Total Care for the Burn Patient
Looking at Your Patient’s Feet
Common Cutaneous Emergencies
Burn Wound Evaluation
Tanzanian Meeting, 25 Nov 2009
Cape Town International Convention Centre
1. ATTENDANCE LIST
2. PPT (view presentation here)
SJ gave an overview via power point.
This power point is attached to these minutes (SJ to please distribute).
There has been a contribution of 3 million dollars from the Abbott fund.
The Emergency Department has hoping as four resus beds and 10 treatment rooms with appropriate support areas and a computerized record system.
There will be extensive bedside testing.
A SWOT analysis has been undertaken.
Strengths
- There are existing specialty support structures in place
- There is a Head of Department in place
- There is funding available
- There is government support at Ministerial level
- The Head of Department is a very respected anaesthetist and second doctor in the department is a trauma specialist
- Fourteen medical officers are being hired for the project
- These doctors can rotate through UCT / Wits for two or three months experience each
Weaknesses
- There is no triage system
- There is no training
- There are no logistics
- There are no protocols etc, etc
Opportunities
- There is an opportunity to improve outcomes clinically to undertake academic and research projects to raise public awareness
- To address the burden of disease and to put residency training in place
Threats
- It’s the only Emergency Department in the City of 4m; this may impact on its ability to change things
- Staff turn-over
- Inter-departmental conflicts
- Recurrent funding from Abbott
- Ownership and buy-in by government
3. STRATEGY
The strategy for Tanzania is to develop Emergency Care using local resources.
That needs be an International Emergency Medicine fellowship and public private partnership.
An ED registry would also be important to drive information.
The needs includes
a) Leadership
To provide the African perspective and develop networks
Provide healthcare management training and develop an Emergency Medicine Society
b) Logistics
To produce reliable procurement and re supplying maintenance systems
To standardise essential equipment list
To buy best practises for cell phone communication and best practises for internet access To build three to four new Emergency Departments.
It was also noted that WHO checklist approach would be ideal for this sort of development.
c) Operations
Sharing of resources and protocols an assistance forum will helpful
d) Administration
e) Finance
Out of budget and resource constrain setting and options for other revenue streams.
f) Planning
Strategic plan for Emergency Medicine Development in Africa and information clearing as for Emergency Medicine Department in Africa
g) Training
A Hybrid programme with Tanzania curriculum co-ordination, grandfathering processes, maximizing education resources’ and faculty sharing.
h) Research
Database options and grant options
There is clearly a need to add EMS into this mix too and there is discussion around to how best advised to development. College of Emergency Medicine South Africa offered to run the DIPPEC in Tanzania only if there was sufficient interest. Ultrasound training can be run as a satellite from Cape Town. LW will provide the IFEM undergraduate curriculum to SJ.
VK may have some funding options. She has been involved in a Canadian driven project in another part of Tanzania and it became clear following the meeting that there were other project ongoing which just needed co-ordinated better.
4. PLAN
The plan going forward was agreed on as follow:
a) To link into the newly formed African Federation of Emergency Medicine as the engine for support and co-ordination resources.
b) To develop a formal list of emergency care needs using the existing 30 part data collection tool (TM to provide).
c) To develop a list of international emergency medicine resources that currently exist for these needs.
d) To develop possible partners
e) To develop a list of possible funding
f) To develop a final plan based on this
All were thanked for attending and LW will develop a distribution list and hope to generate ongoing interest and involvement.
African Journal of Emergency Medicine: Minutes, 25 Nov 2009
Cape Town International Convention Centre
1. ATTENDANCE
Everyone was welcomed to the meeting.
The description point was around the need for a journal, if there was a need the logistics of the journal in terms of online vs print, Medline indexing and so on, and the composition of editorial board / peer review process.
2. DISCUSSION
- There was clearly agreed need for a journal.
- This must be Africa centric
- It must be the same standard of other journals but have in it aims and objectives to increase the access to publication for the African Emergency Care practitioners.
- It must be African focused and relevant.
- It must be period.
Everyone agreed it must be medline indexed and listed with appropriate organizations for funding through universities such as the (South African Department of Education).
There was a lot of discussion around internet verses print. Most people felt that internet is the right way to go and the journal task team will have to look at this.
The international forum of journal editors may help to build journal editorial capacity. They may also be able to provide some advice on how to go to setting up the journal.
There may be a need to publish work at a lower standard initially. Use of a peer and mentor system to hold the hands of authors and develop a co-author network would also be really helpful. Tim Coats’ course may be a vehicle for improving writing skills. It was also suggested that the journal can publish a series of commission articles to help people write. More details provided later.
Tim Coats was recently involved in a launch of Scandinavian journal. It has been directed at the community of Emergency Care to guide the conversation in emergency care in that area that includes critical appraisal, applying evidence, network building and international development articles. This would be very helpful in our settings. We would need to start with a higher proportion of commissioned articles initially.
Access and funding will be a real issue and it wasn’t rely clear how to do that other then this should be initially open access to try and drive leadership. Where internet access is poor printed special editions on certain topics may well help to get the message out on this.
It was accepted that it is going to take 5 years or so to look how we really want it to look. There was discussion that a board when establish should have representation from each of the major countries. Following discussions around the African Federation of Emergency Medicine it was felt that actually housing the journal under the federation would be most sensible way to ensure representivity and ease of access.
3. PLAN GOING FORWARD
Under AFEM a task team has been established one of the functions is of which to look at the issue of a journal. The task team is actually looking at services so may need a sub-committee with co-opted members from outside to address all of the important points about the journal.
The task team should look at funding options, internet verses print options, how to set up an editorial board, how to set up a advisory committee and how more sort of commission articles would be the best place to start. Suggested things include writing articles, reading articles,
International emergency medicine development, how to take overseas literature and how to implement it in a resource constrain setting and scans of other journal articles such as the EMJ Sophia system.
Botswana Meeting: Minutes, 24 Nov 2009
Cape Town International Convention Centre
1. ATTENDANCE LIST
2. GENERAL OVERVIEW
Dr Kestler discussed the private hospital developments and the need to start a residency program from January 2011. There is a lot of nongovernmental organisation and private sector interest and development but these are not really joined up in a cohesive way. All sites are actively recruiting, the number one priority is to have more feet on the ground and the number two priority is to make better use of the existing resources.
Dr Corder gave some details on the hospital and private side Bokomoso. They are using the train a trainers system where overseas experts train locals. One of the key features is to try and recruit expats back into the country.
The university of Botswana timeline needs to have a postgraduate programme in place by January 2011 and this training will accure at Princess Marina state hospital. There are a lot of process improvement steps currently going on. In 2012 or 2013 there will be a new teaching hospital opening.
Questions from the floor were directed at the panel. Discussion point included that the university will train medical students, nurses (as currently being trained) and allied health professions. There is no EMS training or system of note. All EMS services are in the private sector. The health professions board recognises EMS but is not in the pay system for government therefore it’s going to be some time before a government system can be establish.
Medical student training began in August 2009. There will be Medicine and Paeds postgraduate programmes next year: Emergency Medicine and Family Medicine in January 2011; Surgery and Obstetrics possibly and the end of 2011.
The aim is to recruit 60 doctors back into Botswana each year. Most hospitals are run by general Medical Officers.
LW will provide AK with the IFEM curriculum for medical students.
The vision for Emergency Care in Botswana relates to the training projection. The population is under two million and in Gaborone two hundred thousand. The ED see’s 30 000 to 40 000 patients a year. Lower level hospitals see around 15 000 patients per year. Smaller places run on generalists. The aim is to have Gaborone and Francistown with 24 hour Emergency physician coverage eventually.
Co-ordination of effective outreach is the key. Resuscitation training is critical and a Resus council / CEM(South Africa) are key in this.
Rene Grobler pointed out that some postgraduate nurse training has occurred and this needs continue. The Emergency Nursing association drives this process and it is likely that Rene could get further funding for this. LW to pick up with RG to discuss how ENSSA could help with this.
The South African Triage Scale is being modified. There is a proposal to rename it the Southern African Triage Scale which would give Southern African countries more freedom to modify it. This will be discussed at the EMSSA exco.
It was noted that this was a tremendous opportunity to start with no system and then end up with a fully developed system. Therefore we should be using every chance to write up what we are doing so that other countries can learn from it. There is no point repeatedly re-inventing the wheels. To drive this data collection would need start now. AK and BC are looking into this aspect.
A lot of the resources required are already available somewhere in the international community. This is not only academic and research resources but also developmental. The big question that needs answering is, what is the appropriate vehicle to drive co-ordination and implementation of all these resources not only in Botswana but through-out developing African Countries in general.
UB has a fund for five specialist salaries. There is no other public sector funding at the moment. The MBA fund pays for road accident victims at care and they are willing partners for the trauma working group around injury prevention and so on. This may be a source of potential funding.
The College of Emergency Medicine offered to run a DIPPEC examination in Gabarone if there was enough interest there.
Ultrasound training can be done collaboratively with outreach from Cape Town.
3. PLAN
The plan going forward was agreed on as follow:
a) To link into the newly formed African Federation of Emergency Medicine as the engine for support and co-ordination resources.
b) To develop a formal list of emergency care needs using the existing 30 part data collection tool (TM to supply).
c) To develop a list of international emergency medicine resources that currently exist for these needs.
d) To develop possible partners
e) To develop a list of possible funding
f) To develop a final plan based on this
4. FINAL
This meeting was very well attended and shows how much interest there is in support in the local area.
All were thanked for attending and LW will develop a distribution list and hope to generate ongoing interest and involvement.
The African Federation for Emergency Medicine
ANNOUNCEMENT
FORMATION OF
THE AFRICAN FEDERATION FOR EMERGENCY MEDICINE
“SUPPORTING EMERGENCY CARE ACROSS AFRICA”
November 26, 2009 at 12:00 noon
CAPE TOWN, SOUTH AFRICA
We are proud to announce the formation of the African Federation for Emergency Medicine (AFEM), dedicated to “Supporting Emergency Care Across Africa”. Lee Wallis, President of the Emergency Medicine Society for South Africa (EMSSA), organized several meetings on this and other topics during the 2nd EMSSA “EM in the Developing World” Conference, held from 24-26 November, 2009, at the Cape Town International Conference Centre. The AFEM will act as a formative, “umbrella” organization for all the existing and future African National EM Societies. EMSSA is the first and only national EM Society in Africa, but many more are on the brink of formation, including Botswana, Ghana, Kenya, Ethiopia and others. AFEM is also proud to announce that they will accept as full members and / or member societies other health professionals and health professional societies, including EM nursing, EMT’s and paramedics, in recognition of the multi-lateral, multi-disciplinary, multi-professional nature of emergency medicine and acute care. The conference also saw the official formation of the Emergency Nursing Society of South Africa (ENSSA), as an equal-member sub-group of EMSSA, as a further reflection of our natural partnership with the specialty of emergency nursing. The current AFEM interim Executive Committee of 9 elected persons will determine over the oncoming months the ultimate structure of AFEM; 5 initial committees (Identity; Governance, Membership, Terms of Reference and Services) were formed to assist in this most crucial phase.
The Interim Executive Committee is:
Chair – Lee Wallis
Vice Chair – Conrad Buckle
Secretary – Charles Otieno
Officers – Sebastian Spencer, Petra Brysiewicz, Valerie Krym, Steve Justus, Terry Mulligan, Bob Corder
Also announced at the EMSSA conference during these same talks was the formation of the African Journal of Emergency Medicine, a peer-reviewed, indexed journal to be dedicated to clinical, academic and developmental aspects of emergency medicine in the many and varied nations of Africa and elsewhere in the developing world. While the exact details of this journal and the plans for its ultimate structure remain in the planning stages, we are proud to announce this new addition to the growing family of academic and scientific emergency medicine journals.
We welcome the advice and participation of our colleagues in emergency medicine, emergency nursing, pre-hospital emergency care and in all areas of acute care and emergency medicine to join with us and to assist us in the formation of this monumental organization, and we look forward to your active membership in the months and years to come.
For any information, or to be part of this exciting development, contact admin@afem.info
Plea to the South African public: It’s time to learn CPR!
Resuscitation Council of Southern Africa
72 Sophia Street, Fairland, 2170, Johannesburg,
South Africa
Tel: 011-478-3989 Fax: 011-678-5087
www.resuscitationcouncil.co.za
30 November 2009
PLEA TO THE SOUTH AFRICAN PUBLIC – IT’S TIME TO LEARN CPR!
INTRODUCTION
Our aim at the Resuscitation Council of Southern Africa (RCSA) is to get as many people in the region trained in cardio-pulmonary resuscitation (CPR) as possible. It is a simple, practical life-saving skill that is best learnt through practise and ought to be compulsory for everyone. The intent of this RCSA “CPR Saves Lives” campaign is focused on encouraging and urging more bystanders to attempt CPR because without any CPR effort, a victim of sudden collapse who is not breathing stands no chance of survival.
To illustrate, drowning incidents feature on the news often during the summer months. Unfortunately these reports – tragically often involving children – are not unusual at this time of year and more will inevitably feature before the end of the year. As we go into the holiday season, we at the RCSA are thus desperately appealing to the South African public to participate in some formal CPR training to help a victim of drowning or sudden cardiac arrest, to indeed help save a life!
The Resuscitation Council of SA promotes CPR training to the public and health professions alike. Because effective CPR can double or triple a victim’s chance of survival, this skill demands training and practice. The Resuscitation Council of SA website, www.resuscitationcouncil.co.za can be consulted for further details of a training provider near you who you can contact to arrange training for a nominal fee.
One will not forget the day one was unable to assist a victim in sudden cardiac arrest! You can make a difference – learn CPR! That’s the message we want to strongly advocate.
As a Section 21 Company, the RCSA does not have access to significant resources to market our guidelines. However, we do indeed want to be proactive by making our CPR algorithms available to all forms of media in the region, to promote the competency of CPR, and more importantly to persuade people to to learn CPR skills by participating in a recognised RCSA CPR course. It is vital to practise – these courses for the lay public are quick, easy, fun and follow international scientific guidelines!
BACKGROUND
Established in 1988 as an Association not for gain, the Resuscitation Council of Southern Africa (RCSA) is a Section 21 Company, a voluntary organisation that aims to foster & coordinate the practice & teaching of resuscitation, & to promote standardisation of resuscitation techniques in Southern Africa. The objectives of the RCSA are:
➢ To gather & collate scientific information regarding resuscitation techniques & to disseminate this information to all interested parties.
➢ To provide an advisory & resource service regarding techniques, equipment, teaching methods & teaching aids.
➢ To foster research into methods of practice & teaching of resuscitation.
➢ To pursue the development of standards for resuscitation equipment & to provide simplicity & uniformity in techniques & terminology regarding resuscitation.
➢ To establish regular communications with other bodies with similar objectives, both in Southern Africa & abroad, & to provide a forum for discussion of all aspects of resuscitation.
The RCSA has developed an impressive training infrastructure throughout the region, promoting resuscitation training programs & awareness countrywide. As a founder member of the International Liaison Committee on Resuscitation (ILCOR), the RCSA continues to actively contribute to the global resuscitation science review & development of consensus guidelines.
In 1995, the RCSA adopted the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) programs and guidelines to deliver training, and endorsed these as the minimum standard for resuscitation practice in SA. The RCSA is an International Training Organisation (ITO) of the AHA, and has many training centres – BLS, ACLS & PALS – registered under its ambit in Southern Africa. The RCSA is in fact one of the stronger and most highly regarded ITOs globally and we are immensely proud of the standards and quality maintained by our dedicated training network. Current official AHA certification is often required by premier employers to indicate continuing professional development and represents a resounding endorsement of RCSA training quality.
