The aetiology of adult burns in the Western Cape, South Africa.

Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerburg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20-40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. It is likely that those with HIV/AIDS have poorer outcomes. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burns within the Southern African region.

A retrospective evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting.

OBJECTIVE: To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area. DESIGN AND SETTING: The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times relating to the obstetric and neonatal incidents was analysed for 2005 and 2008. RESULTS: There was a significant improvement between 2005 and 2008 in all incidents evaluated. Flying Squad dispatch performance improved from 11.7% to 46.6% of all incidents dispatched within 4 min (p < 0.0001). Response time performance at the 15-min threshold did not demonstrate a statistically significant improvement (p = 0.4), although the improvement in the 30-min performance category was statistically significant in both maternity and neonatal incidents. Maternity incidents displayed the greatest improvement with the 30-min performance increasing from 30.3% to 72.9%. The analysis of the mean transit times demonstrated that neonatal transfers displayed the longest status time in all but one of the categories. Even so, the introduction of the Flying Squad programme resulted in a reduction in a total pre-hospital time from 177 to 128 min. CONCLUSION: The introduction of the Flying Squad programme has resulted in significant improvement in the transit times of both neonatal and obstetric patients. In spite of the severe resource constraints facing developing nations, the model employed offers significant gains.

ECG interpretation skills of South African Emergency Medicine residents.

BACKGROUND: The use and interpretation of electrocardiograms (ECGs) are widely accepted as an essential core skill in Emergency Medicine. It is imperative that emergency physicians are expert in ECG interpretation when they exit their training programme. AIM: It is unknown whether South African Emergency Medicine trainees are getting the necessary skills in ECG interpretation during the training programme. Currently there are no clear criteria to assess emergency physicians' competency in ECG interpretation in South Africa. METHODS: A prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians was conducted between August 2008 and February 2009 using a focused questionnaire. RESULTS: At the time of the study, there were 55 eligible trainees in South Africa. A total of 55 assessments were distributed; 50 were returned (91%) and 49 were fully completed (89%). In this study, we found the overall average score of ECG interpretation was 46.4% [95% confidence interval (CI) 41.5-51.2%]. The junior group had an overall average of 42.2% (95% CI 36.9-47.5%), whereas the senior group managed 52.5% (95% CI 43.4-61.5%). CONCLUSION: In this prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians, we found that there was improvement in the interpretation of ECGs with increased seniority. There exists, however, a low level of accuracy for many of the critical ECG diagnoses. The average score of 46.4% obtained in this study is lower than the scores obtained by other international studies from countries where Emergency Medicine is a well-established speciality.

Identification of performance indicators for emergency centres in South Africa: results of a Delphi study.

BACKGROUND: Emergency medicine is a rapidly developing field in South Africa (SA) and other developing nations. There is a need to develop performance indicators that are relevant and easy to measure. This will allow identification of areas for improvement, create standards of care and allow inter-institutional comparisons to be made. There is evidence from the international literature that performance measures do lead to performance improvements. AIMS: To develop a broad-based consensus document detailing quality measures for use in SA Emergency Centres (ECs). METHODS: A three-round modified Delphi study was conducted over e-mail. A panel of experts representing the emergency medicine field in SA was formed. Participants were asked to provide potential performance indicators for use in SA, under subheaders of the various disciplines that are seen in emergency patients. These statements were collated and sent out to the panel for scoring on a 9-point Lickert scale. Statements that did not reach a predefined consensus were sent back to the panellist for reconsideration. RESULTS: Consensus was reached on 99 out of 153 (65%) of the performance indicators proposed. These were further refined, and a synopsis of the statements is presented, classified as to whether the statements were thought to be feasible or not in the current circumstances. CONCLUSIONS: A synopsis of the useful and feasible performance indicators is presented. The majority are structural and performance-based indicators appropriate to the development of the field in SA. Further refinement and research is needed to implement these indicators. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12245-010-0240-6) contains supplementary material, which is available to authorized users.

Complications of tube thoracostomy for chest trauma.

OBJECTIVE: To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. METHODS: Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department's records and monthly statistics. RESULTS: A total of 3989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). CONCLUSION: Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion.