African Journal of Emergency Medicine最新文献

{"title":"The value of shock index, modified shock index and age shock index to predict mortality and hospitalisation in a district level emergency centre","authors":"Patrick Aleka,&nbsp;Candice Van Koningsbruggen,&nbsp;Clint Hendrikse","doi":"10.1016/j.afjem.2023.09.007","DOIUrl":"10.1016/j.afjem.2023.09.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Triage is the most important step in patients’ journey through an Emergency Centre (EC) and directly impacts time to critical actions. Triage tools, like the South African Triage Scale, are however not designed to predict patient outcomes. The shock index (SI), modified shock index (MSI) and age shock index (ASI) are clinical markers derived from vital signs and correlate with tissue perfusion in critically ill patients. This study aimed to assess the value of SI, MSI and ASI to predict mortality and the need for hospitalisation in all adult patients presenting to a district level emergency centre in South Africa.</p></div><div><h3>Methods</h3><p>This diagnostic study was performed as a retrospective observational study, using data from an existing electronic registry at a district level hospital emergency centre over a period of 24 months. All adult patients who presented to Mitchells Plain Hospital were eligible for inclusion. Sensitivity, specificity and likelihood ratios were calculated for each variable as a predictor of mortality and hospitalisation with pre-determined thresholds.</p></div><div><h3>Results</h3><p>During the study period of 24 months, a total of 61 329 patients ≥ 18 years old presented to the EC with 60 599 included in the final sample. A red SATS triage category (+LR = 7.2) and SI ≥1.3 (+LR = 4.9) were the only two predictors with any significant clinical value. The same two markers performed well for both patients with and without trauma and specifically for patients who died while under the care of the emergency centre.</p></div><div><h3>Discussion</h3><p>The study demonstrated that patients with a SI≥1.3 at triage have a significantly higher likelihood to die or require hospitalisation, whether the presenting complaint is trauma related or not, especially to predict mortality while under the care of the EC. Incorporating this marker as a triage alert could expedite the identification of patients requiring time critical interventions and improve patient throughput in the emergency centre.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 287-292"},"PeriodicalIF":1.3,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/0a/main.PMC10562169.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The understandability and quality of telephone-guided bystander cardiopulmonary resuscitation in the Western Cape province of South Africa: A manikin-based study","authors":"Leonel P De Caires,&nbsp;Katya Evans,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2023.09.008","DOIUrl":"10.1016/j.afjem.2023.09.008","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of cardiovascular disease is on the increase in Africa and with it, an increase in the incidence of out-of-hospital cardiac arrest (OHCA). OHCA carries a high mortality, especially in low-resource settings. Interventions to treat OHCA, such as mass cardiopulmonary resuscitation (CPR) training campaigns are costly. One cost-effective and scalable intervention is telephone-guided bystander CPR (tCPR). Little data exists regarding the quality of tCPR. This study aimed to determine quality of tCPR in untrained members of the public. Participants were also asked to provide their views on the understandability of the tCPR instructions.</p></div><div><h3>Methods</h3><p>This study followed a prospective, simulation-based observational study design. Adult laypeople who have not had previous CPR training were recruited at public CPR training events and asked to perform CPR on a manikin. Quality was assessed in terms of hand placement, compression rate, compression depth, chest recoil, and chest exposure. tCPR instructions were provided by a trained medical provider, via loudspeaker. Participants were also asked to complete a short questionnaire afterwards, detailing the understandability of the tCPR instructions. Data were analysed descriptively and compared to recommended quality guidance.