Background: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. Methods: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. Results: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). Conclusions: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.
Objective: The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peerreviewed and gray literature. Methods: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that | 1329 TREHAN ET Al.
Structured summary 2Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.
Background:
The general public is unfamiliar with the concept of medical drones delivering life-saving technologies. Our research sought to define stakeholder attitudes towards development of drone-based emergency care for out-of-hospital cardiac arrest.
Methods:
Using qualitative methodology, we explored key stakeholder attitudes about using a drone to deliver automated external defibrillators (AED), challenges and facilitators to early establishment of a drone AED network, implementation considerations, and factors related to long-term sustainability. We identified 22 key individuals as potential respondents based on professional position; 16 respondents participated in data collection. Research participants included leaders in government, healthcare, emergency services, business, community, and the aviation industry (regulation and drone operation). Interview data were recorded and transcribed; data were analyzed using NVivo. A coding schema was developed based on constructs identified in previous literature and inductive consideration of this study’s data, including both thematic and descriptive coding.
Results:
We found broad support for a drone-delivered AED network. Such a network was perceived as valuable for reduced response times and for enhanced access to hard-to-reach areas. Identified challenges included operationalizing an autonomous drone AED network, privacy and safety concerns, current legal and regulatory requirements, financial liabilities, public buy-in and concern for public actually using an AED, and the need for research on treatment and cost- effectiveness of a drone network. Facilitators of development for a drone AED network included solidifying key partnerships (including integration into current EMS or fire services), identifying viable funding from private and public entities, and learning from existing drone models (e.g. commercial package or medical supply delivery).
Conclusion:
This study found general and conceptual support for the development of a drone network for AED delivery across key informants from an array of related fields. Such information should be considered in developing a regional drone AED network.
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