African Journal of Emergency Medicine最新文献_第4页

Performance of shock index, lactate and physician’s gestalt in predicting adverse events among critically ill adult patients at an Emergency Department in Tanzania 休克指数、乳酸和医生格式塔在预测坦桑尼亚急诊科危重成人患者不良事件中的表现

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-10-23 DOI: 10.1016/j.afjem.2025.100914

Humphrey G. Medarakini , Alphonce N. Simbila , Ellen Weber , Zeinab B. Hassan , Florian Vedasto , Jennifer Tesha , Rebecca N. Tugara , Peter P. Kunambi , Elizabeth Bernard , Said S. Kilindimo

Introduction

Physicians working in Emergency Departments (ED) must be able to identify critically ill patients likely to deteriorate and prioritize their care. While shock index, point of lactate and physician gestalt are commonly used in high-income countries to predict adverse events their applicability has not been widely tested in low-middle income countries.

Methods

A prospective cohort study of all adult patients (≥18 years) triaged to the resuscitation area of Muhimbili ED in Tanzania from 1^st September - 31^st December 2022. Shock index (SI) on arrival, initial point of care lactate and the physician’s estimates of the probability of an adverse event were recorded. The discriminatory ability of these index tests was compared for prediction of an adverse event in the ED, using DeLong’s test. Sensitivity, specificity, positive and negative predictive values were calculated. For SI, a standard cut off ≥ 1 was used and for lactate a standard cut off > 2 mmol/L was used. For physician gestalt, the optimum cut off of a 70 % probability of adverse event was determined based on Youdens’ index.

Results

A total of 320 critically ill patients were enrolled. SI (AUC = 0.734, 95 % CI 0.658 to 0.810) achieved a sensitivity of 59.3 % and a specificity of 83.1 %. Elevated lactate (AUC = 0.819, 95 % CI 0.76 to 0.88) achieved a sensitivity of 89.8 % and a specificity of 58.2 %. Physician gestalt had an AUC = 0.877, (95 % CI 0.833 to 0.922) using the optimal probability of ≥70 % and achieved a sensitivity of 88.1 % and a specificity of 76.2 %. The AUC of physician’s gestalt was significantly higher than that of SI (p = 0.0008), but was not significantly different from lactate (p = 0.067). The difference in AUC for lactate and SI was also not statistically significant (p = 0.10).

Discussion

Physicians gestalt in our setting demonstrated superior predictive performance compared to shock index and a comparable performance to lactate. This supports the use of gestalt as a low-resource risk stratification tool in emergency settings. However, accuracy of gestalt may depend on physician experience.

在急诊科（ED）工作的医生必须能够识别可能恶化的危重病人，并优先考虑他们的护理。虽然休克指数、乳酸点和医师格式塔在高收入国家常用来预测不良事件，但它们在中低收入国家的适用性尚未得到广泛测试。方法对2022年9月1日至12月31日在坦桑尼亚Muhimbili ED复苏区分类的所有成年患者（≥18岁）进行前瞻性队列研究。记录到达时的休克指数（SI）、初始护理点乳酸和医生对不良事件概率的估计。采用DeLong试验比较这些指标试验预测ED不良事件的区分能力。计算敏感性、特异性、阳性预测值和阴性预测值。SI采用标准截止值≥1，乳酸采用标准截止值2 mmol/L。对于完形医生来说，不良事件概率为70%的最佳临界值是根据Youdens指数确定的。结果共纳入320例危重患者。SI （AUC = 0.734, 95% CI 0.658 ~ 0.810）的敏感性为59.3%，特异性为83.1%。乳酸浓度升高（AUC = 0.819, 95% CI 0.76 ~ 0.88）的敏感性为89.8%，特异性为58.2%。医师格式塔的AUC = 0.877 (95% CI 0.833 ~ 0.922)，最佳概率≥70%，灵敏度为88.1%，特异性为76.2%。医师格式塔的AUC显著高于SI (p = 0.0008)，但与乳酸无显著差异（p = 0.067）。乳酸和SI的AUC差异也无统计学意义（p = 0.10）。讨论：在我们的研究中，医师格式塔比休克指数和乳酸盐表现出更优越的预测性能。这支持在紧急情况下使用格式塔作为低资源风险分层工具。然而，格式塔的准确性可能取决于医生的经验。

{"title":"Performance of shock index, lactate and physician’s gestalt in predicting adverse events among critically ill adult patients at an Emergency Department in Tanzania","authors":"Humphrey G. Medarakini , Alphonce N. Simbila , Ellen Weber , Zeinab B. Hassan , Florian Vedasto , Jennifer Tesha , Rebecca N. Tugara , Peter P. Kunambi , Elizabeth Bernard , Said S. Kilindimo","doi":"10.1016/j.afjem.2025.100914","DOIUrl":"10.1016/j.afjem.2025.100914","url":null,"abstract":"<div><h3>Introduction</h3><div>Physicians working in Emergency Departments (ED) must be able to identify critically ill patients likely to deteriorate and prioritize their care. While shock index, point of lactate and physician gestalt are commonly used in high-income countries to predict adverse events their applicability has not been widely tested in low-middle income countries.</div></div><div><h3>Methods</h3><div>A prospective cohort study of all adult patients (≥18 years) triaged to the resuscitation area of Muhimbili ED in Tanzania from 1<sup>st</sup> September - 31<sup>st</sup> December 2022. Shock index (SI) on arrival, initial point of care lactate and the physician’s estimates of the probability of an adverse event were recorded. The discriminatory ability of these index tests was compared for prediction of an adverse event in the ED, using DeLong’s test. Sensitivity, specificity, positive and negative predictive values were calculated. For SI, a standard cut off ≥ 1 was used and for lactate a standard cut off > 2 mmol/L was used. For physician gestalt, the optimum cut off of a 70 % probability of adverse event was determined based on Youdens’ index.</div></div><div><h3>Results</h3><div>A total of 320 critically ill patients were enrolled. SI (AUC = 0.734, 95 % CI 0.658 to 0.810) achieved a sensitivity of 59.3 % and a specificity of 83.1 %. Elevated lactate (AUC = 0.819, 95 % CI 0.76 to 0.88) achieved a sensitivity of 89.8 % and a specificity of 58.2 %. Physician gestalt had an AUC = 0.877, (95 % CI 0.833 to 0.922) using the optimal probability of ≥70 % and achieved a sensitivity of 88.1 % and a specificity of 76.2 %. The AUC of physician’s gestalt was significantly higher than that of SI (<em>p</em> = 0.0008), but was not significantly different from lactate (<em>p</em> = 0.067). The difference in AUC for lactate and SI was also not statistically significant (<em>p</em> = 0.10).</div></div><div><h3>Discussion</h3><div>Physicians gestalt in our setting demonstrated superior predictive performance compared to shock index and a comparable performance to lactate. This supports the use of gestalt as a low-resource risk stratification tool in emergency settings. However, accuracy of gestalt may depend on physician experience.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100914"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Consensus-based research priorities for post-collision care in the Western Cape province of South Africa 南非西开普省碰撞后护理基于共识的研究重点

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-05 DOI: 10.1016/j.afjem.2025.100900

Naseef Abdullah , Tim Nutbeam , Colleen J. Saunders , Craig Wylie , Nigel Lang , Willem Stassen

Introduction

Road traffic injuries constitute a significant global health burden, causing 1.3 million deaths and 50 million injuries annually, with 92 % of fatalities occurring in low-and middle-income countries (LMICs). Despite this disproportionate impact, research priorities in post-collision care often reflect high-income country contexts, creating a critical misalignment between evidence generation and contextual realities in LMICs.

Methods

This mixed-methods study employed a three-phase approach to identify research priorities for post-collision care in the Western Cape, South Africa. Phase 1 consisted of a comprehensive literature review to identify preliminary thematic areas and research questions. Phase 2 involved a stakeholder engagement workshop using modified nominal group techniques (NGT) with purposively sampled participants representing emergency medical services, fire services, law enforcement, community members and academia. Phase 3 entailed systematic prioritisation, where participants independently scored each theme and associated research questions on a Likert scale.

Results

Eight thematic domains were identified and ranked in order of priority. EMS safety (highest priority), communication and coordination, public awareness and prevention, transportation and access to care, first-responder capabilities, training implementation, resource optimisation, disaster and mass casualty management, and specialised care accessibility. The highest-ranked individual research question concerned the minimum set of practical skills and resources required by first responders to effectively provide immediate post-collision care. Technological integration emerged as a cross-cutting priority across multiple themes.

Conclusion

The study represents the first published systematic approach to identifying post-collision care research priorities in South Africa. Diverging from previous exercises that emphasise advanced interventions or system integration, this study highlights foundational challenges of EMS safety and communication as top priorities, reflecting the contextual realities of emergency service delivery in South Africa. The findings provide a strategic roadmap for researchers, funders, and policymakers to direct resources toward questions with maximal potential to improve post-collision care and strengthen health systems in similar LMIC contexts.

道路交通伤害是一个重大的全球健康负担，每年造成130万人死亡和5000万人受伤，其中92%的死亡发生在低收入和中等收入国家。尽管存在这种不成比例的影响，但碰撞后护理的研究重点往往反映高收入国家的情况，从而在中低收入国家的证据生成与背景现实之间造成严重不一致。方法这项混合方法研究采用三阶段方法来确定南非西开普省碰撞后护理的研究重点。第一阶段包括全面的文献综述，以确定初步的专题领域和研究问题。第二阶段涉及一个利益攸关方参与讲习班，使用改进的名义团体技术（NGT），有目的地抽样了代表紧急医疗服务、消防服务、执法部门、社区成员和学术界的参与者。第三阶段需要系统的优先排序，参与者在李克特量表上独立地对每个主题和相关研究问题进行评分。结果确定了8个专题领域，并对其进行了优先级排序。EMS安全（最高优先级）、沟通和协调、公众意识和预防、运输和获得护理、第一响应者能力、培训实施、资源优化、灾难和大规模伤亡管理，以及专业护理的可及性。排名最高的个人研究问题涉及第一响应者有效提供碰撞后立即护理所需的最低实用技能和资源。技术整合成为跨多个主题的跨领域优先事项。该研究代表了首次发表的确定南非碰撞后护理研究重点的系统方法。与以往强调先进干预措施或系统集成的演习不同，本研究强调了EMS安全和通信的基本挑战，将其作为首要任务，反映了南非紧急服务提供的背景现实。研究结果为研究人员、资助者和政策制定者提供了一个战略路线图，以便将资源用于最有可能改善碰撞后护理和加强类似低收入和中等收入国家卫生系统的问题。

{"title":"Consensus-based research priorities for post-collision care in the Western Cape province of South Africa","authors":"Naseef Abdullah , Tim Nutbeam , Colleen J. Saunders , Craig Wylie , Nigel Lang , Willem Stassen","doi":"10.1016/j.afjem.2025.100900","DOIUrl":"10.1016/j.afjem.2025.100900","url":null,"abstract":"<div><h3>Introduction</h3><div>Road traffic injuries constitute a significant global health burden, causing 1.3 million deaths and 50 million injuries annually, with 92 % of fatalities occurring in low-and middle-income countries (LMICs). Despite this disproportionate impact, research priorities in post-collision care often reflect high-income country contexts, creating a critical misalignment between evidence generation and contextual realities in LMICs.</div></div><div><h3>Methods</h3><div>This mixed-methods study employed a three-phase approach to identify research priorities for post-collision care in the Western Cape, South Africa. Phase 1 consisted of a comprehensive literature review to identify preliminary thematic areas and research questions. Phase 2 involved a stakeholder engagement workshop using modified nominal group techniques (NGT) with purposively sampled participants representing emergency medical services, fire services, law enforcement, community members and academia. Phase 3 entailed systematic prioritisation, where participants independently scored each theme and associated research questions on a Likert scale.</div></div><div><h3>Results</h3><div>Eight thematic domains were identified and ranked in order of priority. EMS safety (highest priority), communication and coordination, public awareness and prevention, transportation and access to care, first-responder capabilities, training implementation, resource optimisation, disaster and mass casualty management, and specialised care accessibility. The highest-ranked individual research question concerned the minimum set of practical skills and resources required by first responders to effectively provide immediate post-collision care. Technological integration emerged as a cross-cutting priority across multiple themes.</div></div><div><h3>Conclusion</h3><div>The study represents the first published systematic approach to identifying post-collision care research priorities in South Africa. Diverging from previous exercises that emphasise advanced interventions or system integration, this study highlights foundational challenges of EMS safety and communication as top priorities, reflecting the contextual realities of emergency service delivery in South Africa. The findings provide a strategic roadmap for researchers, funders, and policymakers to direct resources toward questions with maximal potential to improve post-collision care and strengthen health systems in similar LMIC contexts.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100900"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An assessment of emergency care capacity at three hospitals in the Harare metropol, Zimbabwe: A descriptive cross-sectional study using the WHO Hospital Emergency Assessment Tool (HEAT) 对津巴布韦哈拉雷市三家医院急诊护理能力的评估：使用世卫组织医院急诊评估工具（HEAT）的描述性横断面研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-13 DOI: 10.1016/j.afjem.2025.100915

Prince Deka, Peter Hodkinson

Introduction

Zimbabwe has experienced significant population growth, as well as a rise in noncommunicable diseases, impacting the demand for emergency care services. However, there is limited data on the state of Zimbabwe's emergency care systems to meet this growing need. This pilot study aimed to assess the capacity of Emergency Departments at three major referral hospitals in Harare, Zimbabwe.