</p></div><div><h3>Results</h3><p>Fifty participants were enrolled. Hand placement was accurate in 74 % (<em>n</em> = 37) of participants, while compression depth and chest recoil only had compliance in 20 % (<em>n</em> = 10) and 24 % (<em>n</em> = 12) of participants, respectively. The mean compression rate was within guidelines in just under half (48 %, <em>n</em> = 24) of all participants. Only 20 (40 %) participants exposed the manikin's chest. Only 46 % (<em>n</em> = 23) of participants felt that the overall descriptions offered during the tCPR guidance were understandable, while 80 % (<em>n</em> = 40) and 36 % (<em>n</em> = 18) felt that the instructions on hand placement and compression rate were understandable, respectively. Lastly, 94 % (<em>n</em> = 47) of participants agreed that they would be more likely to perform bystander CPR if they were provided with tCPR.</p></div><div><h3>Conclusion</h3><p>The quality of CPR performed by laypersons is generally suboptimal and this may affect patient outcomes. There is an urgent need to develop more understandable tCPR algorithms that may encourage bystanders to start CPR and optimise its quality.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 281-286"},"PeriodicalIF":1.3,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study","authors":"Ken Diango ,&nbsp;Eric Mafuta ,&nbsp;Lee A. Wallis ,&nbsp;Charmaine Cunningham ,&nbsp;Peter Hodkinson","doi":"10.1016/j.afjem.2023.09.001","DOIUrl":"10.1016/j.afjem.2023.09.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research.</p></div><div><h3>Methods</h3><p>We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data.</p></div><div><h3>Results</h3><p>Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, <em>p</em> &lt; 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted.</p></div><div><h3>Conclusion</h3><p>A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 258-264"},"PeriodicalIF":1.3,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa","authors":"Aloysius Ugwu-Olisa Ogbuanya ,&nbsp;Nonyelum Benedett Ugwu ,&nbsp;Vincent C Enemuo ,&nbsp;Ugochukwu U Nnadozie ,&nbsp;Uche Emmanuel Eni ,&nbsp;Richard L Ewah ,&nbsp;Uzoamaka E Ajuluchuku ,&nbsp;Daniel A Umezurike ,&nbsp;Livinus N Onah","doi":"10.1016/j.afjem.2023.08.005","DOIUrl":"10.1016/j.afjem.2023.08.005","url":null,"abstract":"<div><h3>Background</h3><p>Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment.</p></div><div><h3>Aim</h3><p>To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly.</p></div><div><h3>Methods</h3><p>This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria.</p></div><div><h3>Results</h3><p>Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65–74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (<em>p</em> = 0.036), late presentation (<em>p</em> = 0.004), district location of hospital (<em>p</em> = 0.011) and intestinal resection (<em>p</em> = 0.003).</p></div><div><h3>Conclusion</h3><p>Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 265-273"},"PeriodicalIF":1.3,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of WHO BEC course for nurses at Bugando Medical Center in Mwanza, Tanzania","authors":"Nita Avrith ,&nbsp;Young Suh ,&nbsp;Ramona Sunderwirth ,&nbsp;Shahzmah Suleman ,&nbsp;Ally Munir Akrabi","doi":"10.1016/j.afjem.2023.09.004","DOIUrl":"10.1016/j.afjem.2023.09.004","url":null,"abstract":"<div><h3>Introduction</h3><p>The Basic Emergency Care (BEC) course is an open-access training designed for frontline providers in low resource settings which focuses on recognizing and managing emergent conditions. This study describes the implementation of the BEC course for nurses at Bugando Medical Center (BMC) in Mwanza, Tanzania in March 2020 as part of an educational initiative to improve nurses’ knowledge and confidence in providing emergency care.</p></div><div><h3>Methods</h3><p>This is a 2-week educational intervention with pre-post measurements. 12 nurses (cohort 1) received BEC training from in-country facilitators over the course of 4 days. A training-of-trainers (ToT) course followed immediately and the 5 newly trained facilitators then taught the BEC course to 12 additional nurses (cohort 2). Pre- and post-BEC knowledge was assessed with a standardized 25-question multiple choice (MCQ) exam; confidence levels were evaluated using a 4-point Likert scale survey; and qualitative feedback obtained was examined by thematic analysis.</p></div><div><h3>Results</h3><p>24 participants completed the BEC course, 5 of which completed a ToT to become BEC facilitators. For the combined group, knowledge assessment scores improved significantly from 63.8% to 85.2% with a mean difference of 21.5% (t₍₂₄₎= 9.3, p&lt;0.0001). Similar improvements were seen when cohort 1 and cohort 2 were analyzed separately. Analysis comparing the results across different demographic groups demonstrated a significant improvement in post-course score for each group. Confidence levels increased significantly across all domains. Main qualitative feedback themes were: quality of teaching; method of teaching; applicability of training to daily nursing practice; more time allotment; and the need to expand the course to other healthcare providers and to rural sites.