African Journal of Emergency Medicine最新文献

{"title":"“More fun than studying or reading a textbook” – Perceptions of a boardgame intervention on toxicology education","authors":"Carine Marks ,&nbsp;Catharina E Du Plessis ,&nbsp;Daniël J Van Hoving ,&nbsp;Heinri Zaayman","doi":"10.1016/j.afjem.2025.100936","DOIUrl":"10.1016/j.afjem.2025.100936","url":null,"abstract":"<div><h3>Introduction</h3><div>Undifferentiated poisoning cases are common presentations to emergency departments. Clinicians are required to be familiar and up to date with the identification and management of these cases. Game-based learning is a unique educational intervention that facilitates learning and has a proven track record in toxicology education. This study sought to explore the impact of a newly designed board game (ToxiTrail™) on improving the toxicological knowledge of clinicians.</div></div><div><h3>Methods</h3><div>An explorative, qualitative study was performed using focus group interviews on staff working in emergency departments in Tygerberg and Khayelitsha Hospitals, and students enrolled in the Postgraduate Diploma in Medical Toxicology at Stellenbosch University. Interviews were recorded, transcribed and analysed using Braun and Clarke’s reflexive thematic analysis, developing themes related to the educational experience and optimisation of the boardgame.</div></div><div><h3>Results</h3><div>Thirty participants participated in three distinct focus group interviews. Four primary themes were constructed following the interviews, namely: Educational value and clinical relevance of the board game; Engagement and learning experience; Ideal usage scenarios and target audience; and Recommendations for improvement.</div></div><div><h3>Discussion</h3><div>Our study showed that the boardgame intervention enhanced the learning and understanding of toxicology concepts amongst participants, identified knowledge gaps and promoted storytelling. The active engagement of the game promoted the retention of knowledge from a real-world perspective and was a fun alternative to other educational instruction methods. Furthermore, the interviews assisted in improving the boardgame.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100936"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The assessment and management of acute trauma pain in a Cape Town, South Africa Emergency Centre: A retrospective chart review","authors":"Ngcebo Ndebele ,&nbsp;Laverne Phillips ,&nbsp;Peter Hodkinson","doi":"10.1016/j.afjem.2026.100949","DOIUrl":"10.1016/j.afjem.2026.100949","url":null,"abstract":"<div><h3>Background</h3><div>Trauma accounts for over 60,000 deaths annually in South Africa and is also responsible for a high proportion of emergency centre (EC) visits. Up to 91% of trauma patients in the EC experience acute pain, underscoring a critical public health concern, particularly in low and middle-income countries (LMICS), where research indicates poor pain management and a paucity of data. This study aimed to describe trauma pain assessment and management practices in a busy Cape Town EC.</div></div><div><h3>Methods</h3><div>This single-centre retrospective chart review in a high trauma burden EC collected a convenience sample over two weeks in 2024. Data were extracted from the medical records of adult trauma patients presenting to the EC.</div></div><div><h3>Results</h3><div>A total of 234 patients were included, predominantly male (73.1%), with a median age of 33 (IQR 26–41). Only 32.9% (77) of the patients had their pain assessed and documented, largely only in the triage process, and no patient had their pain reassessed. Furthermore, only 42.3% (99) of patients received analgesia, including opioids administered to 48.5% (48), non-steroidal anti-inflammatories to 45.5% (45), paracetamol to 69.7% (69), and ketamine to 17.2% (17). The time from arrival to the administration of the first analgesia in the EC was documented in 83 patients, with a median time to analgesia of 375 min (IQR 152–611).</div></div><div><h3>Conclusion</h3><div>This study demonstrates findings consistent with the global crisis of inadequate pain management. It reveals poor pain assessment and management, with prolonged waiting times for analgesia despite various indicators of potential pain severity, highlighting a crucial need for changes in pain management strategies. Training, awareness, and protocols to improve pain management are essential, along with considering nurse-led analgesia at triage.