Courses offered by RCSA registered instructors at registered Training Centres are listed on our website www.resuscitationcouncil.co.za and include the following:
• CPR for Family & Friends – a convenient 3-hr practical course for the lay public.
• Heartsaver CPR; Heartsaver AED; Heartsaver CPR in Schools; Heartsaver First Aid
• Basic Life Support for Health Care Providers – a course for health care professionals
CPR works! CPR saves lives!
The research evidence over the last five years has proved it over and over again – cardiopulmonary resuscitation (CPR) is simple and it really does work! The intent and scope of this Resuscitation Council of Southern Africa campaign is focused on encouraging and urging more bystanders to attempt CPR – without any CPR effort, a victim of sudden collapse who is not breathing stands no chance of survival.
All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (i.e., chest compressions of adequate rate and depth with minimal interruptions). Trained or untrained bystanders should at least call the emergency medical response system (in South Africa dial 112 on a cell phone or 10177 on a landline), and provide high-quality chest compressions by pushing hard and fast in the centre of the chest, minimising interruptions.
The American Heart Association (AHA), the European Resuscitation Council (ERC) and the RCSA have recently published statements regarding bystander CPR. The AHA suggests that when a trained or untrained bystander witnesses the sudden collapse of an adult, at a minimum, hands-only CPR should be initiated. It is thus proposed that the bystander should give chest compressions without ventilations, i.e. chest compression-only CPR, if they feel unwilling, unable or unconfident to perform the rescue breaths. It is better to do compression-only CPR than no CPR at all.
You CANNOT learn CPR by reading – you must practise on a manikin!
Bystanders who witness the sudden collapse of an adult should immediately assess the patient for a response. If the patient does not respond in any way, the EMS (emergency medical services) should immediately be activated. Dial 112 on a cell phone or 10177 on a landline to access the EMS. The victim should be placed on a hard, flat surface and in the absence of normal breathing, 2 mouth-to-mouth breaths can be given. Once these 2 breaths have been administered, the victim’s chest should be compressed, with the palms of both hands placed on the centre of the chest, between the nipples, 30 times at a rate of 100/min. Alternate 30 chest compressions with 2 mouth-to-mouth ventilations. Continue these cycles until the Automated External Defibrillator (AED) arrives and is ready for use or until the EMS arrives.
If however, the rescuer is unable or unwilling to do mouth-to-mouth breaths, then chest compression-only CPR is the next best option. Pushing hard and fast in the middle of the victim’s chest, with minimal interruption is the most vital part of the CPR effort.
CPR at its simplest requires a rescuer to:
➢ Call for help if the victim is unresponsive,
➢ Push on the chest if the victim is not breathing normally, and
➢ Recharge the Automated External Defibrillator if one is available.
This “Simply CPR” approach, advocated by Prof Efraim Kramer, Dept Emergency Medicine at Wits Faculty of Health Sciences, reinforces the key concepts crucial to effective CPR. These are easily learnt and practiced and everyone in the community and the health care setting is strongly advised to seek training to learn CPR.
This statement calls attention to the dire need to know how to perform CPR. It is a life-skill that ought to be taught to everyone, so that more people can help a victim of sudden cardiac arrest, to indeed help save a life! If a bystander does nothing in this situation, the victim remains dead. If one is willing, trained and confident, give the person two breaths after every cycle of 30 chest compressions. If one is unwilling or unable to give the mouth-to-mouth breaths, as the next best option chest compression-only CPR is acceptable and will be way more beneficial that attempting nothing at all.
The Resuscitation Council of SA promotes CPR training to the public and health professions alike. Because effective CPR can double or triple a victim’s chance of survival, this skill demands training and practice. Please consult the Resuscitation Council of SA website, www.resuscitationcouncil.co.za for further details of a training provider in your area. You will not forget the day you were unable to assist a victim in sudden cardiac arrest! You can make a difference – learn CPR!
Warm regards
Martin Botha
Chairman: Resuscitation Council of SA
mbotha@vodamail.co.za