Methodology

A cross-sectional descriptive study was conducted using the World Health Organization’s Hospital Emergency Assessment Tool (HEAT). Key participants from each hospital were interviewed in 2023 to gather data on facility characteristics, human resources, diagnostic services, and signal functions.

Results

Three large hospitals offering round-the-clock emergency care services were included. A core of dedicated doctors and nurses manned the Emergency Department in all three facilities, yet none had specific training in emergency medicine. There were various significant challenges to the operation of emergency departments, including access to water for one, and two with limited capacity to perform emergency diagnostic tests as they lacked the necessary equipment and consumables. One hospital reported a sufficient set of emergency protocols and guidelines, while the other two hospitals exhibited varying levels of availability in these areas. Two facilities reported adequate capacity in performing >85 % of signal functions. Common challenges included the absence of emergency-trained staff, lack of a formal triage system, and equipment deficiencies, all of which constrained their ability to deliver certain signal functions.

Conclusion

This assessment revealed a spectrum of service availabilities across the three hospitals, with common barriers identified. To strengthen the country's emergency care system, efforts should be focused on improving consumable supplies, prioritising training initiatives in emergency medicine to build a skilled workforce and implementing standardised protocols and triage systems across facilities. Continuous monitoring and evaluation of implemented interventions are necessary to ensure sustainable improvements in emergency care delivery.

津巴布韦人口大幅增长，非传染性疾病也有所增加，影响了对紧急护理服务的需求。然而，关于津巴布韦紧急护理系统状况的数据有限，无法满足这一日益增长的需求。这项试点研究的目的是评估津巴布韦哈拉雷三家主要转诊医院急诊科的能力。方法采用世界卫生组织医院紧急情况评估工具（HEAT）进行横断面描述性研究。2023年对每家医院的主要参与者进行了访谈，以收集有关设施特征、人力资源、诊断服务和信号功能的数据。结果纳入3家提供24小时急诊服务的大型医院。三家医院的急诊科都有一群敬业的医生和护士，但没有人接受过急诊医学方面的专门培训。急诊部门的运作面临各种重大挑战，包括一个部门无法获得水，两个部门进行紧急诊断测试的能力有限，因为它们缺乏必要的设备和消耗品。一家医院报告说有一套足够的急救规程和准则，而另外两家医院在这些领域显示出不同程度的可用性。两个设施报告有足够的能力执行85%的信号功能。常见的挑战包括缺乏受过紧急训练的工作人员、缺乏正式的分流系统和设备不足，所有这些都限制了他们提供某些信号功能的能力。结论：该评估揭示了三家医院的服务可用性，并确定了共同的障碍。为了加强国家的紧急护理系统，应将工作重点放在改善消耗品供应、优先考虑急诊医学培训举措，以建立一支熟练的劳动力队伍，并在各设施实施标准化协议和分诊系统。必须持续监测和评估实施的干预措施，以确保持续改善急诊服务。

{"title":"An assessment of emergency care capacity at three hospitals in the Harare metropol, Zimbabwe: A descriptive cross-sectional study using the WHO Hospital Emergency Assessment Tool (HEAT)","authors":"Prince Deka, Peter Hodkinson","doi":"10.1016/j.afjem.2025.100915","DOIUrl":"10.1016/j.afjem.2025.100915","url":null,"abstract":"<div><h3>Introduction</h3><div>Zimbabwe has experienced significant population growth, as well as a rise in noncommunicable diseases, impacting the demand for emergency care services. However, there is limited data on the state of Zimbabwe's emergency care systems to meet this growing need. This pilot study aimed to assess the capacity of Emergency Departments at three major referral hospitals in Harare, Zimbabwe.</div></div><div><h3>Methodology</h3><div>A cross-sectional descriptive study was conducted using the World Health Organization’s Hospital Emergency Assessment Tool (HEAT). Key participants from each hospital were interviewed in 2023 to gather data on facility characteristics, human resources, diagnostic services, and signal functions.</div></div><div><h3>Results</h3><div>Three large hospitals offering round-the-clock emergency care services were included. A core of dedicated doctors and nurses manned the Emergency Department in all three facilities, yet none had specific training in emergency medicine. There were various significant challenges to the operation of emergency departments, including access to water for one, and two with limited capacity to perform emergency diagnostic tests as they lacked the necessary equipment and consumables. One hospital reported a sufficient set of emergency protocols and guidelines, while the other two hospitals exhibited varying levels of availability in these areas. Two facilities reported adequate capacity in performing >85 % of signal functions. Common challenges included the absence of emergency-trained staff, lack of a formal triage system, and equipment deficiencies, all of which constrained their ability to deliver certain signal functions.</div></div><div><h3>Conclusion</h3><div>This assessment revealed a spectrum of service availabilities across the three hospitals, with common barriers identified. To strengthen the country's emergency care system, efforts should be focused on improving consumable supplies, prioritising training initiatives in emergency medicine to build a skilled workforce and implementing standardised protocols and triage systems across facilities. Continuous monitoring and evaluation of implemented interventions are necessary to ensure sustainable improvements in emergency care delivery.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100915"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nurses’ knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana 加纳一家转诊医院的护士在院内心脏骤停期间的知识和自我报告对高级生命支持指南的遵守情况

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-17 DOI: 10.1016/j.afjem.2025.100903

Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo

Introduction

Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.

Methods

A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.

Results

Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.

Discussion

Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies

在心脏骤停期间，坚持高级生命支持指南对于提高患者生存率至关重要。护士通常是院内心脏骤停的第一反应者。本研究评估了护士对高级生命支持指南的知识，以及他们在院内心脏骤停期间对推荐做法的自我报告依从性。方法采用描述性横断面设计。采用简单随机抽样的方法，从加纳新塔福政府医院招募了138名注册护士。使用结构化问卷收集参与者的社会人口学特征、对高级生命支持指南的知识和自我报告的依从性的相关数据。采用描述性统计和推理统计进行分析。结果不到一半（39.9%）的护士表现出对高级生命支持指南的良好了解，相似比例（34.8%）的护士在模拟情景中表现出高度的自我报告对高级生命支持指南的遵守，对心脏骤停的反应有信心（39.8%）。大多数受访者（65.2%）从未在临床环境中实施过心肺复苏术，只有22.5%参加过模拟演习。最近的高级生命支持培训（过去12个月内）和更多年的临床经验与更高的知识水平显着相关。讨论护士对高级生命支持指南的知识和自我报告的依从性，以及应对心脏骤停情况的信心水平较低。定期的、结构化的高级生命支持复习培训，包括模拟和实际演练，对于提高护士在心脏紧急情况下的准备和表现至关重要

{"title":"Nurses’ knowledge and self-reported adherence to advanced life support guidelines during in-hospital cardiac arrest in a referral hospital in Ghana","authors":"Gyimaa Nti –Darkwah , Susana Erica Somuah , Amos Prince Otuah , Mary Agongo","doi":"10.1016/j.afjem.2025.100903","DOIUrl":"10.1016/j.afjem.2025.100903","url":null,"abstract":"<div><h3>Introduction</h3><div>Adherence to Advanced Life Support guidelines is vital for improving patient survival during a cardiac arrest. Nurses are often the first responders during inhospital cardiac arrests. This study assessed nurses’ knowledge of advanced life support guidelines and their self-reported adherence to recommended practices during in-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was employed. Using simple random sampling, 138 registered nurses were recruited from the New Tafo Government Hospital in Ghana. A structured questionnaire was used to collect relevant data on the participants’ sociodemographic characteristics, knowledge on and self-reported adherence to advanced life support guidelines. Descriptive and inferential statistics were used for analysis.</div></div><div><h3>Results</h3><div>Less than half (39.9%) of nurses demonstrated good knowledge of advanced life support guidelines, with a similar proportion (34.8%) showing high self-reported adherence to advanced life support guidelines in simulated scenarios, and confidence level (39.8%) in responding to a cardiac arrest. Most respondents (65.2%) had never performed CPR in a clinical setting, and only 22.5% had participated in a simulation exercise. Recent advanced life support training (within the past 12 months) and greater years of clinical experience were significantly associated with higher knowledge levels.</div></div><div><h3>Discussion</h3><div>Nurses’ knowledge of and self-reported adherence to advanced life support guidelines, as well as confidence level in responding to a cardiac arrest situation were low. Regular, structured advanced life support refresher training incorporating simulation and practical drills is essential to enhance nurses’ readiness and performance during cardiac emergencies</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100903"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prehospital care utilization and associated factors among trauma patients during armed conflict: A mixed-methods study in west Amhara, Ethiopia referral hospitals 武装冲突期间创伤患者院前护理的利用及其相关因素：埃塞俄比亚西阿姆哈拉转诊医院的混合方法研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-26 DOI: 10.1016/j.afjem.2025.100931

Temesgen Ayenew , Mengistu Abebe Messelu , Haile Amha , Mamaru Getie Fetene , Fentahun Minwuyelet Yitayew , Anteneh Belayneh , Abere Kassie , Getinet Nibret , Bekele Getenet Tiruneh

Background

Prehospital care is vital for reducing mortality from traumatic injuries, especially in low- and middle-income countries. This study determined prehospital care utilization and associated factors among trauma patients in referral hospitals in West Amhara, Ethiopia.

Methods

A concurrent triangulation mixed-methods design was employed from March–August 2024 in Debre Markos, Tibebe Ghion, and Felege Hiwot hospitals. Quantitative data were collected from 518 trauma patients via questionnaire, with proportional allocation based on patient flow, and analyzed using logistic regression to identify factors associated with prehospital care use. Qualitative data were collected through semi-structured interviews with healthcare professionals and trauma patients, reported in line with the Consolidated criteria for reporting qualitative research (COREQ) checklist. Reflexive thematic analysis guided by the WHO Emergency Care System Framework was used, integrating quantitative and qualitative findings while maintaining reflexivity to understand prehospital care utilization.

Results

The prehospital care utilization rate was 49.8 %. The majority of patients (84.2 %) arrived at hospitals via taxi or on foot, reflecting reliance on non-EMS transport. Rural residence (AOR = 4.80), lower education (AOR = 0.54), violence/quarrel-related injuries (AOR = 2.60), motor vehicle accidents (AOR = 2.00), gunshot injuries (AOR = 8.61), and penetrating injuries (AOR = 0.34) were significantly associated with prehospital care use.

Qualitative findings revealed challenges across four themes

Limited awareness and lack of emergency communication systems during initial contact and dispatch (Scene); scarce ambulances, long response times, and reliance on non-EMS transport in prehospital treatment and transportation (Transport); resource and personnel shortages that indirectly affect prehospital response within facility-based emergency care linkages (Facility); and the need for Advocacy and Public Education.

Conclusion

Prehospital care utilization is sub-optimal, influenced by sociodemographic and injury-related factors. Qualitative insights reveal systemic and community challenges that warrant further investigation through larger, more representative studies.

院前护理对于降低外伤死亡率至关重要，特别是在低收入和中等收入国家。本研究确定了在西阿姆哈拉，埃塞俄比亚转诊医院创伤患者院前护理的利用和相关因素。方法于2024年3 - 8月在Debre Markos、Tibebe gion和freelege Hiwot医院采用并行三角测量混合方法设计。采用问卷调查的方式收集518例创伤患者的定量数据，根据患者流量进行比例分配，并采用logistic回归分析确定院前护理使用的相关因素。通过对医疗保健专业人员和创伤患者的半结构化访谈收集定性数据，并根据定性研究报告综合标准（COREQ）清单进行报告。采用了以世卫组织紧急护理系统框架为指导的反思性专题分析，在保持反思性的同时整合定量和定性研究结果，以了解院前护理的利用情况。结果院前护理使用率为49.8%。大多数患者（84.2%）通过出租车或步行到达医院，反映了对非ems运输的依赖。农村居民（AOR = 4.80）、低学历（AOR = 0.54）、暴力/争吵伤害（AOR = 2.60）、机动车事故（AOR = 2.00）、枪伤（AOR = 8.61）、穿透伤（AOR = 0.34）与院前护理使用显著相关。定性调查结果揭示了四个主题的挑战：在最初接触和调度期间，意识有限，缺乏应急通信系统（现场）；救护车稀少，反应时间长，院前治疗和运输依赖非ems运输（transport）；资源和人员短缺间接影响到以设施为基础的急救联系中的院前反应（设施）；以及宣传和公共教育的必要性。结论院前护理利用不理想，受社会人口学和伤害相关因素的影响。定性的见解揭示了系统性和社区的挑战，需要通过更大、更有代表性的研究进行进一步的调查。

{"title":"Prehospital care utilization and associated factors among trauma patients during armed conflict: A mixed-methods study in west Amhara, Ethiopia referral hospitals","authors":"Temesgen Ayenew , Mengistu Abebe Messelu , Haile Amha , Mamaru Getie Fetene , Fentahun Minwuyelet Yitayew , Anteneh Belayneh , Abere Kassie , Getinet Nibret , Bekele Getenet Tiruneh","doi":"10.1016/j.afjem.2025.100931","DOIUrl":"10.1016/j.afjem.2025.100931","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital care is vital for reducing mortality from traumatic injuries, especially in low- and middle-income countries. This study determined prehospital care utilization and associated factors among trauma patients in referral hospitals in West Amhara, Ethiopia.</div></div><div><h3>Methods</h3><div>A concurrent triangulation mixed-methods design was employed from March–August 2024 in Debre Markos, Tibebe Ghion, and Felege Hiwot hospitals. Quantitative data were collected from 518 trauma patients via questionnaire, with proportional allocation based on patient flow, and analyzed using logistic regression to identify factors associated with prehospital care use. Qualitative data were collected through semi-structured interviews with healthcare professionals and trauma patients, reported in line with the Consolidated criteria for reporting qualitative research (COREQ) checklist. Reflexive thematic analysis guided by the WHO Emergency Care System Framework was used, integrating quantitative and qualitative findings while maintaining reflexivity to understand prehospital care utilization.</div></div><div><h3>Results</h3><div>The prehospital care utilization rate was 49.8 %. The majority of patients (84.2 %) arrived at hospitals via taxi or on foot, reflecting reliance on non-EMS transport. Rural residence (AOR = 4.80), lower education (AOR = 0.54), violence/quarrel-related injuries (AOR = 2.60), motor vehicle accidents (AOR = 2.00), gunshot injuries (AOR = 8.61), and penetrating injuries (AOR = 0.34) were significantly associated with prehospital care use.</div></div><div><h3>Qualitative findings revealed challenges across four themes</h3><div>Limited awareness and lack of emergency communication systems during initial contact and dispatch (<em>Scene</em>); scarce ambulances, long response times, and reliance on non-EMS transport in prehospital treatment and transportation (<em>Transport</em>); resource and personnel shortages that indirectly affect prehospital response within facility-based emergency care linkages (<em>Facility</em>); and the need for <em>Advocacy and Public Education.</em></div></div><div><h3>Conclusion</h3><div>Prehospital care utilization is sub-optimal, influenced by sociodemographic and injury-related factors. Qualitative insights reveal systemic and community challenges that warrant further investigation through larger, more representative studies.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100931"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing junior doctors' knowledge and attitude on advanced life support in Egypt: a cross-sectional study 评估初级医生对埃及晚期生命支持的知识和态度：一项横断面研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-25 DOI: 10.1016/j.afjem.2025.100927

Yasser Ahmed Khalid , Mohamed Bosily Saad , Mohamed Ezzat Nasreddin

Introduction

Cardiovascular diseases are a leading cause of mortality worldwide, with cardiac arrest survival heavily dependent on timely and effective resuscitation efforts. Junior doctors often serve as first responders in hospitals, yet their advanced life support (ALS) knowledge and training adequacy remain underinvestigated in Egypt. This study assessed the knowledge and attitudes of junior doctors in Egypt regarding basic life support (BLS) and ALS, identified knowledge gaps, and suggests improvements in resuscitation training programs.

Methods

A cross-sectional survey was conducted among 184 junior doctors, including house officers, general practitioners, and residents, across multiple healthcare centres in Egypt. Data was collected via an online questionnaire based on European Resuscitation Council guidelines, evaluating demographic factors, BLS/ALS knowledge, and attitudes toward cardiac arrest management. Statistical analysis explored associations between knowledge scores and participant characteristics.

Results

Participants demonstrated inadequate knowledge with mean BLS and ALS scores of 59 % and 61.8 %, respectively. Significant deficiencies were noted in pediatric resuscitation, cardiac arrest diagnosis, IV access, and capnography interpretation. Residents and those attending ALS workshops scored significantly higher (p < 0.05), while prior clinical exposure did not correlate with higher knowledge scores. Most participants (91.3%) expressed a need for further ALS training.

Discussion

Junior doctors in Egypt show deficient ALS knowledge with critical gaps that may impact patient outcomes. Structured ALS training and curriculum reforms are urgently needed to enhance emergency preparedness and improve cardiac arrest survival.

心血管疾病是世界范围内死亡的主要原因，心脏骤停的生存严重依赖于及时有效的复苏努力。初级医生通常是医院的第一响应者，但他们的高级生命支持（ALS）知识和培训充足性在埃及仍未得到充分调查。本研究评估了埃及初级医生关于基本生命支持（BLS）和ALS的知识和态度，确定了知识差距，并提出了复苏培训计划的改进建议。方法对184名初级医生进行横断面调查，包括住院医生、全科医生和住院医生，来自埃及多个医疗保健中心。数据通过基于欧洲复苏委员会指南的在线问卷收集，评估人口统计学因素、BLS/ALS知识和对心脏骤停管理的态度。统计分析探讨了知识得分与参与者特征之间的关系。结果受试者的BLS和ALS平均得分分别为59%和61.8%。在儿科复苏、心脏骤停诊断、静脉注射和血管造影解释方面存在显著缺陷。住院医师和参加ALS研讨会的患者得分显著高于其他患者（p < 0.05），而先前的临床暴露与更高的知识得分无关。大多数参与者（91.3%）表示需要进一步的ALS培训。讨论埃及的初级医生对渐冻症的了解不足，存在可能影响患者预后的严重差距。迫切需要结构化的ALS培训和课程改革，以加强应急准备和提高心脏骤停存活率。

{"title":"Assessing junior doctors' knowledge and attitude on advanced life support in Egypt: a cross-sectional study","authors":"Yasser Ahmed Khalid , Mohamed Bosily Saad , Mohamed Ezzat Nasreddin","doi":"10.1016/j.afjem.2025.100927","DOIUrl":"10.1016/j.afjem.2025.100927","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular diseases are a leading cause of mortality worldwide, with cardiac arrest survival heavily dependent on timely and effective resuscitation efforts. Junior doctors often serve as first responders in hospitals, yet their advanced life support (ALS) knowledge and training adequacy remain underinvestigated in Egypt. This study assessed the knowledge and attitudes of junior doctors in Egypt regarding basic life support (BLS) and ALS, identified knowledge gaps, and suggests improvements in resuscitation training programs.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted among 184 junior doctors, including house officers, general practitioners, and residents, across multiple healthcare centres in Egypt. Data was collected via an online questionnaire based on European Resuscitation Council guidelines, evaluating demographic factors, BLS/ALS knowledge, and attitudes toward cardiac arrest management. Statistical analysis explored associations between knowledge scores and participant characteristics.</div></div><div><h3>Results</h3><div>Participants demonstrated inadequate knowledge with mean BLS and ALS scores of 59 % and 61.8 %, respectively. Significant deficiencies were noted in pediatric resuscitation, cardiac arrest diagnosis, IV access, and capnography interpretation. Residents and those attending ALS workshops scored significantly higher (<em>p</em> < 0.05), while prior clinical exposure did not correlate with higher knowledge scores. Most participants (91.3%) expressed a need for further ALS training.</div></div><div><h3>Discussion</h3><div>Junior doctors in Egypt show deficient ALS knowledge with critical gaps that may impact patient outcomes. Structured ALS training and curriculum reforms are urgently needed to enhance emergency preparedness and improve cardiac arrest survival.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100927"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Embracing 3D printing in emergency medicine training in Africa 在非洲急诊医学培训中采用3D打印技术

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-13 DOI: 10.1016/j.afjem.2025.100904