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100949"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leave no one behind: An African perspective on the first World Health Organization Global Status Report on Drowning Prevention","authors":"Colleen J. Saunders ,&nbsp;Frederick Oporia ,&nbsp;Caroline Lukaszyk ,&nbsp;Binta Sako","doi":"10.1016/j.afjem.2026.100944","DOIUrl":"10.1016/j.afjem.2026.100944","url":null,"abstract":"<div><div>Drowning is a significant but under-recognised public health challenge in the African region. The 2024 World Health Organization Global Status Report on Drowning Prevention provides the first comprehensive overview of national drowning prevention efforts across 139 countries and territories, including 33 from Africa. This commentary explores key findings from the report through an African lens, highlighting persistent disparities in drowning burden and response. The African region recorded only a 3% reduction in drowning mortality between 2000 and 2021, compared to 38% globally. Weak civil registration systems, limited data on non-fatal drowning, and under-reporting of flood and transport-related incidents contribute to a significant underestimation of the true burden. Policy and legislative gaps remain widespread, with few countries having national strategies, enforceable legislation, or adequately resourced multisectoral coordination mechanisms. While some countries have implemented vessel safety laws and appointed national focal points, legislation mandating lifejacket use, pool fencing, and alcohol regulation around water is inconsistent and poorly enforced. Critically, only a minority of countries offer community-based child drowning prevention interventions, swimming or water safety education, or lifeguard and bystander rescue training. The African region's high exposure to water during everyday life, work, and disaster, exacerbated by vulnerabilities including poverty, rurality, and climate volatility, underscores the need for urgent investment in locally relevant, evidence-informed drowning prevention efforts. This commentary calls for strong leadership, improved data systems, and equitable, sustainable partnerships to support whole-of-society responses to drowning in Africa.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100944"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to thrombolysis in acute ischaemic stroke: an epidemiological review from a tertiary hospital in the Eastern Cape, South Africa","authors":"Roswyn Pasio ,&nbsp;Roshen Maharaj ,&nbsp;Kevin Pasio","doi":"10.1016/j.afjem.2026.100945","DOIUrl":"10.1016/j.afjem.2026.100945","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke is one of the leading causes of morbidity and mortality globally, with a significant impact on health systems. In South Africa, especially the Eastern Cape, the epidemiology of acute stroke and the barriers to optimal care remain poorly described.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients (≥18 years) presenting with acute stroke at a hospital in Gqeberha, Eastern Cape, from 1 July 2019 to 30 June 2020.</div></div><div><h3>Results</h3><div>A total of 403 patients met the inclusion criteria, with 38 excluded from time-based analysis. The median patient age was 60.4 years (IQR 51.6 – 70.6); 54 % were female. Most patients (56 %) arrived via private transport, and 58 % had radiological evidence of an ischaemic stroke. Common stroke risk factors included hypertension, diabetes, and smoking. The median time from symptom onset to hospital presentation was 06 h and 30 min; with 9 % of patients presenting with a wake-up stroke. The median door-to-doctor time was 52 min with 51.8 % seen within 60 min. The median door-to-CT time was 5 h 7 min. A higher proportion of imaging occurred after hours. 99 patients presented within the 4.5-hour thrombolytic window (hyperacute stroke). Of these, 32 had radiological evidence of an intracranial haemorrhage. In the hyperacute stroke cohort, the median door-to-doctor and door-to-CT times were shorter: 25 min and 2 h 19 min respectively. Of those with ischaemic stroke, 35 % were excluded from thrombolysis due to time related factors, 34 % had contraindications, and 31 % were not offered treatment due to clinical and physician related factors. No patients admitted via the emergency department received thrombolysis. None of the national or international time-based quality metrics for acute stroke care were met.</div></div><div><h3>Conclusion</h3><div>This study provides valuable insights into the region’s stroke epidemiology and identifies areas for improvement for acute stroke care.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100945"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-method approach to the development of contextual telephone triage systems","authors":"Willem Stassen","doi":"10.1016/j.afjem.2025.100935","DOIUrl":"10.1016/j.afjem.2025.100935","url":null,"abstract":"<div><h3>Background</h3><div>Emergency medical services (EMS) resources are limited on the African continent and in other low- to middle-income countries. An inappropriate emergency response may increase EMS operational costs, response time intervals for subsequent emergencies, and influence patient outcome negatively. Established telephone triage systems are cost-prohibitive; are not validated to the heterogenous cultures, countries and systems across Africa; and have only moderate diagnostic accuracy performance. The aim of this paper is to describe a multi-method approach to developing contextual telephone triage systems that can be replicated or adapted to other contexts.</div></div><div><h3>Methods</h3><div>Seven distinct but integrated steps are proposed to develop contextual telephone triage systems iteratively. The seven steps are: 1) understanding context and purpose, 2) review qualitative descriptions, 3) review quantitative clinical variables, 4) build an algorithm and script, 5) test the algorithm for accuracy, 6) refine the algorithm, 7) implement with training, coaching and quality assurance. This approach combines multiple methods including qualitative content analysis, classification and regression models, and diagnostic accuracy studies.</div></div><div><h3>Conclusion</h3><div>By developing and implementing accurate and contextual telephone triage systems, dispatch decision-making can be guided which may result in improved EMS efficiency, decreased cost, and improved patient outcomes.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100935"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of early warning scores in predicting in-hospital mortality and adverse events in adult general-ward patients in low- and middle-income countries: A systematic review","authors":"Esmael Tomás ,&nbsp;Ernesto Ulica ,&nbsp;Carla Alves ,&nbsp;Capela Pascoal ,&nbsp;António Jeremias ,&nbsp;Ana Escoval ,&nbsp;Maria Lina Antunes","doi":"10.1016/j.afjem.2026.100943","DOIUrl":"10.1016/j.afjem.2026.100943","url":null,"abstract":"<div><h3>Background</h3><div>Early Warning Score systems (EWSs) based on bedside physiological parameters are widely implemented in high-income countries, yet their performance and utility in low- and middle-income countries (LMICs) remain uncertain, particularly in emergency and acute care settings, due to limited evidence and health system constraints. We systematically reviewed the effectiveness of EWSs for predicting in-hospital mortality and adverse events among adult general-ward patients in LMICs.</div></div><div><h3>Methods</h3><div>This systematic review followed PRISMA 2020 and PRISMA-S guidance and was prospectively registered in PROSPERO (CRD420251029273). We searched PubMed, Scopus, LILACS and African Journals Online (AJOL) from inception to May 2025, with no language restrictions. We included studies enrolling adult general-ward patients in LMICs, and excluded studies conducted solely in intensive care units, emergency departments, paediatric or obstetric populations. Data were narratively synthesised, and risk of bias was assessed using PROBAST.</div></div><div><h3>Results</h3><div>Twenty-eight observational studies comprising a total of 36,638 participants — primarily from sub-Saharan Africa and South Asia — met inclusion criteria. The Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) were most frequently assessed and generally demonstrated moderate-to-good discrimination for in-hospital mortality, with substantial heterogeneity by setting. The Universal Vital Assessment (UVA) showed promising discrimination relative to MEWS and qSOFA in some resource-limited contexts, however its dependence on HIV testing and laboratory support limits comparability with purely bedside scores. Only a minority of studies examined unplanned ICU admission, cardiac arrest or rapid-response activation. Limitations included substantial heterogeneity in methodology, outcomes, cut-off values and follow-up periods, which limited comparability, as well as the absence of studies originating from Central and South America.</div></div><div><h3>Conclusion</h3><div>Evidence in LMIC wards is largely observational and frequently based on statistical simulations with small samples; it should not be interpreted as proof of clinical effectiveness. Before widespread adoption, rigorous local validation and recalibration, along with multicentre, pragmatic implementation studies, are needed to define thresholds, workflows and escalation pathways appropriate to LMIC health-system capacity.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100943"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of emergency care services in Nigerian hospitals: A cross-sectional study","authors":"Kelechi Umoga ,&nbsp;Muzzammil Muhammad ,&nbsp;Melissa A. Meeker ,&nbsp;Jessica Rayo ,&nbsp;Kehinde Olawale Ogunyemi ,&nbsp;Christine Ngaruiya","doi":"10.1016/j.afjem.2025.100939","DOIUrl":"10.1016/j.afjem.2025.100939","url":null,"abstract":"<div><h3>Background</h3><div>The Accident and Emergency (A&amp;E) unit is a key entry point for healthcare in Nigeria, yet data on its functionality and capacity for emergency care remain limited. This study evaluates the functional capacity of A&amp;E units in Nigeria using a modified Emergency Care Assessment Tool (ECAT).