The aim of this literature review was to collect and appraise literature related to curricula in critical care transportation and retrieval, pre-hospital care, and aeromedical transportation. The search strategy was twofold. Firstly peer-reviewed published literature was sourced from established platforms. Secondly, grey literature was sourced from internet sources. An assessment of reliability and validity was performed on peer-reviewed literature in the appraisal process. The results of the literature review show that there is a paucity of literature describing critical care modules of pre-hospital educational programmes in South Africa. This lack of literature has led the authors of this review to conclude that there is a potential for insufficient benchmarking and standardisation of the critical care module between universities. The results of this study could allow stakeholders to begin the process of academic standardisation. To provide a comprehensive background on the field of critical care transportation and retrieval and specifically education and training, this literature review starts by describing the field locally. It then attempts to outline the risks associated with critical care retrieval and thereby demonstrating the importance of quality education and regulation that can guide practitioners who perform retrievals. It then seeks to understand the importance of standardsetting within education broadly and the role of curricula in standard-setting. Finally, it provides an overview of methods for comparing curricula. After the background sections, the gathered literature was grouped into themes according to the types of curricula included in the literature. All these types of curricula form part of the critical care transportation and retrieval field, as graduates from these programmes are usually involved in the transportation of critically ill patients between facilities.

Includes abstract. Includes bibliographical references (leaves 67-72).

Background: The emergency centre (EC) is a vibrant and challenging environment from both an operational and clinical perspective. Emergency centre crowding has been referred to as one of the biggest challenges confronting policy-makers, emergency healthcare professionals (including physicians and nursing staff) and their patients globally. Elsewhere, EC crowding has been thoroughly studied. Resource restrictions render more detailed flow studies less achievable locally. Anecdotally, our local ECs are perceived to be fairly crowded. This study aimed to describe the EC crowd at Khayelitsha hospital by establishing the number and different categories of people at predefined times during the day over a four week period. Method: A prospective, cross-sectional, design was used. Headcounts were made by predefined groups at 09:00, 14:00 and 21:00 every day for four weeks. Predefined groups included doctors, nurses, visitors, patients, and other allied health staff. Summary statistics were used to describe the data and precision were described using the 95% confidence interval. Results: There were 37, 34 and 27 different people categories found in the EC during the three different shifts respectively. A total of 16353 people were counted during the study period. On average 6370 (39%) of the groups were staff, 5231 (32%) were patients and 4752 (29%) were visitors. Of the staff, 1488 (9%) were EC nurses, 733 (4.4%) were non-EC doctors, 586 (3.6%) were EC doctors, and 445 (3%) were non-EC nurses. The EC was consistently crowded – average occupancy: 130%. Notably, Mondays had the highest occupancy of 144% and Sundays had the lowest of 130%. Conclusion: Describing the people categories that contribute to the EC crowd in a low-to-middle income setting may provide a uniform template in defining EC crowding. In our study, we can conclude that the main findings were: Staff levels fluctuated predictably with less staff at night and over weekends whilst patients remained constant. Non-EC doctors more than doubled during the day on week shifts, in significantly more numbers than EC doctors, suggesting that many of the patients in the EC were likely to be admissions without a place to be admitted to. Although clinical staff numbers did not reduce during the busiest visitor times (afternoons), given the huge amount of crowding at this time care was likely to suffer. Further research is recommended to describe the findings in more detail including some of the limitations mentioned in this thesis.

Includes abstract. Includes bibliographical references.

