African Journal of Emergency Medicine最新文献

{"title":"Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa","authors":"Keabetsoe Hlanze ,&nbsp;Kylen Swartzberg ,&nbsp;Mike Wells","doi":"10.1016/j.afjem.2024.11.001","DOIUrl":"10.1016/j.afjem.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.</div></div><div><h3>Methods</h3><div>A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.</div></div><div><h3>Results</h3><div>Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.</div></div><div><h3>Conclusion</h3><div>The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 1","pages":"Pages 513-517"},"PeriodicalIF":1.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886432","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":"Framework first: Key insights on developing emergency medical care policy in low- and middle-income countries","authors":"Hendry Robert Sawe","doi":"10.1016/j.afjem.2024.11.002","DOIUrl":"10.1016/j.afjem.2024.11.002","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 534-535"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014389","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":"Developing emergency medical care policy across Kenya: A framework for policy development","authors":"Zoe Siegel ,&nbsp;Trina Swanson ,&nbsp;Emily Nyagaki ,&nbsp;Adam R. Aluisio ,&nbsp;Benjamin W. Wachira","doi":"10.1016/j.afjem.2024.10.222","DOIUrl":"10.1016/j.afjem.2024.10.222","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The Kenya Emergency Medical Care (EMC) Policy 2020–2030 was created to guide the advancement of EMC throughout Kenya. This report describes and maps the ongoing EMC policy development process across Kenya's 47 counties, serving as a real-world example of EMC policy development within a decentralized healthcare system in a low—or middle-income country (LMIC).</div></div><div><h3>Methods</h3><div>This report evaluates the development of county-specific EMC policies using the Kenya Institute for Public Policy Research and Analysis (KIPPRA) six stages for policy development: 1) problem identification, 2) agenda setting, 3) policy design, 4) approval, 5) implementation, and 6) monitoring and evaluation. Meeting minutes, workshop proceedings, and draft and final EMC policy documents were used to analyze the policy development process and provide a snapshot of current EMC policy statuses by county.</div></div><div><h3>Results</h3><div>As of August 2024, 23 counties have engaged in EMC policy development. Thirteen have finalized and are implementing their EMC policies, while 10 await approval. The remaining 24 counties are still in the planning stages. This process included gathering baseline emergency medical care standards to identify areas for improvement in each county. A core vision, mission, and goal aligned with the national policy were established and tailored to the county's needs. County-specific strategies were developed to address gaps between the existing system and national objectives. EMC policies were drafted, collaboratively reviewed, revised, and finalized before official approval. The next steps will be implementation, monitoring, and evaluation. Growth and improvement will be measured post-implementation based on baseline EMC metrics.</div></div><div><h3>Conclusion</h3><div>Kenya's strategy for EMC policy development across the 47 counties, utilizing KIPPRA's guidelines for public policy formulation, established a structured approach that included engaging stakeholders, conducting situational analyses, and aligning policy objectives with national goals. It is a comprehensive example of developing EMC policies for LMICs within decentralized healthcare systems.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 527-533"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014388","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":"Pelvic sheet binders: Are doctors placing them in the correct position?","authors":"Marcus William Kruger ,&nbsp;Jana du Plessis ,&nbsp;Pravani Moodley","doi":"10.1016/j.afjem.2024.12.001","DOIUrl":"10.1016/j.afjem.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Unstable pelvic fractures cause significant bleeding, morbidity, and mortality. Commercially available Pelvic Circumferential Compression Devices (PCCDs) are used in the initial resuscitation and management of these cases. In the trauma-burdened, resource limited setting of Southern Africa, the available alternative is a pelvic sheet binder (PSB). For optimal results placement should be at the greater trochanters (GTs). Prior studies have shown that practitioners are inaccurate in their placement. This study aimed to describe placement of PSBs by doctors and factors influencing placement.</div></div><div><h3>Methods</h3><div>This was a multicentre, prospective, observational, simulation-based study. Doctors working in Emergency Departments (EDs) and Trauma Emergency Units (TEUs) in Johannesburg were asked to place a PSB on two healthy male models of differing body mass index (BMI), as simulated patients (SPs). Outcomes were based on PSB position relative to the GTs, marked using an ultraviolet pen, and photographed under ultraviolet light. Data on techniques of placement, as well as practitioner factors, were also collected to investigate their influence on accuracy.