Comparison of mean on-scene times: road versus air transportation of critically ill patients in the Western Cape of South Africa
ABSTRACT
Background: The South African setting lends itself to the extensive use of air transport. There is a perception with healthcare providers that flight crews spend too much time with a patient before departure. The main advantage of aero medical transport is to minimise the delay to definitive care and prolonged on-scene time defies this objective. A study was carried out to examine the mean on-scene times of aero medical and road transport of critically ill patients in the Western Cape of South Africa. Keep Reading
State of emergency medicine in South Africa
Abstract
Introduction: Emergency medicine is a new speciality in South Africa. It was first registered in 2003, and there are now 30 specialists in the country, with 10 new graduates from local registrar training programmes and over 40 trainees on four programmes across the country. Keep Reading
Emergency department procedural sedation practice in Cape Town, South Africa
Abstract
Background: There are no general policies or protocols for procedural sedation in the emergency department and no literature on present practice in South Africa. Keep Reading
A procedure based alternative to the injury severity score for major incident triage of children: results of a Delphi consensus process
ABSTRACT
Background: Triage at the site of a major incident is key to effective scene management. A number of triage algorithms have been suggested to assist the triage officer to determine triage priorities. However, many advocated scores were not specifically developed for use in major incidents, nor are they designed for multiple age groups.
Many of these algorithms have not been validated: those that have were validated against the Injury Severity Score, which is of little relevance in a major incident—it is the urgency of medical intervention that is of importance in this setting. Keep Reading
Validation of the Paediatric Triage Tape
ABSTRACT
Introduction: The Paediatric Triage Tape (PTT) is an easy to use major incident primary triage tool, based upon a modification of the Triage Sieve. The purpose of this study was to prospectively validate the PTT for use in paediatric major incidents. Keep Reading
The cape triage score: a new triage system South Africa. Proposal from the cape triage group
ABSTRACT
The Cape Triage Group (CTG) convened with the intention of producing a triage system for the Western Cape, and eventually South Africa. The group includes in-hospital and prehospital staff from varied backgrounds. The CTG triage protocol is termed the Cape Triage Score (CTG), and has been developed by a multi-disciplinary panel, through best available evidence and expert opinion. The CTS has been validated in several studies, and was launched across the Western Cape on 1 January 2006.
Comparison of paediatric major incident primary triage tools
ABSTRACT
Objectives: To determine the sensitivity and specificity of paediatric major incident triage scores. The Paediatric Triage Tape (PTT), Careflight, Simple Triage and Rapid Treatment (START), and JumpSTART systems were tested.
Methods: In total, 3461 children presenting to a South African emergency department with trauma were scored using the four different methods. The sensitivity and specificity of the four scores was calculated against the Injury Severity Score (ISS), New ISS (NISS), and a modification of the Garner criteria (a measure of need for urgent clinical intervention). We also performed a Bayesian analysis of the scores against three different types of major incident.
Results: None of the tools showed high sensitivity and specificity. Overall, the Careflight score had the best performance in terms of sensitivity and specificity. The performance of the PTT was very similar. In contrast, the JumpSTART and START scores had very low sensitivities, which meant that they failed to identify patients with serious injury, and would have missed the majority of seriously injured casualties in the models of major incidents.
Conclusion: The Careflight or PTT methods of triage should be used in paediatric major incidents in preference to the jumpSTART or START methods.
Effect of introduction of nurse triage on waiting times in a South African emergency department
ABSTRACT
Background: In a resource poor setting with poverty, a high burden of disease and critically low medical staff numbers, triage could potentially improve the long waiting times experienced at South African public hospital emergency departments (ED) and render timely emergency care to those in most need. Keep Reading
Limitations in validating emergency department triage scales
ABSTRACT
Objective: To examine whether current validation methods of emergency department triage scales actually assess the instrument’s validity.
Methods: Optimal methods of emergency department triage scale validation are examined in developed countries and their application to developing countries is considered.
Results and conclusion: Numerous limitations are embedded in the process of validating triage scales. Methods of triage scale validation in developed countries may not be appropriate and repeatable in developing countries. Even in developed countries there are problems in conceptualising validation methods. A new consensus building validation approach has been constructed and recommended for a developing country setting. The Delphi method, a consensual validation process, is advanced as a more appropriate alternative for validating triage scales in developing countries.
Imaging the oesophagus after penetrating cervical trauma using water-soluble contrast alone: simple, cost-effective and accurate
ABSTRACT
Aim: This audit aims to gauge the safety and efficacy of iso-oncotic water-soluble contrast media as the sole imaging evaluation of the distal pharynx and cervical oesophagus after penetrating cervical trauma.
Methods: A retrospective audit was performed over a 4-year period of all patients with penetrating cervical trauma to zones 1 and 2 of the neck who were subjected to imaging evaluation as part of a selective non-operative management policy for penetrating cervical trauma. The outcome was reviewed and the sensitivity, specificity and predictive values of the investigation were determined. The surgical management of identified injuries is also described.
Results: Four hundred and sixty-five contrast studies were included with 11 studies positive for pathology (9 injuries, 2 incidental findings). Surgery was undertaken in 4 patients with cervical oesophageal injuries and conservative management was carried out in 5 cases of distal pharyngeal injury. No missed injuries and no significant adverse events were identified during the study period.
Conclusion: A contrast study of the oesophagus with water-soluble iso-oncotic contrast media as the sole diagnostic imaging modality is safe (avoiding the risk of aspiration pneumonia), reliable (identifying all injuries) and cost-efficient (avoiding the need for additional expensive investigations) in cases of penetrating cervical trauma.