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aim was to propose evidence-based protocols for the use of PS for those EDs where current practices are found to be outdated and not evidence based.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).

Includes abstract. / Includes bibliographical references. / The purpose of this study was to describe the outcomes of patients with severe traumatic brain injury managed by emergency care providers in the Cape Town Metropole.

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. The prediction of outcome in severe burns is important to aid in clinical decision making, improve scarce resource allocation and allow comparisons between different burn units. Age, burn size and the presence of inhalational injury have been determined to be the most important factors in predicting mortality. There is little published data on the outcome of severe burns in the Southern African region. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerberg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20 to 40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. A stepwise logistic regression analysis was done on the derivation cohort where age, gender, TBSA% and presence of inhalational injury were identified as significant for predicting death. A mortality prediction model is presented which was internally validated on the validation cohort. An easy to use EXCEL calculator was created to estimate the probability of death. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burn injuries within the Southern African region. Further interventions are needed to tackle this serious public health issue. A mortality prediction model is proposed for use in the burn unit, but needs external validation before being adopted into clinical practice. Further research is needed to improve data capturing in the burn unit.

Background & Objectives: Major incidents occur commonly in Uganda, but little is known about either local hazards which risk causing major incidents, or health system preparedness for such events. Understanding risk and current preparedness is the first step in improving response. Methods: We undertook a cross - sectional study across four teaching hospitals in Kampala (Mulago National Referral Hospital, Nsambya Hospital, Mengo Hospital and Lubaga Hospital). A local geographic area Hazard Vulnerability Analysis (HVA) f or each site was combined with a key informant questionnaire and standardized facility checklist within the hospitals. Data collected included status of major incident committees, operational major incident plans and facility major incident operation centres, bed capacity, equipment and supplies and staffing. The HVA assessed the human impact, impact on property and on business of the hazards as well as measures for mitigation (preparedness, internal response and external response) in place at the hospitals. Results: Only one of the four hospitals was found to have had an operational major incident plan. The designated coordinator for major incidents across all facilities was mostly a general surgeon; no funds were specifically allocated for planning .All hospitals have procedures for triage, resuscitation, stabilization and treatment. None of the facilities had officially designated a major incident committee. All the facilities had sufficient supplies for daily use but none had specifically stock piled any reserves for major incidents. All hospitals were staffed by at least a medical officer, clinical officers, nurses and a specialist with procedures for mobilizing extra staff s for major incidents. Some staffs had received some emergency care training in courses namely basic life support, advanced trauma life support, primary trauma care and emergency triage and treatment but no team had received training in major incident response. Only one hospital carried out annual simulation exercises. Incidents involving human hazards specifically bomb threats, road crash mass casualty incidents, civil disorder and epidemics posed the highest risk to all four hospitals and yet preparation and response measures were inadequate. Conclusion: Hospitals in Kampala face a wide range of hazards and frequent major incidents but despite this they remain under - prepared to respond. Large gaps were identified in as far as staffing, equipment and infrastructure.

Includes bibliographical references (leaves 45-50).

Includes abstract. / Includes bibliographical references (leaves 42-55). / The aim of my study is to directly compare the patient’s perceptions of care received in the emergency department to that of the attending physician’s. The aim is to give us better insight into how the patient experiences their care, with a view to improving the level of care offered. The study elucidates the emphasis a patient places on aspects of their care such as empathy, communication, waiting times, etc. The study was conducted at GF Jooste Emergency Department over a period of eight weeks. Patients voluntarily, and with full anonymity, filled in a short questionnaire. The attending physician did the same. Questionnaires were collected and data fed into a database, analyzed and the results interpreted.