</div></div><div><h3>Results</h3><div>In this study 147/176 (83.5 %) of the PSBs placed were correct (trochanteric). Of those placed on the normal BMI SP 71/88 (81 %) were correct and 76/88 (86 %) of those on the increased BMI SP. BMI did not appear to influence accuracy of placement. Practitioner factors that had statistically significant association with accurate placement included the following: Working in the TEU, work experience of ≥6 years, a diploma in primary emergency care (DipPEC, College of emergency medicine, South Africa), all methods of placing the PSB and inspecting to find the GTs.</div></div><div><h3>Conclusion</h3><div>The overall accuracy of PSBs placement was high (83.5 %). Additional postgraduate training (DipPEC) and work experience improved placement accuracy. This study highlighted the importance of additional trauma training and areas of possible future research, such as optimal binder width and method of securing PSBs.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 512-517"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985120","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":"Editorial—AfJEM Dec 2024","authors":"Peter Hodkinson (Editor in Chief, African Journal of Emergency Medicine (AfJEM))","doi":"10.1016/j.afjem.2024.12.002","DOIUrl":"10.1016/j.afjem.2024.12.002","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 518-519"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985115","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":"Triage implementation audit at the adult emergency department of Debre Tabor Comprehensive Specialized Hospital in Ethiopia","authors":"Belayneh Dessie Kassa ,&nbsp;Mebratu Libanos ,&nbsp;Kumlachew Geta ,&nbsp;Natnael Moges","doi":"10.1016/j.afjem.2024.10.001","DOIUrl":"10.1016/j.afjem.2024.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>In an emergency room, triage is a crucial element that determines the clinical urgency of patients. Triage can dictate important decisions on the use of resources and the treatment that patients need. Many patients are seen later than necessary, wasting resources and time, and some may even be discharged without being seen, risking their lives. This study aimed to determine whether the triage tool was fully completed, properly measured, and documented, the triage early warning score (TEWS) was calculated, and whether patients were examined, distributed, and managed in appropriate areas.</div></div><div><h3>Methods</h3><div>An institution-based cross-sectional study with a retrospective chart review was conducted at Debre Tabor Comprehensive Specialized Hospital by selecting patients’ charts using simple random sampling among patients who visited the adult Emergency Department from January 1, 2021, to December 31, 2023. The descriptive statistics were presented to characterize individual variables, and cross-tabulation was used to see the relationship between individual patient-related factors and their final triage status.</div></div><div><h3>Results</h3><div>From the randomly selected 345 patients’ charts, 67 (19.4 %) didn't contain a triage sheet. The total triage early warning score was correctly calculated for only 21 (7.6 %) patients and properly triaged. Most of the patients were improperly triaged (92.4 %, <em>n</em> = 257), of which 253 (91 %) were under-triaged and four (1.4 %) were over-triaged. Fischer's exact test revealed a statistically significant relationship between patients’ color-coding category, triage early warning score documentation, and the use of clinical discriminators and final triage assessment (p = 0.007, p = 0.000, and p = 0.000 respectively).</div></div><div><h3>Conclusion</h3><div>The status of our triage implementation is alarming and specifically the level of under-triage. There is a significant gap regarding the application of clinical discriminators and TEWS calculations.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 506-511"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886428","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":"Exploring trauma surgeons' views on trauma care in Nigeria: A qualitative study","authors":"Oluwafunmilayo Akinlade ,&nbsp;Adebisi Adeyeye ,&nbsp;Brandon L. Ellsworth ,&nbsp;Christopher W. Reynolds ,&nbsp;Chiamaka Eneh ,&nbsp;Ayobami Olufadeji","doi":"10.1016/j.afjem.2024.03.001","DOIUrl":"10.1016/j.afjem.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><div>In Nigeria, trauma care faces challenges due to high injury and death rates from road traffic accidents and violence. Improvements are underway, but gaps in service availability, training, and coordination persist, necessitating evidence-based interventions.</div></div><div><h3>Purpose</h3><div>To evaluate trauma care practices in Nigeria, focusing on practitioners' perceptions of training, resources, and care quality to inform policy and practice enhancements.</div></div><div><h3>Methods</h3><div>An exploratory qualitative study was conducted with seven trauma surgeons across Nigeria, using semi-structured interviews and an Interpretive Description analysis approach, adhering to SRQR standards.</div></div><div><h3>Results</h3><div>Analysis of interviews with seven Nigerian trauma surgeons highlighted a trauma care system burdened by high incidences of traffic-related injuries. Despite varying caseloads—from 20 cases per month to 65 weekly—common challenges included delayed care, leading to complications like infection and misaligned wound healing. Surgeons noted strengths in motivated staff and sub-specialization but stressed barriers such as underdeveloped prehospital care, financial constraints, and resource shortages, which hindered effective trauma management and outcomes.