African Journal of Emergency Medicine最新文献

{"title":"Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review","authors":"Jared MCDOWALL ,&nbsp;Andrew William MAKKINK ,&nbsp;Kelton JARMAN","doi":"10.1016/j.afjem.2023.03.006","DOIUrl":"10.1016/j.afjem.2023.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS.</p></div><div><h3>Methods</h3><p>We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results.</p></div><div><h3>Results</h3><p>The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department.</p></div><div><h3>Conclusion</h3><p>The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662951","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":"A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces","authors":"Neville Vlok,&nbsp;Craig Wylie,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2023.05.007","DOIUrl":"10.1016/j.afjem.2023.05.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions.</p></div><div><h3>Methods</h3><p>A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 – June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces.</p></div><div><h3>Results</h3><p>A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%).</p></div><div><h3>Conclusion</h3><p>Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10238258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9575850","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":"Global health research abstracts: July ‘23","authors":"Dr. Jonathan Kajjimu","doi":"10.1016/j.afjem.2023.05.003","DOIUrl":"10.1016/j.afjem.2023.05.003","url":null,"abstract":"<div><p>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9697123","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":"Obtaining feedback from patients and their family in the emergency department","authors":"Yemisi Okikiade Oyegbile ,&nbsp;Petra Brysiewicz","doi":"10.1016/j.afjem.2023.06.002","DOIUrl":"10.1016/j.afjem.2023.06.002","url":null,"abstract":"<div><p>Obtaining feedback from the patient and their family members regarding their experience of the care they received in the emergency department is important. This provides an extremely valuable opportunity for healthcare professionals to assess the quality of care and serves to highlight any areas of weakness or strength in the care experience. Through a synthesis of available literature, this article describes the challenges in measuring such an experience especially in emergency departments in Africa, and outlines tools that are currently available in literature to measure the patient and family experience and or satisfaction. Implementation considerations are outlined in order to provide recommendations for emergency department healthcare professionals wanting to undertake such assessments.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812406","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":"Analgesia use in trauma patients at a university teaching hospital in Kigali, Rwanda","authors":"Jean Muragizi ,&nbsp;Mindi Guptill ,&nbsp;Bogdan G. Dumitriu ,&nbsp;Michael B. Henry ,&nbsp;Adam R. Aluisio ,&nbsp;Jean Paul Nzabandora ,&nbsp;Appolinaire Manirafasha ,&nbsp;Janette Baird ,&nbsp;Katelyn Morretti ,&nbsp;Naz Karim","doi":"10.1016/j.afjem.2023.05.002","DOIUrl":"10.1016/j.afjem.2023.05.002","url":null,"abstract":"<div><h3>Introduction</h3><p>While trends in analgesia have been identified in high-income countries, little research exists regarding analgesia administration in low- and middle-income countries (LMIC). This study evaluates analgesia administration and clinical characteristics among patients seeking emergency injury care at University Teaching Hospital-Kigali in Kigali, Rwanda.</p></div><div><h3>Methods</h3><p>This retrospective, cross-sectional study utilized a random sample of emergency center (EC) cases accrued between July 2015 and June 2016. Data was extracted from the medical record for patients who had an injury and were ≥ 15 years of age. Injury-related EC visits were identified by presenting complaint or final discharge diagnosis. Sociodemographic information, injury mechanism and type, and analgesic medications ordered and administered were analyzed.</p></div><div><h3>Results</h3><p>Of the 3,609 random cases, 1,329 met eligibility and were analyzed. The study population was predominantly male (72%) with a median age of 32 years and range between 15 and 81 years. In the studied sample, 728 (54.8%) were treated with analgesia in the EC. In unadjusted logistic regression, only age was not a significant predictor of receiving pain medication and was excluded from the adjusted analysis. In the adjusted model, all predictors remained significant, with being male, having at least one severe injury, and road traffic accident (RTA) as injury mechanism being significant predictors of analgesia administration.</p></div><div><h3>Conclusion</h3><p>In the study setting of injured patients in Rwanda, being male, involved in RTA or having more than one serious injury was associated with higher odds of receiving pain medication. Approximately half of the patients with traumatic injuries received pain medications, predominantly opioids with no factors predicting whether a patient would receive opioids versus other medications. Further research on implementation of pain guidelines and drug shortages is warranted to improve pain management for injured patients in the LMIC setting.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/37/main.PMC10272278.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662957","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":"Global health research abstracts: April ‘23","authors":"Dr. Jonathan Kajjimu","doi":"10.1016/j.afjem.2023.05.004","DOIUrl":"10.1016/j.afjem.2023.05.004","url":null,"abstract":"<div><p>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9697126","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":"Global Health research abstracts: June ‘23","authors":"Dr. Jonathan Kajjimu","doi":"10.1016/j.afjem.2023.05.006","DOIUrl":"10.1016/j.afjem.2023.05.006","url":null,"abstract":"<div><p>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9697125","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 preparedness capacity of a university hospital in Ghana: a cross-sectional study","authors":"Estella Antoinette Boateng-Osei ,&nbsp;Isaac Osei ,&nbsp;Abigail Kusi-Amponsah Diji ,&nbsp;Bernice Agyeman Pambour ,&nbsp;Rejoice Wireko-Gyebi ,&nbsp;Portia Okyere ,&nbsp;Alberta Yemotsoo Lomotey","doi":"10.1016/j.afjem.2023.05.001","DOIUrl":"10.1016/j.afjem.2023.05.001","url":null,"abstract":"<div><h3>Background</h3><p>The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana.</p></div><div><h3>Methods</h3><p>A facility-based cross-sectional study was conducted between December 2018 and February 2019 using three guidelines developed respectively by the World Health Organization, the Ministry of Health-Ghana, and the Ghana Health Service. The hospital's emergency preparedness was assessed regarding the emergency policies, plan, protocol, equipment, and medications.</p></div><div><h3>Results</h3><p>Overall, the hospital's emergency preparedness level was weak (57.36%). Findings revealed that the hospital had inadequate emergency equipment, and supplies for emergency care delivery, especially during upsurge. It also did not have an emergency planning committee. There were noticeable deficiencies in some emergency resources such as chest tubes, basic airway supplies, and many emergency drugs. Other vital emergency tools such as pulse oximeter, thermometer, and emergency medications were inadequate. The hospital had a strong emergency plan and policies on assessment (77.8% and 78%) respectively.</p></div><div><h3>Conclusion</h3><p>The Kwame Nkrumah University of Science and Technology hospital is not prepared sufficiently for an emergency surge, and this poses a major health challenge. Emergency items must be made available, and the organization and planning of emergency service provisions must be improved to avoid preventable deaths during an emergency surge.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10276015","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":"Accuracy of two-rescuer adult CPR performed by medical registrars at a South African university","authors":"Bianca Hartslief ,&nbsp;Carmen Janse van Rensburg ,&nbsp;Alicia Maartens ,&nbsp;Pieter G. Marais ,&nbsp;Erwain T. Meyer ,&nbsp;Joleen P. Cairncross ,&nbsp;Gina Joubert ,&nbsp;Wilhelm Johannes Steinberg","doi":"10.1016/j.afjem.2023.06.006","DOIUrl":"10.1016/j.afjem.2023.06.006","url":null,"abstract":"<div><h3>Background</h3><p>Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient's spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation.</p></div><div><h3>Objectives</h3><p>This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci-Anne® manikin performed by registrars from the University of the Free State, South Africa.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. During a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne® manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association's tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded.</p></div><div><h3>Results</h3><p>The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C technique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars.</p></div><div><h3>Conclusion</h3><p>The study found that registrars were not consistently performing high-quality CPR on a Resusci-Anne® manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10344687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816106","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":"A qualitative assessment of stakeholder perspectives on barriers and facilitators to emergency care delays in Northern Tanzania through the Three Delays","authors":"Leah Hosaka ,&nbsp;Anna Tupetz ,&nbsp;Francis M. Sakita ,&nbsp;Frida Shayo ,&nbsp;Catherine Staton ,&nbsp;Blandina T. Mmbaga ,&nbsp;Anjni Patel Joiner","doi":"10.1016/j.afjem.2023.06.007","DOIUrl":"10.1016/j.afjem.2023.06.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Emergency conditions cause a significant burden of death and disability, particularly in developing countries. Prehospital and Emergency Medical Services (EMS) are largely nonexistent throughout Tanzania and little is known about the community's barriers to accessing emergency care. The objective of this study was to better understand local community stakeholder perspectives on barriers, facilitators, and potential solutions surrounding emergency care in the Kilimanjaro region through the Three Delays Model framework.</p></div><div><h3>Methods</h3><p>A qualitative assessment of local stakeholders was conducted through semi-structured focus group discussions (FGDs) from February to June 2021 with five separate groups: hospital administrators, emergency hospital workers, police personnel, fire brigade personnel, and community health workers. FGDs were conducted in Kiswahili, audio recorded, and translated to English verbatim. Two research analysts separately coded the first two FGDs using both inductive and deductive thematic analysis. A final codebook was then created to analyze the remaining FGDs.</p></div><div><h3>Results</h3><p>A total of 24 participants were interviewed. Thematic analysis revealed that participants identified significant barriers within the Three Delays Model as well as identified an additional delay centered on community members and first aid provision. Perceived delays in the decision to seek care, the first delay, were financial constraints and the lack of community education on emergency conditions. Limited infrastructure and reduced transportation access were thought to contribute to the second delay. Potential barriers to receiving timely appropriate care, the third delay, included upfront payments required by hospitals and emergency department intake delays. Suggested solutions focused on increasing education and improving communication and infrastructure.</p></div><div><h3>Conclusion</h3><p>The findings outline barriers to accessing emergency care from a stakeholder perspective. These themes can support recommendations for further strengthening of the prehospital and emergency care system. Due to logistical constraints, emergency care workers interviewed were all from one hospital and patients were not included.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10344688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816110","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}