ABSTRACT
Background:Waveform capnography has proven to be of great value in the provision of safe patient care especially in the intubated patient. Although seldom available, or used in African contexts, capnography has become standard practice in well-resourced out-of-hospital services for confirmation of intubation, and optimization of resuscitation and ventilation. To date there has been little research into the knowledge of out-of-hospital staff, both local and internationally, utilising capnography. This study describes the knowledge of paramedics who use waveform capnography in the out-of-hospital environment.Methods: A cohort of advanced life support qualified paramedics in a private ambulance service in South Africa undertook a web-based survey around their background, training and use of capnography. Participants' knowledge was assessed by exploring their interpretation of waveform capnography and establishing attitudes pertaining to training and constraints of availability of capnography. Results:Seventy eight paramedics responded, and most (91%) indicated they were likely to use capnography when the tool was available. The majority of training in capnography had been during their primary qualification (85%). Most participants indicated that they would like further training (91%). Use of capnography for confirmation of endotracheal tube placement and quality of compressions during cardiopulmonary resuscitation was well understood (correct in 94% and 84% respectively), while more complicated knowledge such as waveform changes during ventilation (66%) and the effect of hypovolaemia (48%) on capnography were lacking. Conclusion Paramedics report using waveform capnography extensively when it is available in the South African out-of-hospital environment. Although the knowledge around capnography and its usage was found to be good in most areas, more complicated scenarios exposed flaws in the knowledge of many paramedics and suggest the need for improved and ongoing training, as well as incorporation into curricula as the field develops across the continent
ABSTRACT
Objective. To describe the utilisation and safety of air medical services (AMS); when being used for inter-facility transfers of paediatric patients in the Western Cape Province; South Africa. Methods. A retrospective descriptive analysis was conducted for the time period January 2010 to December 2011. Data were recorded from the Cape Town base of the AMS provider for the Western Cape Provincial Department of Health Emergency Medical Services. Patient demographics; flight and transfer details; interventions performed and adverse events encountered were documented for all patients 13 years of age transferred by either helicopter or fixed-wing aircraft. Results. A total of 485 patients was analysed. More patients were transported by helicopter (n10 from baseline were the most common critical adverse events encountered (6). Conclusion. Current utilisation of the AMS for paediatric inter-facility transfer is relatively high; at ~25. Across both the helicopter and fixed-wingplatforms; patients with a diverse range of pathologies of equally varying severities were transferred. The adverse events observed were found to be lower than those of trials examining non-specialised paediatric transfer; and were comparable to those seen with transfer by specialised paediatric retrieval teams. The AMS remain a safe and viable alternative to non-specialised paediatric transfer; and may serve as a potential alternative to specialised paediatric transfer in the Western Cape