</div></div><div><h3>Conclusions</h3><div>Effective trauma care in Nigeria is crucial and achievable through policy reforms, better resource distribution, and enhanced training. Systematic data collection and a national trauma care protocol are recommended to improve patient outcomes and guide future research and policymaking.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 520-526"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706841","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":"Barriers to accessing appendectomy in the public sector health system in the Western Cape Province, South Africa","authors":"Johnelize Louw ,&nbsp;Kathryn M. Chu ,&nbsp;Peter S. Nyasulu ,&nbsp;Réne English","doi":"10.1016/j.afjem.2024.10.221","DOIUrl":"10.1016/j.afjem.2024.10.221","url":null,"abstract":"<div><h3>Background</h3><div>Appendectomy is the surgical treatment for acute appendicitis and barriers to timely care can lead to morbidity and mortality. In South Africa, patients experience delays during the stages of seeking, reaching, and receiving care. This study explored the perceptions and experiences of barriers to accessing appendectomy among patients, caregivers, and surgeons employed at selected public hospitals in the Western Cape, South Africa.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted through semi-structured in-depth interviews. Study sites comprised four public hospitals. The interviews were audio recorded, transcribed, and translated verbatim. Excerpts in the qualitative data were systematically categorised and themes were generated using inductive thematic analysis according to Braun and Clarke's methodology.</div></div><div><h3>Findings</h3><div>The following themes were generated from the analysis 1) barriers related to late presentation to a healthcare facility and 2) barriers related to healthcare facility delays. Identified barriers were perceptions of appendicitis-like symptoms, the influence of beliefs, customs and culture on healthcare-seeking behaviour, personal and social positions and values, lack of knowledge of the health system, transport accessibility and affordability, delayed ambulance response time, and proximity of healthcare facilities. Key barriers experienced after presentation to a healthcare facility related to inter-facility transfers, surgical capacity, and the diagnostic and management capabilities of facilities.</div></div><div><h3>Conclusion</h3><div>Participants in the study experienced, and perceived similar delays to accessing appendectomy to that reported in other African countries. Improved health literacy in communities could lead to timely healthcare-seeking behaviour for appendicitis and other emergency conditions. Efforts are needed to ensure access to affordable and available transport options, and healthcare facilities need to be better equipped to diagnose and treat appendicitis. This can be achieved through upskilling and augmenting human and other resources, which will require the support of the government and other relevant stakeholders.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 499-505"},"PeriodicalIF":1.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656375","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":"Abstracts from African Conference of Emergency Care 2024. Gaborone, Botswana November 2024","authors":"","doi":"10.1016/j.afjem.2024.10.002","DOIUrl":"10.1016/j.afjem.2024.10.002","url":null,"abstract":"","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 277-498"},"PeriodicalIF":1.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656376","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":"Impact of COVID-19 pandemic on the utilization of emergency medical services in Nairobi, Kenya","authors":"Maurine Mumo Mutua ,&nbsp;Benjamin Wachira ,&nbsp;Nancy Chege ,&nbsp;Sammy Simiyu ,&nbsp;Moses Masika","doi":"10.1016/j.afjem.2024.10.220","DOIUrl":"10.1016/j.afjem.2024.10.220","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medical services (EMS) are vital for providing immediate medical or trauma care to patients and stabilizing them for transportation to hospitals. Following the confirmation of the first case of coronavirus disease 2019 (COVID-19) in Kenya on March 13th, 2020, the government announced several measures to curb its spread, including movement restrictions and the use of ambulance services for confirmed or suspected COVID-19 patients. This study aimed to determine the utilization of EMS in Kenya the year before and one year into the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>This retrospective study collected data on all calls received from two dispatch centers in Nairobi City County from March 2019 to February 2021, encompassing the period both before and during the COVID-19 pandemic. Data collected was analyzed based on the number of calls, sex, call timing and call type.</div></div><div><h3>Results</h3><div>The two dispatch centers received 3,477 calls during the study period. The total number of calls made during the first year of the pandemic was 1,376, compared to 2,014 the year before, a decrease of 31.7%. The proportion of trauma-related calls increased from 15% (293/2014) to 22% (303/1376) while the proportion of nighttime calls increased from 20% (410/2014) to 35% (479/1376) during the pandemic.</div></div><div><h3>Conclusion</h3><div>EMS utilization decreased during the pandemic, and trauma calls increased. While most calls were made during the day, there was a notable increase in calls made during night shifts.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 4","pages":"Pages 273-276"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573067","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}