Chronic obstructive pulmonary disease: emergency care in acute exacerbation

Chronic obstructive pulmonary disease (COPD) is a preventable condition affecting more than 230 million people globally; and is expected to become the world's third largest cause of mortality by 2030. Despite this fact; it is thought to be widely underdiagnosed and underreported across the African continent. This presents a challenge to emergency medicine (EM) providers in the region; who are faced with treating large numbers of patients presenting with exacerbation of previously undiagnosed COPD. This is complicated by other factors; including lack of public awareness; high prevalence of other chronic respiratory illnesses; and difficulties in access to healthcare.The purpose of this paper is to outline the current state of research and international guidelines surrounding the management of acute exacerbation of COPD in the emergency centre. Strict adherence to international guidelines for management of acute exacerbation of COPD may be difficult for many African providers given factors affecting diagnosis; treatment; and access to care for many Africans suffering from COPD. Research looking into the role of the African EM practitioner in providing more cost-effective means of diagnosis and treatment of COPD is limited

Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: a qualitative study

Introduction :In 2002; the West-African nation of Gabon established an emergency medical system (EMS); Service d'Aide Medicale Urgente (SAMU); in Libreville; yet few people access it. Our objective was to describe Libreville residents' knowledge and attitudes toward the SAMU in an effort to understand why this service is underutilized. Methods :Qualitative interviews consisting of nine open-ended questions were conducted on a convenience sample of twenty patients; three visitors and two patient/visitor dyads at the Jeanne Ebori Hospital Emergency Centre in October 2009. Eligible subjects arrived in vehicles other than the SAMU and were ill enough to require hospital admission. Exclusion criteria were: under 21years old; unable to speak French; or medically unstable. A bilingual team member audio-recorded the interviews in French and transcribed them into eng. Investigators organized text into codes; then into themes and theoretical constructs. Intercoder agreement was excellent. Data were collected until theoretical saturation was achieved. Results: Analysis of data revealed no difference in response between patients and visitors. People underused SAMU because of financial costs; lack of awareness of the program; use of traditional modes of transportation; infrastructure flaws; perceived response times and other misconceptions. Conclusion: We identified remediable barriers to EMS (SAMU) access in Libreville; Gabon: lack of awareness; misperceptions; established alternatives; and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas