African Journal of Emergency Medicine

Improving pain management for trauma patients at two Rwandan emergency departments
Hagenimana JP, Banguti PR, Anderson RLC, Tuyishime JD, Nyirigira G and Tuyishime E
Little is known regarding the effectiveness of pain protocols and guideline use in Emergency Departments (ED) in Sub-Saharan Africa. Therefore, to shed light on this research gap, this study had the following objectives: 1) to evaluate if the implementation of the Essential Pain Management (EPM) course combined with mentorship to use the World Health Organization (WHO) pain ladder-based protocol improves the quality of pain management among trauma patients at the ED of two teaching hospitals in Rwanda; and 2) to determine barriers to implementing the WHO pain ladder-based protocol among trauma patients in the same settings.
Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia
Getahun GK, Shewamare A, Andabob WA, Duressa EM and Birhanu MY
Emergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023.
From vocational to graduation: A mixed methods study of support needs for vocational learners pursuing post-graduate education in South Africa
Groome D and Cunningham C
Vocational learning has been critical in shaping South Africa's workforce, especially for paramedicine. The introduction of the National Qualification Framework (NQF) in 1995 phased out previous short course learning systems and redesigned qualifications within the framework. While recognition of prior learning is well advocated in the NQF, the predominant focus is undergraduate studies. The leap from vocational to Higher Education can be significant, especially for non-seasoned learners, and additional support may be required to ensure a successful transition. This study describes the support needs of vocational paramedics transitioning to post-graduate education.
The impact of the COVID-19 pandemic on presentations with suicidal behaviour in a tertiary hospital Emergency Centre in the Eastern Cape, South Africa-A cross-sectional analysis
Els JR, Hendrikse C and Taljaard L
Suicidal behaviour is a public health emergency, causing an estimated one million deaths globally each year. The impact of the COVID-19 pandemic on suicidal behaviour is not fully understood. This study aimed to describe the impact of the COVID-19 pandemic on presentations with suicidal behaviour at a tertiary hospital in the Eastern Cape, South Africa.
South African palliative care provider perspectives on emergency medical services in palliative situations
Gage CH, Gwyther L and Stassen W
Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations.
Barriers to accessing appendectomy in the public sector health system in the Western Cape Province, South Africa
Louw J, Chu KM, Nyasulu PS and English R
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.
Impact of COVID-19 pandemic on the utilization of emergency medical services in Nairobi, Kenya
Mutua MM, Wachira B, Chege N, Simiyu S and Masika M
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.
Workplace violence in three public sector emergency departments, Gauteng, South Africa: A cross-sectional survey
Nkadimeng M, Engelbrecht A and Rajan S
Workplace violence against healthcareworkers in Emergency Departments (EDs) is a global concern. The purpose of this study was to determine the prevalence and types of workplace violence in EDs.
Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid
Drake JH, Kiwango G, Kitapondya D, Mashili F and Kivlehan SM
In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid.
Accuracy of focused cardiac ultrasound interpretation among emergency and critical care medicine residents in Ethiopia: A multi-center cross-sectional study
Mekonen NM, Abicho TB, Asfaw KG, Leulseged TW, Mera NA, Habte YW, Moges FH, Birhan YA, Tesfaye M and Tesfaye B
Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia.
The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session
Henning J and Hindle L
Accurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses.
Improving the time to pain relief in the emergency department through triage nurse-initiated analgesia - a quasi-experimental study from Ethiopia
Kefyalew M, Deyassa N, Gidey U, Temesgen M and Mehari M
Pain management is crucial for improving patients' quality of care. Persistent pain has been linked to higher depression, anxiety, and work-related difficulties. This study aimed to enhance the time to pain relief in the emergency department through triage nurse-initiated analgesia. It evaluated the impact of nurse-led analgesia on patient satisfaction compared to standard pain management at Tikur Anbessa Specialized Hospital and Kidus Paulos Specialized Hospital. Additionally, it compared the time to analgesia between the two hospitals and assessed the effect of nurse-led analgesia on reducing the length of stay for patients with pain.
Can plethysmographic capillary refill time predict lactate during sepsis? An observational study from Morocco
Rahmani C, Belhadj A and Aissaoui Y
Blood lactate is a marker of tissue hypoxia while capillary refill time (CRT) is a surrogate of tissue perfusion. Measuring these parameters is recommended for assessing circulatory status and guiding resuscitation. However, blood lactate is not widely available in African emergency departments. Additionally, CRT assessment faces challenges related to its precision and reproducibility. This study aims to evaluate the accuracy of visual CRT(V-CRT) compared to plethysmographic CRT (P-CRT) in predicting lactate levels among septic patients.
