Emergency centers, communication systems, and hospitals are essential infrastructures for emergency rescue and subsequent reconstruction activities. An investigation into the Nepal 2015 earthquake ...sequences found that the visited government offices were functioning normally 40 days after the main shock; that the local media failed to coordinate with the entire society at the beginning, but mobile phone-based communication recovered quickly; and that the hospitals in high-intensity areas were badly damaged as a result of improper design and adverse site configuration. Recommendations are proposed to enhance the aseismic capacity of structural and non-structural components using earthquake early warning and base isolation.
Background
Procedural sedation and analgesia are considered a core competency in emergency medicine as patients present to the emergency centre on an unscheduled basis, often with complex complaints ...that necessitate emergent management. Previous evidence has consistently shown that procedural sedation and analgesia in the emergency centre in the paediatric population, even the very young, are safe if appropriate monitoring is performed and appropriate medications are used. The aim of the study was to describe the indications for procedural sedation and analgesia, the fasting status of paediatric patients undergoing procedural sedation and analgesia and the complications observed during procedural sedation and analgesia in the paediatric population at a single emergency centre in Cape Town, South Africa.
Methods
A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the emergency centre and received procedural sedation and analgesia during the study period (December 2020–April 2021) were included in the study. Data was extracted from a standardised form, and simple descriptive statistics were used.
Results
A total of 113 patients (69% male) were included: 13 infants (< 1 year of age), 47 young children (1–5 years of age) and 53 older children (5–13 years of age). There was only 1 (0.9%) complication documented, which was vomiting and did not require admission. The majority of patients received ketamine (96.5%). The standardised procedural sedation and analgesia form was completed in 49.1% of cases. Indications included burns debridement (11.5%), suturing (17.7%), fracture reduction (23.9%), lumbar punctures (31.9%) and others (15.0%). The indications for procedural sedation and analgesia varied between the different age groups. The majority of patients in this study did not have their fasting status documented (68.1%), and 18.6% were not appropriately fasted as per American Society of Anaesthesiology guidelines. Despite this, there was an extremely low rate of documented complications of 0.9%.
Conclusion
The study findings are in accordance with previous international literature reporting low complication rates. Although fasting status was unknown in the majority of patients, there was an extremely low rate of documented complications and no interventions required. Safe, timely procedural sedation and analgesia with minimal pain and unnecessary suffering can become the norm in emergency medicine practice in South Africa.
The nature and scope of emergency nursing exposes nurses to a wide array of patient populations with rapidly changing and unexpected clinical conditions, sophisticated logistics and procedures. ...Hence, emergency centre (EC) nurses ought to be ready to face diverse clinical challenges and deliver care to patients in a timely cost-effective manner and with the needed competence. The current study aimed at examining the self-assessed competencies of nurses, and comparing ratings among certified emergency nurses (ENs) and general nurses (GNs) working at an EC of a tertiary hospital in Ghana.
A descriptive cross-sectional quantitative study was carried out among 109 conveniently sampled nurses. Participants evaluated their perceived competencies on a validated instrument under five domains, namely: diagnostic function (DF), administering and monitoring therapeutic interventions (AMTI), effective management of rapidly changing situations (EMRCS), organisational and work load competency (OWLC), and the helping role (HR). Descriptive and inferential data analyses were by SPSS version 25.
Participants generally had good competencies in the performance of emergency nursing procedures. Highest scores were obtained in OWLC (median score of 83.3%) while EMRCS recorded the least scores (median score of 57.9%). With the exception of the DF domain (p = 0.166), ENs perceived themselves as significantly more competent than their counterpart GNs in 4 (OWLC, HR, AMTI, EMRCS) out of the five studied domains (p < 0.05).
Specialist training enhances nurses' perceived competences in emergency nursing procedures. This reiterates the need for regular theory and practice-based education for GNs on intermediate and advanced procedures as they prepare to enrol in specialist programmes. As nurses take on expanded professional roles in this emerging nursing specialty in low- and middle-income countries, it is important the needed capacity is developed to adequately address the needs of patients and families that require services in ECs.
Cerebrovascular disease remains one of the leading causes of morbidity and mortality globally. In South Africa, it was the fourth leading cause of death in 2016, responsible for 5.1% of all deaths - ...the leading cause of death in individuals 65 years and older. Atrial fibrillation accounts for 15% of all strokes and 25% are diagnosed when patients present with a stroke. We set out to determine the prevalence of atrial fibrillation in patients with confirmed ischaemic strokes in a district level hospital in the Western Cape, South Africa.
This descriptive study was conducted at Mitchells Plain Hospital in Cape Town and data was collected over a one-year period. Patients diagnosed with a stroke were identified from an electronic patient register and relevant radiology and clinical data were sourced retrospectively. The diagnosis of ischaemic stroke was confirmed by a CT scan report and ECGs were independently screened by two Emergency Physicians. Ethical approval was granted by the University of Cape Town Human Research Ethics Committee 790/2018.
The proportion of adult patients with a stroke diagnosis was 2%. Of the included cases, 80% had ischaemic strokes and 11% had haemorrhagic strokes. 11% of all patients with ischaemic strokes had atrial fibrillation, 67% of those presumed new. A total of 60 (15%) of all patients with ischaemic stroke were aged 45 years or younger. The inpatient mortality rate was statistically higher in patients who had atrial fibrillation (26% vs 7%, p < 0.001).
With the increasing population life expectancy, and prevalence of cardiovascular disease the prevalence of atrial fibrillation and its complications will increase. Since the risk of stroke related to atrial fibrillation can be reduced significantly by oral anticoagulation, further studies should aim to explore barriers and challenges to effective screening.
High-acuity patients are typically transported directly to the emergency centre via ambulance by trained prehospital care providers. As such, the emergency centre becomes the first of many physical ...transition points for patients, where a change of care provider (or handover) takes place. The aim of this study was to describe the variables perceived to be important during patient handover by a cohort of South African prehospital care providers.
A purpose-designed questionnaire was used to gather data related to prehospital emergency care provider opinions on the importance of certain patient variables.
We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%) ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important, followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations and patient allergies.
This study has provided some interesting results related to which handover elements prehospital care providers consider as most important to include in handover. More research is required to correlate these findings with the opinions of emergency centre staff.
•There is a paucity of literature related to handover within the African context.•Adverse events as a result of poor handover have a significant cost implication that healthcare systems can ill-afford.•Identification of the importance of handover variables in emergency centre handover have the potential to improve handover.
•Little is known about triage in the private health-care setting in the UAE.•Emergency centre presentations in this setting are typically less serious.•Triage nurses agree on urgent but not on ...non-urgent patient presentations.•Using internationally validated triage systems in this setting is not appropriate.
To measure and compare the reliability and validity of three international triage systems (CTAS, MTS and ESI) when applied to patient presentations in the emergency centres of a private health-care group in the United Arab Emirates.
The ability of triage systems to sort patients into categories based on the urgency of their need and time to physician is a key indicator. Three international triage systems are being used for this purpose in private emergency centre settings.
Bespoke reference scenarios, 50 vignettes (10 per severity level) were created and validated by a local expert panel. Nurses performing triage at four emergency centres in the Emirate of Dubai completed online surveys to categorise the vignettes based on the triage system they used in their emergency centre.
Overall inter-rater reliability per triage category was substantial for allocations in category one, moderate for those in categories two and five, and fair for those in categories three and four. Agreement between raters and the reference standard was consistent throughout all four emergency centres. The accuracy of triaging allocations into categories one, two and five were good, whereas allocations in categories three and four were less accurate.
International triage systems focus on the identification of more urgent cases and perform poorly in discriminating between those that are less serious, which is less ideal in a setting where less-serious cases are more prevalent.
The indications for cardiac point of care ultrasound (PoCUS) vary somewhat in different parts of the world, and training programs may also differ. We set out to describe the self-reported cardiac ...PoCUS indications and imaging windows used at a selection of secondary-level, public hospital emergency centres in Cape Town.
A descriptive study with prospective data collected from emergency centres of Mitchells Plain District, Victoria and New Somerset Hospitals in Cape Town were used. Data were collected over a three-month period by providers who have completed a basic emergency ultrasound course, using a purpose-designed data collection tool for all cardiac PoCUS scans.
Fifteen PoCUS providers recorded 267 data entries over the three-month study period; there were 17 exclusions, leaving 250 entries for analysis. The most common indication for performing cardiac PoCUS was electrocardiogram abnormalities, 27% (n = 112); dyspnoea, 25% (n = 102); chest pain, 16% (n = 65); cardiomegaly on chest x-ray, 12% (n = 51); new murmur, 6% (n = 23); and chest trauma, 5% (n = 22). Other indications made up the remaining 10% (n = 40). Parasternal long and short axis were the predominantly used views.