Marvin Jansen, Fahmi Adams

Africa's emergency medicine training faces challenges of limited resources, inadequate simulation tools, and few locally relevant training models. This article explores how three-dimensional (3D) printing can help address these gaps by enabling the creation of affordable, customizable models for procedural skills and simulation-based education. We discuss the context of emergency medicine training in Africa, where limited access to high-fidelity manikins and other teaching aids hampers skills acquisition. The model printing format may be of limited applicability in the context of dynamic simulations, where the model is required to interact and perform a function, versus static simulation, with the emphasis on identification and directed procedures. We highlight illustrative use cases, including a 3D-printed airway management manikin and a basic suturing practice pad, to demonstrate the technology’s potential for hands-on learning. Key benefits of integrating 3D printing into training programs are examined, such as improved access to simulation, better local adaptability, and increased opportunity for producing affordable task trainers that are suited for hands-on emergency procedures. We also acknowledge challenges, from startup costs and infrastructure needs to the learning curve of 3D printers and suggest practical steps for implementation. This commentary encourages educators and institutions in Africa to explore 3D printing for education, and we envision it becoming integral to emergency medicine training across the continent; fostering skill development, self-sufficiency, and ultimately improving patient care.

非洲的急诊医学培训面临着资源有限、模拟工具不足以及缺乏与当地相关的培训模式等挑战。本文探讨了三维（3D）打印如何通过为程序技能和基于模拟的教育创建负担得起的、可定制的模型来帮助解决这些差距。我们讨论了非洲急诊医学培训的背景，在那里，高保真人体模型和其他教学辅助工具的有限获取阻碍了技能的获得。模型打印格式在动态仿真环境中可能适用性有限，在动态仿真环境中，需要模型进行交互并执行功能，而静态仿真环境则强调识别和指导过程。我们重点介绍了说导性用例，包括3d打印气道管理假人和基本缝合练习垫，以展示该技术在实践学习方面的潜力。研究了将3D打印集成到培训计划中的主要好处，例如改进模拟访问，更好的本地适应性，以及增加生产适合动手紧急程序的负担得起的任务培训器的机会。我们也承认挑战，从启动成本和基础设施需要3D打印机的学习曲线，并建议实施的实际步骤。这篇评论鼓励非洲的教育工作者和机构探索3D打印教育，我们设想它将成为整个非洲大陆急诊医学培训的一部分；促进技能发展，自给自足，并最终改善病人护理。

{"title":"Embracing 3D printing in emergency medicine training in Africa","authors":"Marvin Jansen, Fahmi Adams","doi":"10.1016/j.afjem.2025.100904","DOIUrl":"10.1016/j.afjem.2025.100904","url":null,"abstract":"<div><div>Africa's emergency medicine training faces challenges of limited resources, inadequate simulation tools, and few locally relevant training models. This article explores how three-dimensional (3D) printing can help address these gaps by enabling the creation of affordable, customizable models for procedural skills and simulation-based education. We discuss the context of emergency medicine training in Africa, where limited access to high-fidelity manikins and other teaching aids hampers skills acquisition. The model printing format may be of limited applicability in the context of dynamic simulations, where the model is required to interact and perform a function, versus static simulation, with the emphasis on identification and directed procedures. We highlight illustrative use cases, including a 3D-printed airway management manikin and a basic suturing practice pad, to demonstrate the technology’s potential for hands-on learning. Key benefits of integrating 3D printing into training programs are examined, such as improved access to simulation, better local adaptability, and increased opportunity for producing affordable task trainers that are suited for hands-on emergency procedures. We also acknowledge challenges, from startup costs and infrastructure needs to the learning curve of 3D printers and suggest practical steps for implementation. This commentary encourages educators and institutions in Africa to explore 3D printing for education, and we envision it becoming integral to emergency medicine training across the continent; fostering skill development, self-sufficiency, and ultimately improving patient care.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100904"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Knowledge, attitude and practice of emergency care providers on obstetric haemorrhage in KwaZulu-Natal, South Africa: A cross-sectional study 南非夸祖鲁-纳塔尔省紧急护理提供者对产科出血的知识、态度和做法：一项横断面研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-27 DOI: 10.1016/j.afjem.2025.100909

S Govender , OP Khaliq , T Abel , J Moodley

Background

Obstetric haemorrhage (OH) is a leading cause of maternal deaths worldwide. The South African Department of Health recommends that all childbirths be managed by skilled personnel who can identify and manage complications to reduce adverse maternal, perinatal and neonatal outcomes. Emergency Care (EC) providers are prehospital personnel mandated to fulfil this role; however, little is known about their knowledge, attitudes and practices (KAP) for OH emergencies. This study assesses EC providers’ knowledge (specifically pathophysiology, diagnosis and treatment), attitude and practices regarding OH management in KwaZulu-Natal (KZN), South Africa.

Methods

A cross-sectional KAP survey was administered to public-sector EC providers at designated central locations in each of the 11 KZN districts, with participants representing multiple ambulance stations in their respective districts. Data were collected through a structured questionnaire completed by 417 participants enrolled between July 2022 and August 2023. Modified Bloom’s cut-off points were used to develop KAP scores, enabling categorical assessment. Data analysis included descriptive and inferential statistics.

Results

Participants (n = 417) were predominantly male (75.3 %, n = 314). The majority were aged ≥40 years (66.4 %, n = 277), ranging from 18 to 60 years. Regarding OH, 95.7 % demonstrated poor knowledge, 65.5 % a positive attitude and 96.6 % poor practices. The Kruskal-Wallis test (p < 0.001) showed knowledge scores varied substantially by qualification level. Logistic regression indicated higher qualifications were associated with better knowledge, attitude and practices.

Conclusion

Targeted up-skilling and mandatory obstetric simulation for EC providers in KZN are needed to close knowledge-practice gaps. Despite a positive attitude, EC providers demonstrated poor knowledge and practices in OH management. These shortcomings appear influenced by systemic and contextual barriers and require further investigation. Nevertheless, our findings highlight the importance of sustained, targeted training and EMS support to address critical gaps and improve obstetric outcomes in emergency settings.

背景产科出血（OH）是全世界孕产妇死亡的主要原因。南非卫生部建议，所有分娩应由能够识别和处理并发症的熟练人员进行管理，以减少孕产妇、围产期和新生儿的不良后果。急诊服务提供者是受命履行这一职责的院前工作人员；然而，对他们的知识，态度和实践（KAP）对OH紧急情况知之甚少。本研究评估了南非夸祖鲁-纳塔尔省（KZN） EC提供者关于OH管理的知识（特别是病理生理学、诊断和治疗）、态度和做法。方法在KZN 11个区的指定中心地点对公共部门EC提供者进行了横断面KAP调查，参与者代表各自地区的多个救护站。数据通过结构化问卷收集，417名参与者在2022年7月至2023年8月期间注册。采用改良的Bloom分界点编制KAP分数，进行分类评估。数据分析包括描述性统计和推断性统计。结果417例患者以男性为主（75.3 %,n = 314）。年龄≥40岁（66.4%,n = 277）居多，年龄在18 ~ 60岁之间。对于健康护理，95.7%的人表现为知识贫乏，65.5%的人表现为积极态度，96.6%的人表现为行为不良。Kruskal-Wallis检验（p < 0.001）显示知识得分因资格水平的不同而有很大差异。逻辑回归显示，学历越高，知识、态度和行为越好。结论有针对性的技能提升和强制性产科模拟需要在KZN的EC提供者缩小知识和实践差距。尽管态度积极，但电子商务提供者在OH管理方面表现出较差的知识和实践。这些缺点似乎受到系统和背景障碍的影响，需要进一步调查。然而，我们的研究结果强调了持续的、有针对性的培训和EMS支持对于解决紧急情况下的关键差距和改善产科结果的重要性。

{"title":"Knowledge, attitude and practice of emergency care providers on obstetric haemorrhage in KwaZulu-Natal, South Africa: A cross-sectional study","authors":"S Govender , OP Khaliq , T Abel , J Moodley","doi":"10.1016/j.afjem.2025.100909","DOIUrl":"10.1016/j.afjem.2025.100909","url":null,"abstract":"<div><h3>Background</h3><div>Obstetric haemorrhage (OH) is a leading cause of maternal deaths worldwide. The South African Department of Health recommends that all childbirths be managed by skilled personnel who can identify and manage complications to reduce adverse maternal, perinatal and neonatal outcomes. Emergency Care (EC) providers are prehospital personnel mandated to fulfil this role; however, little is known about their knowledge, attitudes and practices (KAP) for OH emergencies. This study assesses EC providers’ knowledge (specifically pathophysiology, diagnosis and treatment), attitude and practices regarding OH management in KwaZulu-Natal (KZN), South Africa.</div></div><div><h3>Methods</h3><div>A cross-sectional KAP survey was administered to public-sector EC providers at designated central locations in each of the 11 KZN districts, with participants representing multiple ambulance stations in their respective districts. Data were collected through a structured questionnaire completed by 417 participants enrolled between July 2022 and August 2023. Modified Bloom’s cut-off points were used to develop KAP scores, enabling categorical assessment. Data analysis included descriptive and inferential statistics.</div></div><div><h3>Results</h3><div>Participants (<em>n</em> = 417) were predominantly male (75.3 %, <em>n</em> = 314). The majority were aged ≥40 years (66.4 %, <em>n</em> = 277), ranging from 18 to 60 years. Regarding OH, 95.7 % demonstrated poor knowledge, 65.5 % a positive attitude and 96.6 % poor practices. The Kruskal-Wallis test (<em>p</em> < 0.001) showed knowledge scores varied substantially by qualification level. Logistic regression indicated higher qualifications were associated with better knowledge, attitude and practices.</div></div><div><h3>Conclusion</h3><div>Targeted up-skilling and mandatory obstetric simulation for EC providers in KZN are needed to close knowledge-practice gaps. Despite a positive attitude, EC providers demonstrated poor knowledge and practices in OH management. These shortcomings appear influenced by systemic and contextual barriers and require further investigation. Nevertheless, our findings highlight the importance of sustained, targeted training and EMS support to address critical gaps and improve obstetric outcomes in emergency settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100909"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Workplace violence against nurses in the Emergency Department in a Ghanaian Tertiary Hospital 加纳一家三级医院急诊部对护士的工作场所暴力

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-09-23 DOI: 10.1016/j.afjem.2025.100905

Florence Nana Amoah , Cecilia Eliason , William Wilberforce Amoah , Philemon Adoliwine Amooba

Introduction

Workplace Violence (WPV) is a shared problem in healthcare settings as well as a complex and perilous universal concern, specifically for the nursing profession. Violence in various Emergency Departments (ED) has increased in recent years, with accumulative data of nursing staff exposed to violent behaviors in the health sector that negatively affect the quality of care provided. However, limited research conducted in the Ghanaian context has subdued the understanding of workplace violence and its impact on emergency nurses.

Methods

A qualitative approach, using an explorative-descriptive design to delve into the experiences of nurses who have had WPV at the ED. A purposive sampling technique was used to select 20 participants. Data was collected using a semi-structured interview guide until saturation was attained. Thematic analysis approach was used to analyze the data.

Results

Four themes identified were understanding of WPV, coping strategies, effects on work performance, and experiences and responses to WPV. Participants reported encountering incidences of violence at the workplace. Abuse was perceived as predictable and increasing in intensity and frequency which victims acknowledged significantly affected both their level of devotion to their jobs and capacity to care for patients. The normalization of WPV has led to significant under-reporting of incidents.

Conclusion

The study identified verbal abuse as the leading cause of WPV, which greatly affects the service rendered to patients. Safe working environments, occupational health measures, and effective prevention policies and interventions are needed in emergency department settings.

工作场所暴力（WPV）是医疗保健环境中的一个共同问题，也是一个复杂而危险的普遍问题，特别是对护理专业而言。近年来，各急诊科的暴力事件有所增加，积累的数据表明，护理人员在卫生部门遭受暴力行为，对所提供的护理质量产生了负面影响。然而，在加纳背景下进行的有限研究削弱了对工作场所暴力及其对急诊护士影响的理解。方法采用定性方法，采用探索性描述设计，深入研究在急诊科接受过WPV的护士的经历。采用有目的抽样技术，选择20名参与者。使用半结构化访谈指南收集数据，直到达到饱和。采用主题分析法对数据进行分析。结果确定了四个主题，分别是对工作消极情绪的理解、应对策略、对工作绩效的影响以及对工作消极情绪的经历和反应。参与者报告了在工作场所遇到的暴力事件。虐待被认为是可预见的，而且强度和频率都在增加，受害者承认这大大影响了他们对工作的投入程度和照顾病人的能力。WPV的正常化导致严重漏报事件。结论言语虐待是WPV发生的主要原因，严重影响了对患者的服务。急诊科需要安全的工作环境、职业卫生措施以及有效的预防政策和干预措施。