Oxygen therapy practice and associated factors among nurses working at an Ethiopian Referral Hospital
Teshale MM, Moges NA, Bitew MS, Birhanie SA, Gedfew M, Negese B, Telayneh AT, Ayenew T and Tsegaye D
Supplemental oxygen therapy is suppling oxygen at quantities higher than those found in the atmosphere (>21 %) and is mostly prescribed for hypoxic patients. To avoid hypoxemia, hypercapnia, and oxygen poisoning, nurses closely monitor patients receiving oxygen therapy. There are considerable gaps in nurses' practice of oxygen therapy. Patients who receive inappropriate oxygen therapy may have negative effects, and it has financial repercussions for both individuals and nations. The aim of this study was to assess oxygen therapy practices and associated factors influencing oxygen administration among nurses in an Ethiopian Regional Hospital.
Mapping the evidence of emergency nursing research in who Afro-region states: A Scoping Review
Chironda G, Mbeje P, Heyns T and Brysiewicz P
The introduction of emergency nursing in Africa has resulted in the establishment of several training schools across the continent. This has translated into a growing body of emergency care research being carried out by nurses; however, the breadth and extent of evidence remains unclear. The aim of the review was to map and collate the available literature on emergency nursing research in WHO Afro-region states.
The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education
Muller G and Brits H
Inadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices.
A needs assessment for formal emergency medicine curriculum and training in Zambia
Alavian S, Birkland B, Mwanza K and Mondoux S
Emergency medicine (EM) is a nascent field in Zambia. While not yet recognized as a medical specialty, there is national interest for developing more robust emergency care systems in this setting. One key element of strengthening EM in Zambia is identifying current gaps in emergency healthcare provision and opportunities for advancement in the field. This research used a modified version of the Emergency Care Assessment Tool to characterize the landscape of EM in Zambia. We collected data on the extent of EM training and teaching engagement among physicians practicing EM in Zambia. The survey assessed three aspects of core EM "signal functions" among the respondents which included; how often they performed the function, how confident they felt with the function, and how important they deemed the function to be in their practice. Finally, we asked respondents to identify barriers to performing the functions in their departments. The majority of respondents were early in their career, all below the age of 50, and participated in some form of teaching and supervision of learners, with minimal access to teaching resources to enhance their work. There was unanimous agreement with the need for formal postgraduate EM training in Zambia. The EM functions performed least often by EM physicians, and in which they felt the least confident, were high-acuity low-occurrence (HALO) procedures such as surgical airway and pericardiocentesis. The most common barrier to performing an EM function was access to supplies, equipment and medication. The second most commonly cited barrier was healthcare worker training. This research identified several critical needs for EM curricula in Zambia, specifically teaching resources for clinicians who supervise learners, directed learning on HALO procedures, and formal postgraduate training in EM based in Zambia.
Characteristics of paediatric injuries as predictors of 24-hour disposition from the Emergency Department of a teaching hospital in Southwestern Uganda
Olinga D, Oyania F, Bagonza K, Odakha JA, Balu MC, Mwanje W, Flanery A, Okello A, Musau EM and Kizito PM
Paediatric injuries are among the leading causes of morbidity and mortality globally, especially in low- and middle-income countries. We aimed to characterize paediatric injuries as predictors of disposition from Mbarara Regional Referral Hospital Emergency Department (ED) Southwestern Uganda.
Undergraduate acute care clinical competencies for managing acute care cases in adult patients within a South African in-hospital environment: A modified Delphi Study
Jansen MJ, Hartman N and Grant D
With the increase of global population, there has been an increased demand for acute care services both locally and globally. In the absence of an acute care competency-based curriculum in South Africa, this study sought to identify the core competencies required by undergraduate medical students to safely manage adult patients within an acute care setting in a South African hospital environment.
The National Ambulance Service of Ghana: Changes in capacity and utilization over 20 years
Zakariah AN, Boateng E, Achena C, Ansong-Bridjan F and Mock C
Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas.
Outcome of non-traumatic coma in a tertiary referral hospital in Cameroon
Gams Massi D, Kedonkwo Mbogne AH, Siysi VV, Metogo Mbengono JA, Magnerou AM, Bila Lamou EG, Sini V, Mbonda Chimi PC, Doumbe J, Kuate Tegueu C and Yacouba MN
Coma is a medical emergency, and optimal management, especially in a resource-poor setting, depends on knowledge of its aetiology and predictors of outcome. This study aimed to provide hospital-based data on the prevalence, etiology, and outcome of non traumatic coma (NTC) in adults at a tertiary level in Cameroon.