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Introduction Triage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH. Methods This cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12 years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached. Results 52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories. Conclusion Under-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses.

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SUMMARYBackground: We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. Design: A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting -pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. Participants: All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. Intervention: This was an observational study using qualitative and quantitative assessment techniques. Main outcome measures: The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. Results: NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. Conclusions:The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.

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Objective To establish the associations between pedestrian injury and explanatory variables such as vehicular characteristics, temporal trends, and road environment. Methods A retrospective analysis of de-identified pedestrian crash data between 2002 and 2006 was conducted using the Building & Road Research Institute’s crash data bank. We estimated the odds ratios associated with casualty fatalities using a multinomial logistic regression. Results There were 812 pedestrian casualties reported, out of which 33% were fatal, 45% sustained serious injuries requiring hospitalization, and 22% were slightly injured but were not hospitalized. Crossing the roadway accounted for over 70% of all pedestrians deaths. Whereas fatalities in 2002 and 2003 were statistically indistinguishable from those of 2004(p>0.05), in comparison with 2004, there were significantly fewer fatalities in 2005 and 2006 (78% and 65% reduction respectively). According to police report, the probability that a pedestrian fatality occurring in Ghana is attributable to excessive speeding is 65%. The adjusted odds ratio of pedestrian fatality associated with speeding compared with driver inattentiveness was 3.6(95% CI: 2.5 to 5.2). It was also observed that generally, lighter vehicular masses were associated with lower pedestrian fatalities. Compared with buses, pedestrians were less likely to die when struck by private cars (52%), pick-up trucks (57%), and motorcycles (86%). Conclusion Pedestrian death remains the leading cause of fatality among urban road users in Ghana. Risk factors associated with pedestrian fatality include being hit by heavy vehicles, speeding, and roadside activities such as street hawking, jaywalking and nighttime walking. Steps which may contribute to reducing pedestrian fatalities include measures to reduce vehicles speeds in settlements, providing traffic medians and lighting streets in settlements, and discouraging street and roadside activities such as hawking.

Problem International medical electives typically represent a unidirectional flow of students from economically advantaged countries in the global “North” to resource-poor nations in the global “South.” Little is known about the impact of bilateral exchanges on students from less affluent nations. Approach Since 2007, students from the University of Michigan Medical School (UMMS) and medical schools in Ghana have engaged in a bilateral clinical exchange program. A 45-item online survey was distributed to all 73 Ghanaian medical students who had rotated at UMMS from 2008 to 2010 to assess perspectives on the value and impact of their participation. Outcomes Incoming Ghanaian students outnumbered outgoing UMMS students 73 to 33 during the study period. Of eligible Ghanaian students, 70% (51/73) participated in the survey, with 40 of 51 providing valid data on at least 50% of questions. Ninety-seven percent (37/38) reported that the UMMS rotation was valuable to their medical training, 90% (35/39) reported changes in how they approach patient care, and 77% (24/31) reported feeling better equipped to serve patients in their home community. Eighty-five percent of students (28/33) felt more inclined to pursue training opportunities outside of their home country after their rotation at UMMS. Next Steps More studies are needed to determine the feasibility of bidirectional exchanges as well as the short-term and long-term impact of rotations on students from under-resourced settings and their hosts in more resource-rich environments.