</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from September to October 2020 in seven tertiary hospitals across Nigeria. Six hospitals, one from each of the country’s six geopolitical zones, were randomly selected, while the seventh-Nigeria’s main trauma center located in the capital-was purposively included. Doctors and nurses routinely working in A&amp;E units were interviewed using a modified Emergency Care Assessment Tool (ECAT), which evaluates the availability of essential medical interventions (signal functions) for managing six common, life-threatening sentinel conditions: Maternal and Child emergencies, Respiratory failure, Trauma, Shock, Altered mental status, and Severe pain.</div></div><div><h3>Results</h3><div>Among 503 healthcare providers surveyed (393 doctors and 110 nurses), significant differences were observed in the performance of signal functions across all six sentinel conditions (<em>p</em> &lt; 0·001) and across the seven study sites (<em>p</em> &lt; 0·001). The overall average capacity score was 2·69 out of 3. Federal Medical Center Katsina (North-West zone) recorded the highest mean score of 2·92 (95% CI: 2·77 - 3·07), while UCTH (South-South zone) had the lowest at 2.44 (95% CI: 2·27 - 2·60). Among the conditions assessed, respiratory failure had the lowest mean score at 2·55 (1·88–3·21).</div></div><div><h3>Conclusion</h3><div>This study reveals a higher-than-expected national average A&amp;E capacity score (2·69 out of 3) in Nigerian tertiary hospitals but highlights ongoing challenges, particularly in managing respiratory emergencies. Notable regional disparities were observed, with the Northern region outperforming others. Findings emphasize the need for objective, on-site evaluations and broader inclusion of facilities, along with targeted, region-specific investments to improve equitable emergency care nationwide.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100939"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and practice of adult cardiopulmonary resuscitation among nurses in the Emergency Department of a tertiary hospital in Ghana","authors":"Alice Oppong Damprane ,&nbsp;Isaac Nyanor ,&nbsp;Augustine Kwakye Sampah ,&nbsp;Gloria Achempim-Ansong ,&nbsp;Nicholas Adjei ,&nbsp;Bernard Arhin ,&nbsp;Paa Kobina Forson","doi":"10.1016/j.afjem.2026.100947","DOIUrl":"10.1016/j.afjem.2026.100947","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiopulmonary Resuscitation (CPR) is an important emergency care skill for all healthcare professionals. The success of CPR is determined by multiple patient and healthcare professional factors, such as CPR training and adhering to the guidelines for managing sudden cardiac arrest. Nurses have a high chance of identifying a patient in sudden cardiac arrest and initiating CPR for a better health outcome. This study assessed the knowledge and practice of adult CPR among nurses at the Emergency Department (ED) of a tertiary Hospital in Ghana.</div></div><div><h3>Methods</h3><div>A quantitative cross-sectional study was employed, where 132 nurses were randomly selected and interviewed from June 2020 to November 2020. Data was collected by trained research assistants with a structured questionnaire and analysed with STATA Version 16.0</div></div><div><h3>Results</h3><div>Majority (<em>n</em> = 117, 86.64%) of the respondents could identify a patient in sudden cardiac arrest, and 94.70% (<em>n</em> = 125) had performed CPR at least once within the last two years. Availability of guidelines and protocol based on the AHA guidelines for managing sudden cardiac arrest (<em>p</em> = 0.020) and good CPR practice (<em>p</em> = 0.044) were associated with good knowledge of CPR in this study.</div></div><div><h3>Conclusion</h3><div>Our study found respondents generally had good knowledge and good practice of CPR. Making AHA guidelines available to ED nurses for managing sudden cardiac arrest was significantly associated with good knowledge of CPR. Therefore, regular CPR training and providing AHA guidelines for managing sudden cardiac arrest are recommended to increase the level of knowledge of adult CPR.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100947"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintenance of competence in rarely performed clinical skills by advanced life support providers in Gauteng, South Africa: A mixed-methods study","authors":"Jared Eric Surtees,&nbsp;Craig Vincent Lambert","doi":"10.1016/j.afjem.2025.100932","DOIUrl":"10.1016/j.afjem.2025.100932","url":null,"abstract":"<div><h3>Introduction</h3><div>Advanced Life Support (ALS) providers are highly trained emergency care professionals with a broad range of clinical skills. Confidence and competence to perform a clinical skill or intervention has been linked to frequency of application. Differences in training, caseloads, and the context in which ALS providers operate can influence how often they get to perform different skills. Although the Health Professions Council of South Africa (HPCSA) mandates Continuing Professional Development (CPD), there is no requirement for ALS providers to demonstrate maintenance of procedural competence. In this study we investigated approaches to the maintenance of competency in rarely performed clinical skills among a sample of Gauteng-based ALS providers.</div></div><div><h3>Methods</h3><div>An exploratory, descriptive mixed-methods design was employed. A quantitative survey of 41 ALS providers assessed frequency of performance and self-reported confidence across 55 clinical skills was performed in March 2023. This was followed by two focus group discussions to explore in greater depth participant’s experiences with regard to maintenance of clinical skills.</div></div><div><h3>Results</h3><div>More than half of the 55 skills we assessed were reported to be “rarely” performed. Confidence to perform a particular skill generally mirrored the frequency with which the skill was performed. Focus group participants identified valuable strategies for maintaining skills that included clinical rotations across diverse work environments, peer discussions, instructional videos, and CPD-accredited courses that included a practical component. Limitations were identified in the current CPD system with regard to maintenance of clinical skills.</div></div><div><h3>Conclusion</h3><div>Skill decay and a reduction in confidence among ALS providers can be linked to infrequent performance of certain clinical skills and interventions. A more purposeful coordinated strategy involving education and training providers, employers and practitioners is required to better support the maintenance of clinical skills that are infrequently performed.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100932"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is the emergency care community? A qualitative exploration of stakeholder roles and relationships in engaged research within a South African provincial emergency care system","authors":"Robert Holliman,&nbsp;Willem Stassen,&nbsp;Colleen Saunders","doi":"10.1016/j.afjem.2026.100950","DOIUrl":"10.1016/j.afjem.2026.100950","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective emergency care (EC) in low- and middle-income countries (LMICs) depends on evidence that is relevant, implementable, and locally informed. Engaged research offers a means to achieve this, yet practical understanding of how to identify and involve communities remains limited. Defining the “community” is a critical but underexplored step, and little is known about how engagement operates within LMIC EC systems. This study explored stakeholder perspectives on the composition and relationships of the EC community.</div></div><div><h3>Method</h3><div>This was a qualitative study using semi-structured interviews and descriptive content analysis exploring stakeholder perspectives on the EC community. Purposive and snowball sampling ensured diverse representation. Transcripts were analysed inductively drawing on Braun and Clarke’s thematic framework and reported in accordance with COREQ guidelines.</div></div><div><h3>Results</h3><div>Thirty stakeholders participated, including emergency physicians, nurses, prehospital providers, academics, policymakers, and community representatives, many holding overlapping roles. Analysis identified three overarching categories:(1) breadth, variability, and ambiguity within the community;(2) fragmentation and exclusion; and (3) engagement potential and the role of frontline clinicians.</div></div><div><h3>Conclusions</h3><div>This study highlights the complexity of defining the EC community, with boundaries that are broad, variable, and often contested. Participants identified the absence or unclear roles of key stakeholders, including patients, decision-makers, and frontline clinicians, within research processes. Fragmentation and limited trust were viewed as major barriers to meaningful engagement, reinforcing the need for stronger, more transparent relationships within the community. Frontline clinicians were consistently recognised as underutilised yet uniquely positioned to connect clinical realities with academic research and community priorities. Strengthening engaged research in this context will require clearer guidance on how and when to involve stakeholders, structured mechanisms to build and sustain trust, and practical support for clinician participation. Together, these steps could help embed engagement more deeply into research culture and enhance the relevance and impact of EC scholarship.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"16 1","pages":"Article 100950"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}