Background Emergency centres (ECs) serve as a main entry point for patients into hospitals, and patients that present here are undifferentiated with varying levels of acuity. Uncertainty, interruptions, multiple – often conflicting – priorities, and gaps in information flow are inherent to EC work practices, making it a high-risk environment for operational failure. The EC team, the core of which is formed by doctors and nurses, needs the ability to collaboratively and reliably sense and respond to the constant change and flux of information. This depends on the interactions and sense-making of the EC team. Objectives People give meaning to situations through the process of sense-making; they then subjectively construct their reality and share it via plausible stories regarding their situation and environment. The main objective of this study was to explore the collective team-based sense-making of the operational challenges and decisions within the EC. This interprofessionalstudy focused on the dynamics and negotiations within the EC as a complex adaptive system. Methods This exploratory study used narrative-based inquiry with abductive reasoning to meet the objectives. It was divided into two sections. The first was a thick description of the EC context, daily operations and processes. Then, using the SenseMaker® tool, we captured stories about a situation that stood out to participants, and thus mattered to them. Using this novel method, once they told their story, the storytellers self-analysed their stories within a specially designed framework. The results were then explored to find patterns based on the perspectives of sense-making. Results There is no proof of interprofessional sense-making in the EC, and if it occurs it is due to the informal networks between doctors and nurses, and despite formal structure. There is an operational disconnect between doctors, nurses and management, which is caused by information asymmetry, poor feedback loops and disparate communication channels. Because there is no collective sense-making, the EC team is vulnerable to operational failure and crises. Currently, they respond to operational challenges via quick fixes that result in constant firefighting, the impact of which could be seen by the extensive use of war-related metaphors in their stories.

Includes bibliographical references (leaves 74-77). / The aims of this study were to describe procedural sedation practice in EDs, with specific emphasis on facilities for PS, characteristics of clinicians performing PS, monitoring equipment and personnel, drug regimes, complications and clinician satisfaction with present PS practice. A second aim was to propose evidence-based protocols for the use of PS for those EDs where current practices are found to be outdated and not evidence based.

Includes abstract. / Includes bibliographical references. / The aim of this study is: to determine whether Emergency Physicians have knowledge to optimally mechanically ventilate the intubated patient.

Background: An understanding of pregnancy related morbidity (obstetric near miss) provides valuable information that can be used in reduction of maternal mortality. This study aims to (i) Describe the prevalence and short term outcomes of obstetric near misses (ii) Evaluate the level of care through comparative analysis of obstetric near misses and maternal mortality in Kagadi district hospital, Uganda Methods: A facility based retrospective review of obstetric near miss cases and maternal deaths that occurred between 1st January 2015 and 31st December 2015. Obstetric near miss case definition was based on disease-specific criteria including: haemorrhage, hypertensive disorders of pregnancy, dystocia, infection and anaemia. Main outcome measures included the frequency of near-miss in each disease specific group, duration of hospital stay and maternal death. Secondary outcome measures included distribution of referral categories, caesarean section rate, hysterectomy and foetal outcomes measures i.e live births, still births, abortions, neonatal deaths. A comparative analysis of obstetric near miss and maternal mortality was done to determine the maternal near miss incidence ratio (MNMR), maternal mortality ratio (MMR) and Mortality indices. The maternal near miss to mortality ratio for the period of study was calculated. Results: There were 7169 admissions to the maternity ward with 4366 deliveries, 752 near misses and 12 maternal deaths. The prevalence of maternal near misses was 10.7%. Maternal near miss and maternal mortality ratio were 177.1 per 1000 and 282 per 100,000 live births respectively. The near miss to mortality ratio was 63:1. Dystocia (69.3%) was the most common near miss event, followed by haemorrhage (19.5%), infection (5.2%), anaemia (4.5%) and hypertension (1.5%). The mortality indices were 27.3%, 4.1%, 2.9%, 2.5% and 0.2% for hypertension, haemorrhage, anaemia, infection and dystocia respectively. Most complications developed at home (46.7%) while 36.5% and 16.5% occurred at the study site and other public facilities respectively. The mean duration of hospital stay was 3.6 days. The caesarean section rate was 12% of all hospital deliveries and 6 near misses had hysterectomy. Foetal outcomes were 78.4%, 14.2%, 5.6% and 1.8% for live births, abortions, fresh still births and neonatal deaths respectively. Conclusion: There is a high occurrence of near miss events at the health facility. Dystocia is the leading cause of obstetric near miss but hypertension and haemorrhage are associated with poor maternal outcome. Although most obstetric complications develop at home, a comparative analysis of morbidity and mortality at the health facility shows substandard care. In order to improve the quality of care there is need for advocacy for hospital delivery, development evidence management based protocols and routine audit of near miss.

Includes abstract. Includes bibliographical references.

Includes bibliographical references (leaves 48-56).