ABSTRACT
Background and objective: Critical care transport (CCT) involves the movement of critically ill patients between healthcare facilities. South Africa (SA), like other low- to middle-income countries, has a relative shortage of ICU beds, making CCT an inevitability. In SA, CCTs are mostly done by emergency care practitioners; however, it is unclear how universities offering Bachelor in Emergency Medical Care (BEMC) courses approach their teaching in critical care and whether the content taught is consistent between institutions. In our study we formally evaluate and compare the intensive and critical care transport modules offered at SA universities in their BEMC programmes. Methods: The electronic version of curricula of the critical care transport modules from higher education institutes in SA offering the BEMC were subjected to document analysis. Qualitative (inductive content analysis) and quantitative (descriptive analysis) methods were used to describe and compare the different components of the curriculum. Curricula were assigned into components and sub-components according to accepted definitions of curricula. The components included: aims, goals, composition and objectives of the course; content or teaching material and work-integrated learning. Results: The four universities that offer BEMC programmes were invited to participate, and three (75%) consented and provided data. The duration of the modules ranged from 6 to 12 months, corresponding with notional hours of 120 - 150. A total of 83 learning domains were generated from the coding process. These domains included content on mechanical ventilation, patient monitoring, arterial blood gases, infusions and fluid balance, and patient preparation and transfer. Two universities had identical structures and learning outcomes, while one had a different structure and outcomes; it corresponded with a 58% similarity. Clinical placements were in critical and emergency care units, operating theatres and prehospital clinical services. Conclusion: In all components compared, the universities offering BEMC were more similar than they were different. It is unclear whether the components taught are relevant to the SA patient population and healthcare system context, or whether students are adequately prepared for clinical practice. Postgraduate educational programmes might need to be developed to equip emergency care practitioners to function in this environment safely. Contributions of the study: Owing to the limited availability of ICU beds in South Africa, optimising and standardising critical care transport is an important consideration. This study identifies important elements for improving emergency medical care training in South Africa, as well as areas needing further research.
ABSTRACT
Background: Critical care transfer (CCT) involves the movement of high-acuity patients between facilities. Internationally, CCTs are commonly performed by a dedicated team using specialised vehicles and equipment. These transfers comprise a significant portion of the work of local ambulance services; however, there is a dearth of literature on current approaches and practices. Objectives: To investigate and describe the experiences of a sample of Gauteng Province-based emergency care (EC) providers conducting CCTs. Methods: A qualitative descriptive design used thematic analysis to gather data from 14 purposely selected participants during semi-structured focus group discussions, which were recorded and transcribed verbatim. Data were coded and analysed using ATLAS.ti to generate themes and sub-themes. Results: The two dominant themes that emerged from the study were that there is no common understanding or clear definition of a CCT in the local context, and that systemic challenges are experienced. Participants indicated that their undergraduate training did not sufficiently prepare them to conduct CCTs. Local ambulance services appear to lack a common definition and understanding of exactly what constitutes a CCT and how this differs from 'normal' ambulance operations. Participants felt undervalued and poorly supported, with several systemic challenges being highlighted. Conclusion: The absence of a contextually relevant definition of what constitutes a CCT, coupled with potential curriculum deficits in undergraduate EC programmes, negatively impacts on the experiences of EC providers conducting CCTs. Acknowledging CCT as an area of specialisation is an important step in addressing some of the frustrations and challenges experienced by EC providers tasked with conducting such transfers. Further research into formal postgraduate programmes in CCT is recommended. Contributions of the study: This study provides insights into the experiences of South African emergency care providers conducting critical care transfers (CCTs). The research highlights a need to develop a common understanding and definition accepted by industry of what constitutes a CCT and how CCTs differ from primary response incidents, including the need for additional education and a focus on the conducting of CCTs.
ABSTRACT
Background: Rapid sequence intubation (RSI) involves inducing unconsciousness and paralysis in rapid succession in order to facilitate endotracheal tube placement. RSI has recently been introduced to the scope of practice of South African prehospital emergency care practitioners (ECPs). Despite this, there remains limited evidence supporting the efficacy and safety of RSI within this context. While in-hospital studies have shown that it can take 20 minutes or more to perform an RSI, little is known about the time taken to perform the procedure in the prehospital setting. Objectives: To measure the time taken to perform an RSI in a simulated prehospital environment. Methods: A sample of final-year ECP students were video-recorded performing RSIs on a mannequin within a simulated prehospital environment. Data were gathered through an analysis of the recordings, allowing for the capturing of times taken to complete each of the phases of a RSI. Results: A mean time of 15 minutes 5 seconds was recorded to complete the procedure. This was shorter than times reported for in-hospital studies. Conclusion: RSI is a potentially harmful procedure if improperly performed and has the potential to create delays in transport that may not always be in the patient's best interest. With a mean time of 15 minutes 5 seconds, the performance of RSI by ECP students in the simulated prehospital environment was faster than expected. Further research is recommended to explore the relationship between the performances observed in this mannequin-based study with those in authentic prehospital settings. Contributions of the study: This study adds to a currently limited body of knowledge surrounding the performance of out-of-hospital anaesthesia by emergency care practitioners in the African context. The study highlights the fact that while prehospital rapid sequence intubation may be a lifesaving procedure, anaesthetising patients in an uncontrolled prehospital environment is not without risk. An important consideration that needs to be taken into account when making a decision on whether or not to perform the procedure within the prehospital setting is the potential delay this might have on transport time and arrival at the receiving facility.
