate ordinal model also showed statistical difference that non specialist handing over were likely to agree with circumstances of handover. The study suggests that it is necessary for ED and ICU nurses to have an agreement on the content of the structured handover framework as different specialists have different expectations. / MT2017

Thesis--University of Florida. / Description based on print version record. Typescript. Vita. Bibliography: leaves 152-158.

Study Setting: Two rural Indonesian districts served by the national midwife-in-the-village programme. Methods: Three critical incident audits of maternal mortality and severe morbidity: confidential enquiry, a verbal autopsy survey, and a participatory community-based review. Results: A range of inter-related factors contributed to poor quality and access. When delivery complications occurred, many women and families were un-informed, un-prepared, found care unavailable, unaffordable, and relied on traditional providers. Social health insurance was poorly promoted, inequitably distributed, complex, bureaucratic, and often led to lower quality care. Public midwives were scarce in remote areas and lacked incentives to provide care to the poor. Emergency transport was often unavailable and private transport incurred further expense. In facilities, there was reluctance to admit poor women, and ill-equipped, under-staffed wards for those accepted. Referrals between hospitals were also common. Examining adverse events from user and provider perspectives yielded multi-level causal explanations. These were used to develop a conceptual model relating structural arrangements (such as decentralisation, commodified care and reductions in public funding) to constrained service provision and adverse health consequences. Conclusions and recommendations: A policy shift towards healthcare as a public good may provide a route to reduce available maternal ill-health. Engaging with those who require and provide critical care in routine assessments can inform more robust health planning, and promote inclusion and participation in health.

The Federal Government recognizes that collaboration between the various departments and local, federal and private sector can best support maritime security. Of course the question is how to get these entities to collaborate? Collaborative technology can provide an answer to Maritime Domain Awareness (MDA) and Emergency Response collaboration, but the right tool for this mission must be selected. In order for the right tool to be selected, then the right criteria must be used to evaluate the tool for this particular mission. The criteria must not only look at the tool or the network, but the whole picture: cognitive processes, organizational structure, and the doctrine and procedures of the players involved. This thesis will focus on establishing criteria for evaluating collaborative tools in the tactical environment of MDA and Emergency Response collaboration. In this environment, an Incident Commander will need to coordinate military, coalition, federal, state, local entities, as well as non-governmental organizations. A methodology does exist that meets these criteria, the North Atlantic Treaty Organization Code of Best Practice for assessing Command and Control Systems.

Introduction and Background Trauma Casualty is an environment of constant unpredictability which has an impact on the both the casualty staff, the patient and family. Family members are usually not prepared for the sudden crisis of having a loved one injured. The Trauma Nurse therefore, has a very important role with regards to meeting the needs of the family of patients brought into the unit. The needs of family members in the Intensive Care or Critical Care setting has been extensively researched using the critical care family needs inventory (CCFNI), however very little has been researched in the setting of a trauma or emergency setting. The needs of family members in the emergency setting has been researched in Australia, but no work has been done in South Africa. There is, therefore, a need for research in this area. Purpose of the study The aim of the study was to determine the needs of family members accompanying patients into trauma casualty, in order of importance as perceived by them, and to determine if these needs are being met. Identification of needs will inform the role of the nurse with regard to holistic nursing care including care of the family of the patient. Research Method The study made use of a quantitative descriptive exploratory design. The population (n=97) included family members of patients brought into casualty. The sample size was determined in consultation with a statistician from the Medical Research Council. The inclusion Criteria incorporated family members, over the age of 18, who were willing to complete a self administered questionnaire. Family members of patients who had died in the unit were excluded. An Australian developed instrument, using a Likert Scale to categorise and quantify needs statements, was used. The tool was validated by review of a panel of experts and an inter rater agreement of 90% established. The tool was adapted for the South African context and validated on a subscale level using the Cronbach Alpha correlation test. Five major themes make up the critical care family needs inventory, these consist of “Meaning”, “Proximity”, “Communication”, “Comfort”, and “Support”. Two questionnaires were used, comprised of the same needs statements, however CCFNI-1 was used to determine the level of importance of needs statements, while CCFNI-2 sought to determine the level of satisfaction of needs met. The study setting made use of a Level 1 Trauma Casualty in a Public Tertiary Academic Hospital, in which the pilot study was conducted before data collection in the same setting. The data analysis process made use of descriptive statistics. After cleaning and coding, the data were exported to STATA statistical software for values to be calculated and interpreted. Data were analysed in three steps, namely analysis of demographic data, thematic organisation of analysed data and content analysis of open ended questions. Main Findings The main findings highlighted the importance of needs relating to the themes “Meaning” and “Communication”, while satisfaction was highest in the theme “Meaning”. A concerning finding was the low level of satisfaction with needs being met related to communication.

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No description available.