</p></div><div><h3>Conclusion</h3><p>Implementation of the BEC course at BMC led to an improvement in nursing emergency care knowledge and self-confidence. The course was well received and the ToT model was successful, giving the nurses the ability to train additional local nurses.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 274-280"},"PeriodicalIF":1.3,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/ee/main.PMC10560998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda","authors":"Mediatrice Niyonsaba ,&nbsp;Menelas Nkeshimana ,&nbsp;Jean Marie Uwitonze ,&nbsp;Justine Davies ,&nbsp;Rebecca Maine ,&nbsp;Jeanne D'Arc Nyinawankusi ,&nbsp;McKenna Hunt ,&nbsp;Rob Rickard ,&nbsp;Sudha Jayaraman ,&nbsp;Melissa H. Watt","doi":"10.1016/j.afjem.2023.07.002","DOIUrl":"10.1016/j.afjem.2023.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges.</p></div><div><h3>Methods</h3><p>In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants’ perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo.</p></div><div><h3>Results</h3><p>Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data.</p></div><div><h3>Conclusion</h3><p>Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 250-257"},"PeriodicalIF":1.3,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antivenom supply and demand: An analysis of antivenom availability and utilization in South Africa","authors":"Natalie R Neumann ,&nbsp;Arina du Plessis ,&nbsp;Daniël J van Hoving ,&nbsp;Christopher O Hoyte ,&nbsp;Anné Lermer ,&nbsp;Stephen Wittels ,&nbsp;Carine Marks","doi":"10.1016/j.afjem.2023.08.002","DOIUrl":"10.1016/j.afjem.2023.08.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Snakebites are a neglected tropical disease. In many areas, envenoming incidence and antivenom administration rates are unknown. This study compared antivenom (AV) availability to rates of envenoming and recommendations to treat (RTT) in South Africa.</p></div><div><h3>Methods</h3><p>This retrospective study identified, extracted, and reviewed all cases of envenoming (snake bites and spits) reported to the Poisons Information Helpline of the Western Cape of South Africa (PIHWC) from June 1, 2015 to May 31, 2020 by public hospitals in the Western Cape. A standardized interview was administered to the pharmacies of the 40 hospitals in winter and summer to determine how many vials of monovalent and polyvalent AV they had on hand at the time of the call and their expiration dates<em>.</em> Descriptive analysis was used to compare rates of envenoming and recommendations to treat to antivenom stock in winter and summer and by hospital type and location.</p></div><div><h3>Results</h3><p>Public hospitals reported 300 envenomings, 122 from snakes. The PIHWC recommended antivenom administration in 26% of cases (<em>N</em> = 32). All hospital pharmacies queried answered our questions. Our study demonstrates urban district hospitals have higher ratios of AV vials compared to mean annual rates of envenoming and RTT than rural district hospitals at both the winter and summer timepoints.</p></div><div><h3>Conclusion</h3><p>This study evaluates antivenom supply and demand in a province of South Africa. The findings suggest South African urban hospitals have a relative excess of antivenom, and thus more capacity to meet demand, than their rural counterparts. It supports consideration of a redistribution of antivenom supply chains to match seasonal and local rates of envenoming. It indicates a need for higher quality, prospective data characterizing envenoming incidence and treatment.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 245-249"},"PeriodicalIF":1.3,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa","authors":"Nicole Kissmer ,&nbsp;David Morris","doi":"10.1016/j.afjem.2023.09.002","DOIUrl":"10.1016/j.afjem.2023.09.002","url":null,"abstract":"<div><h3>Background</h3><p>The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients.</p></div><div><h3>Methods</h3><p>In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa.</p></div><div><h3>Results</h3><p>A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (<em>p</em>&lt;0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), <em>p</em>&lt;0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (<em>p</em>&lt;0.001).</p></div><div><h3>Conclusion</h3><p>The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 241-244"},"PeriodicalIF":1.3,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial medicine as a source of moral distress: An unrecognised pathway to moral injury in the South African EMS systems","authors":"Colin Giovanni Mosca ,&nbsp;Jaco P Kruger","doi":"10.1016/j.afjem.2023.09.003","DOIUrl":"10.1016/j.afjem.2023.09.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The phenomenon of Financial Medicine is a wide spread practice within the South African prehospital domain, which remains poorly researched. Similarly the impact of this phenomenon is not well understood, with many healthcare providers grappling with the moral dilemmas introduced into the work systems through the effects of the practice of Financial Medicine. Persisting, repetitive moral dilemmas can lead to instances of Moral Distress and Moral Injury. The practice of Financial Medicine in the South African prehospital domain proves to introduce many moral dilemmas and subsequently can serve as a source of Moral Distress and Moral Injury.</p></div><div><h3>Methods</h3><p>This study used a qualitative research methodology in the form of a constructivist grounded theory design. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity.</p></div><div><h3>Results</h3><p>The sub-category presented in this study stems from the development of 6 final analytical labels that were abstracted in the process of a theory construction, not presented in this article. This sub-category is nested under 1 of the final analytical labels, and comprised of 3 preliminary analytical labels and an associated code and proposition list.</p></div><div><h3>Conclusion</h3><p>Understanding the sources of Moral Distress and Moral Injury within the South African prehospital domain are key steps in promoting and supporting the adoption and sustainability of ethical practices. This article presents a key finding that demonstrates a link between the experience of the phenomenon of Financial Medicine and the suffering of a Moral Injury by South African prehospital personnel.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 235-240"},"PeriodicalIF":1.3,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences and Interventions by Botswana police officers in providing emergency care in road traffic collisions in the greater Gaborone region","authors":"M. Sebakeng ,&nbsp;M. Cox","doi":"10.1016/j.afjem.2023.08.004","DOIUrl":"10.1016/j.afjem.2023.08.004","url":null,"abstract":"<div><h3>Background</h3><p>Close to 500 people die annually from Road Traffic Collisions in Botswana. The country's Emergency Medical Service is limited in capacity and coverage and greatest in the region of the capital city, Gaborone. Botswana Police Service officers are often first responders to the incidents and provide first aid, however the extent of their interventions and their experiences has not been studied.</p></div><div><h3>Methods</h3><p>A questionnaire based cross-sectional survey was conducted in January 2016 on a sample of 99 officers on past pre-hospital care training, attitudes towards providing pre-hospital care for accident victims, the number of road traffic collision related deaths and injuries encountered in the last 6 months, their interventions to the victims and limitations encountered in providing care.</p></div><div><h3>Results</h3><p>The officers self-reported attending to a median of 10 injured victims (IQR = 5 – 20) and a median of 2 deaths (IQR = 0 – 4) in the preceding 6 months. The officers generally acknowledged their role and responsibility to provide pre-hospital care to the victims. Officers frequently secured accident scenes and transported injured victims to health facilities. They rarely performed haemorrhage control on victims, performed any airway manoeuvres or splint injured limbs. The major limitations to providing care were lack of first aid supplies and personal protective equipment, lack of knowledge and skills to provide care and interference from onlookers at accident scenes.</p></div><div><h3>Conclusion</h3><p>Botswana Police officers in the greater Gaborone area attend to a considerable number of traffic related injuries and fatalities. These results support many opportunities for educational interventions to add value to pre-hospital care.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 4","pages":"Pages 230-234"},"PeriodicalIF":1.3,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/a1/main.PMC10497991.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10252727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}