{"title":"Workplace violence against nurses in the Emergency Department in a Ghanaian Tertiary Hospital","authors":"Florence Nana Amoah , Cecilia Eliason , William Wilberforce Amoah , Philemon Adoliwine Amooba","doi":"10.1016/j.afjem.2025.100905","DOIUrl":"10.1016/j.afjem.2025.100905","url":null,"abstract":"<div><h3>Introduction</h3><div>Workplace Violence (WPV) is a shared problem in healthcare settings as well as a complex and perilous universal concern, specifically for the nursing profession. Violence in various Emergency Departments (ED) has increased in recent years, with accumulative data of nursing staff exposed to violent behaviors in the health sector that negatively affect the quality of care provided. However, limited research conducted in the Ghanaian context has subdued the understanding of workplace violence and its impact on emergency nurses.</div></div><div><h3>Methods</h3><div>A qualitative approach, using an explorative-descriptive design to delve into the experiences of nurses who have had WPV at the ED. A purposive sampling technique was used to select 20 participants. Data was collected using a semi-structured interview guide until saturation was attained. Thematic analysis approach was used to analyze the data.</div></div><div><h3>Results</h3><div>Four themes identified were understanding of WPV, coping strategies, effects on work performance, and experiences and responses to WPV. Participants reported encountering incidences of violence at the workplace. Abuse was perceived as predictable and increasing in intensity and frequency which victims acknowledged significantly affected both their level of devotion to their jobs and capacity to care for patients. The normalization of WPV has led to significant under-reporting of incidents.</div></div><div><h3>Conclusion</h3><div>The study identified verbal abuse as the leading cause of WPV, which greatly affects the service rendered to patients. Safe working environments, occupational health measures, and effective prevention policies and interventions are needed in emergency department settings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100905"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trauma beyond the limbs: Epidemiology and outcomes of non-extremity penetrating trauma in a tertiary hospital Emergency Department, Eastern Cape, South Africa 四肢以外的创伤：南非东开普省一家三级医院急诊科非四肢穿透性创伤的流行病学和结果

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

African Journal of Emergency Medicine

Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.afjem.2025.100916

Laetitia Lüttich, Sian Geraty, Roshen Maharaj

Introduction

Trauma is a major health burden in low- to middle-income countries, with penetrating injuries being a leading cause of death. South Africa’s trauma rates are estimated to be 5–9 times higher than the global average. Penetrating injuries, compared to blunt trauma, carry higher morbidity and mortality. This study describes the epidemiology and resource burden of penetrating non-extremity injuries presenting to a teriary hospital Emergency Department (ED) in Gqeberha, South Africa.

Methods

This descriptive retrospective study was conducted at Livingstone Tertiary Hospital (LTH) ED in Gqeberha, Eastern Cape, and included all patients with non-extremity penetrating trauma from 1 June 2020 to 31 January 2021.

Results

During the study period, there were 6020 consecutive trauma presentations to the ED, of which 1107 cases met inclusion criteria and were included in the study. The study revealed a male predominance, with a male-to-female ratio of 5.6:1 (p < 0.001). The median age was 29 years (range: 1–80 years). Most patients presented over the weekend (Saturday and Sunday) [N = 488, 44%, p < 0.001] and after hours on weekdays (N = 444, 40%). Resource utilisation in the ED increased during these periods, including increased diagnostic imaging, procedural interventions, and blood product requests. Of the study participants, 828 (75%) were brought to the ED using private transport. There were a total of 30 deaths (3%), of which 17 (57%) were deceased on arrival in the ED; the remaining 13 deaths (43%) occurred while in the ED or after disposition to a specialist.

Conclusion

This study offers insight into the epidemiology and outcomes of non-extremity penetrating trauma, including prolonged hospital stays and ICU admissions. It underscores the need for multidisciplinary prevention strategies, structured trauma systems, and comparative research to guide best practices, improve resource allocation, and reduce the broader economic impact of trauma on individuals and communities.

在低收入和中等收入国家，创伤是一个主要的健康负担，穿透性损伤是死亡的主要原因。据估计，南非的创伤率是全球平均水平的5-9倍。与钝性创伤相比，穿透性损伤具有更高的发病率和死亡率。本研究描述了南非Gqeberha一家三级医院急诊科（ED）的穿透性非四肢损伤的流行病学和资源负担。方法本描述性回顾性研究在东开普省Gqeberha的Livingstone三级医院（LTH） ED进行，纳入了2020年6月1日至2021年1月31日期间所有非四肢穿透性创伤患者。结果在研究期间，共有6020例外伤患者连续出现在急诊科，其中1107例符合纳入标准，被纳入研究。研究显示男性占优势，男女比例为5.6:1 （p < 0.001）。中位年龄为29岁（范围：1-80岁）。大多数患者在周末（周六和周日）就诊[N = 488, 44%, p < 0.001]，工作日下班后就诊（N = 444, 40%）。在此期间，急诊科的资源利用率增加，包括诊断成像、程序干预和血液制品需求增加。在研究参与者中，828人（75%）是乘坐私人交通工具去急诊室的。共有30例死亡（3%），其中17例（57%）在抵达急诊科时死亡；其余13例死亡（43%）发生在急诊科或交由专科治疗后。结论本研究提供了非四肢穿透性创伤的流行病学和结局，包括延长住院时间和ICU入院。它强调需要多学科预防策略、结构化创伤系统和比较研究来指导最佳实践，改善资源分配，并减少创伤对个人和社区的更广泛的经济影响。

{"title":"Trauma beyond the limbs: Epidemiology and outcomes of non-extremity penetrating trauma in a tertiary hospital Emergency Department, Eastern Cape, South Africa","authors":"Laetitia Lüttich, Sian Geraty, Roshen Maharaj","doi":"10.1016/j.afjem.2025.100916","DOIUrl":"10.1016/j.afjem.2025.100916","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is a major health burden in low- to middle-income countries, with penetrating injuries being a leading cause of death. South Africa’s trauma rates are estimated to be 5–9 times higher than the global average. Penetrating injuries, compared to blunt trauma, carry higher morbidity and mortality. This study describes the epidemiology and resource burden of penetrating non-extremity injuries presenting to a teriary hospital Emergency Department (ED) in Gqeberha, South Africa.</div></div><div><h3>Methods</h3><div>This descriptive retrospective study was conducted at Livingstone Tertiary Hospital (LTH) ED in Gqeberha, Eastern Cape, and included all patients with non-extremity penetrating trauma from 1 June 2020 to 31 January 2021.</div></div><div><h3>Results</h3><div>During the study period, there were 6020 consecutive trauma presentations to the ED, of which 1107 cases met inclusion criteria and were included in the study. The study revealed a male predominance, with a male-to-female ratio of 5.6:1 (<em>p</em> < 0.001). The median age was 29 years (range: 1–80 years). Most patients presented over the weekend (Saturday and Sunday) [<em>N</em> = 488, 44%, <em>p</em> < 0.001] and after hours on weekdays (<em>N</em> = 444, 40%). Resource utilisation in the ED increased during these periods, including increased diagnostic imaging, procedural interventions, and blood product requests. Of the study participants, 828 (75%) were brought to the ED using private transport. There were a total of 30 deaths (3%), of which 17 (57%) were deceased on arrival in the ED; the remaining 13 deaths (43%) occurred while in the ED or after disposition to a specialist.</div></div><div><h3>Conclusion</h3><div>This study offers insight into the epidemiology and outcomes of non-extremity penetrating trauma, including prolonged hospital stays and ICU admissions. It underscores the need for multidisciplinary prevention strategies, structured trauma systems, and comparative research to guide best practices, improve resource allocation, and reduce the broader economic impact of trauma on individuals and communities.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100916"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0