Cardiac PoCUS is used for a wide range of indications beyond the recommended training guidelines. Some indications may be more useful in low- to middle-income settings. Further research needs to be done to ascertain the extent of the use of cardiac PoCUS, and possibly the need for a more comprehensive training program with adequate training in these clinical conditions, to ensure safe practice.
Nerve blocks are commonplace in the operating theatre and have recently made their way into emergency centres as a viable alternative to traditional methods of analgesia. Their use and safety has ...been documented for a variety of pathologies and it has been shown that they spare opioids and shorten time to discharge. No data exists on their use in South Africa. The purpose of this study was to analyse data from an existing nerve block registry from an emergency centre in South Africa.
The study was a retrospective, descriptive analysis of a nerve block registry from an academic emergency centre in Johannesburg, South Africa from May 2016 to September 2017.
There were 168 nerve blocks performed by 36 different operators of varying experience. The most common indication was for fracture management and the most frequently performed blocks were femoral 3-in-1 (44.6%), pop-sciatic (16.7%) and forearm-ultrasound nerve blocks (16.7%). Ultrasound guidance was used in 88.6% of the blocks. The average time taken to perform a nerve block was 10 min. The success rate was 91.8%. None of the variables analysed (i.e., operator experience, type of nerve block performed, time taken to perform the nerve block, ultrasound guidance, amount of anaesthetic used and time taken to evaluate outcome) had any effect on the success rate.
This study illustrates the use of nerve blocks as an effective, safe and timeous analgesic solution to a wide variety of musculoskeletal injuries in an academic emergency centre in South Africa.
PurposeThe purpose of this paper is to describe handover in the emergency centre from the perspective of prehospital emergency care providers in Johannesburg, South Africa. Reference to emergency ...centre handover from the prehospital perspective will have particular relevance to all deliverers of emergency centre handover.Design/methodology/approachA purposive, cross-sectional design addressed the study aim by using a purpose-designed, validated, paper-based questionnaire to collect data relating to prehospital emergency care personnel's perspectives on emergency centre handover.FindingsThere were 175 completed questionnaires collected from South African prehospital personnel within the Johannesburg area. The response rate was 175/290 or 62%. Training on handover was described as poor. There was a general appreciation of mnemonics and how well they ensured that all relevant information was handed over. However, this was countered by poor familiarity of common mnemonics. Perception of the accuracy of their own and observed prehospital handovers was generally positive. Handover length was generally perceived to be appropriate. The qualification of emergency centre personnel was perceived to impact on how handovers were received.Research limitations/implicationsThe study was limited to one geographical area and did not include all potential participants in the study area. The self-reported data collection meant that there was a risk of self-report bias. These factors may have negatively affected the generalisability of the data.Originality/valueThis paper seeks to describe perceptions related to emergency centre handover from the perspective of prehospital emergency care personnel. In doing so, it is postulated that there is the potential to use these findings to improve certain aspects of emergency centre handover.
Late presentation, usually to the emergency centre (EC), is frequently reported among patients with chronic kidney disease (CKD) in resource-limited settings, and is known to be associated with poor ...outcomes. This study aims to describe the pattern of EC presentation of adults with CKD in Southwest Nigeria.
This was a prospective observational study of 158 consecutively presenting CKD patients at the EC of two tertiary hospitals in Southwest Nigeria. Patients 18 years of age or older who were admitted into the EC at either study site with an admitting diagnosis of CKD and who consented to participate in the study were recruited. Socio-demographic characteristics, primary reason(s) for admission into the EC, requirement for dialysis, as well as the indication for dialysis were documented. The patients were followed-up for the duration of their stay in the EC and the outcome of EC admission documented.
Overall, 54 (34.2%) were females, median age was 49 years and 74.1% were not known to have CKD prior to EC admission. The commonest indications for admission into the EC were uraemia, sepsis and hypertensive crisis, with 73.4% of the patients having at least one indication for dialysis at EC admission. The commonest indications for dialysis were uraemia, marked azotaemia and acute pulmonary oedema. The median time to first session of dialysis was 48 h and 24.1% of patients who required dialysis were not dialysed. Death during the period of EC admission occurred in 14 (8.9%) patients all of whom were not previously known to have CKD.
There is a large pool of undiagnosed CKD among the general population. In many of these, the diagnosis will likely be made only when they present to the EC with complications. Late diagnosis is associated with worse outcomes.
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