Access to out-of-hospital emergency care in Africa: Consensus conference recommendations

Stein, Christopher; Mould‐Millman, Nee‐Kofi; Vries, Shaheem de; Wallis, Lee

doi:10.1016/j.afjem.2016.08.008

Cited by 20 publications

(44 citation statements)

References 5 publications

(3 reference statements)

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“…Access to EMS in most low- and middle-income countries including the African continent is very limited [49–52]. According to Mould-Millman et al [28], 61.1% of African countries have no evidence of EMS systems.…”

Section: Discussionmentioning

confidence: 99%

Acute Pain in the African Prehospital Setting: A Scoping Review

Lourens

McCaul

Parker

et al. 2019

Pain Research and Management

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Background. Acute pain is a common reason for seeking prehospital emergency care. Regrettably, acute pain is often underestimated and poorly managed in this setting. The scoping review was conducted to gain insight into existing research on the topic and to make recommendations for future work. Objectives. To identify all available evidence related to acute pain assessment and management in the African prehospital setting, describe the extent of the evidence, encapsulate findings, and identify research gaps. Methods. The scoping review considered primary and secondary research related to acute pain assessment and management of both medical and traumatic origins in all age groups in the African prehospital setting. The search strategy aimed to identify published, unpublished, and ongoing research which met the inclusion criteria. Potentially eligible studies were identified by a comprehensive search of electronic databases, trial registers, dissertation/thesis databases, grey literature databases, and conference proceedings. Screening and data extraction were conducted independently and in duplicate. Results. The comprehensive search identified 3823 potential studies, duplicate titles were removed, and 3358 titles/abstracts were screened. Full text of 66 potentially eligible titles was screened, 60 were excluded, and six publications met the inclusion criteria. Despite recommendations for pain assessment during general patient care, most studies reported no/limited pain assessment. In general, pain management was concluded to be insufficient and not conforming to best practice. Conclusions. Only six publications addressing prehospital acute pain care in Africa could be identified, possibly indicative of a knowledge gap. Future research is indicated to enable a better understanding of the epidemiology of acute pain and barriers and enablers of acute pain care and to develop evidence-based clinical practice guidelines (CPGs) catering for all EMS systems in Africa. Additionally, educational initiatives should be implemented to improve the quality of acute pain care and to monitor quality through continuous quality improvement (CQI) programs.

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Section: Discussionmentioning

confidence: 99%

Acute Pain in the African Prehospital Setting: A Scoping Review

Lourens

McCaul

Parker

et al. 2019

Pain Research and Management

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“…Lack of awareness, accessibility challenges and the inappropriate utilization of emergency medical services (EMS) by the public are possible reasons for this delay. (10) In the work-up of a patient with a first-episode seizure, routine investigations such as full blood count, glucose, renal profile, electrolyte profile and toxicology screen are recommended as they may suggest the underlying aetiology and guide further management. (18) Venous blood gas analysis within the first hour has also been identified as a useful tool.…”

Section: Discussionmentioning

confidence: 99%

“…(9) In addition, difficulties in accessing healthcare services may result in delays in initiating treatment. (10) Local data and guidelines pertaining to the presentation and management of a first-episode seizure are lacking. The aim of this study was to describe the presentation and management of adult patients presenting to the ED with a first-episode seizure.…”

Section: Introductionmentioning

confidence: 99%

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

Sofola-Orukotan¹,

Motara²,

Bentley³

et al. 2019

Wits Journal of Clinical Medicine

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Background: First-onset seizures are not a diagnosis per se but may be a harbinger of a potentially life-threatening underlying illness. The aim of this pilot study was to describe the pattern of presentation of adults presenting with a first-onset seizure to the emergency department (ED). Methods: Medical records of patients >18 years who presented over a 6-month period (November 2016 to May 2017) to the study centre with a first-episode seizure were retrospectively reviewed. Results: A total of 60 patients, with a median age of 37.4 years (IQR; 29.3-47.7 years) presented with first-onset seizures over the study period. The median time to ED presentation after a seizure episode was 120 min (IQR; 51-244 min). More than half the number of subjects (58.3%) were male, 28.3% were HIV positive, 84.2% had a generalized tonic-clonic seizure and 56.7% required admission. A decrease in the level of consciousness, foaming around the mouth, tongue biting and urinary incontinence were evident in 76.7%, 36.7%, 31.7% and 33.3% of subjects, respectively. Hypoglycaemia (26.7%), ring-enhancing space occupying lesion/s (16.7%) and cerebrovascular infarction (11.7%) accounted for approximately two-thirds of causes of first-episode seizures. Long-acting anticonvulsants were administered to 66.7% of subjects in the ED and prescribed to 53.3% of subjects upon hospital discharge. Conclusion: Hypoglycaemia and intracranial pathologies are common causes of first-episode seizures that must be considered in all patients. The late presentation of patients to the ED in this pilot study is a major concern. Due to the high prevalence of HIV in South Africa, there is a need to develop local guidelines on the management of first-presentation seizures in HIV-positive as well as HIV-negative patients.

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“…A well-designed prehospital system is built on a centralized communications structure that allows the public to easily access the emergency care systems through a simple and free phone number [ 13 , 14 ]. Resources are coordinated in real time by a dispatcher, with ambulances scheduled and prepositioned based on historical data trends [ 15 ].…”

Section: The Components Of a High Quality Emergency Care Systemmentioning

confidence: 99%

Emergency care systems in Africa: A focus on quality

Kannan

Tenner

Sawe

et al. 2020

African Journal of Emergency Medicine

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Emergency care systems (ECS) are undergoing a period of rapid development on the African continent. What were formerly large intake zones are now being shaped into dedicated emergency units. Emergency care providers are being trained via certificate and even residency programs. However, significant challenges still exist. Resource limitations, staffing, and other system inputs are often the easiest issues to identify, but they only account for part of the problem. There are other prominent barriers to the delivery of high quality emergency care including lack of governmental leadership, poor system and facility organization, lack of provider training, and community misunderstanding of ECS functions. Released in May 2019, World Health Assembly (WHA) 72 resolution 12.9 “Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured” has squarely placed ECS strengthening as a priority item to member state governments. Moving forward, it will be important to ensure that these systems are set up for success, as high-quality emergency care systems have the potential to avert half of all deaths in low- and middle-income countries (LMIC). With momentum building from the recent WHA amendment and the health systems community more focused than ever on the consideration of quality in health systems design, it is of the utmost importance that ECS planners dovetail these interests such that these nascent systems are designed while 1) applying a systems thinking lens and 2) maintaining a focus on quality. This article helps to accomplish this by breaking down ECS into five major categories for evaluation as defined by the WHO Emergency Care Systems Assessment tool, providing an understanding of the functions of each, and identifying which indicators might be used to gauge performance. We also reinforce the notion that these indicators must dive deeper than system inputs and health outcomes, they must be patient centered in order to truly be reflective of success.

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Access to out-of-hospital emergency care in Africa: Consensus conference recommendations

Cited by 20 publications

References 5 publications

Acute Pain in the African Prehospital Setting: A Scoping Review

Acute Pain in the African Prehospital Setting: A Scoping Review

A Cross-sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates

Emergency care systems in Africa: A focus on quality

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