The AfJEM blog
Following seven years of a highly successful, dual language policy in publication, the African journal of Emergency Medicine (AfJEM) will cease to include French translations in publication from the September 2017 issue. Instead we will be taking it online to our newly created family of blogs.
From the outset our policy has always been towards inclusivity – no-one with a great research idea should be excluded from disseminating their work through publication, and no-one hoping to access research should be excluded from doing so either. Fully subsidised by the African Federation for Emergency Medicine, the AfJEM charges no processing or accessing fees, provides free author assistance and up until this issue published all titles and abstracts in both English and French. Oddly enough this did not make us as inclusive as we had hoped. Perhaps through ignorance we neglected to acknowledge Africa’s diverse, regional language culture, one that cannot simply be described through English and French.
Whereas English is mainly spoken in the South and the West, and French in the centre and parts of the North, Arabic is spoken in the East and parts of the North, with Swahili along most of the East coast and large parts of Central Africa. The fact that there are more Arabic speakers in Africa than anywhere in Asia, and that Swahili has been the official language of the Africa Union since 2006 oddly eluded us – until now. So, in September 2017 we will launch an Arabic and French blog to accompany our published issues (which will continue on in English only). What will the blogs be for? Well, initially the blogs will host translations of the titles and abstracts of all AfJEM publications, just like we used to do in print. But instead of just English translations we will now include Arabic translations, hopefully adding Swahili in 2018 too.
We have also decided to empower our readers, whom will henceforth be responsible for the translations. Anyone willing to contribute to the journal can now do so through assisting with translations, which will then be posted in our various blogs, with the authors fully acknowledged. We would also like to encourage emergency care providers to submit topical blogposts to our family of blogs, in any of the supported languages, in order to start discussions around the various emergency care topics that are relevant to the various African regions. We have been quietly experimenting with the blogs and the Arabic version saw a soft launched in March 2017. Go and have a look: http://www.afjem.com/afjem-arabic, and give us some feedback. We strongly feel that this initiative will lead to a greater sense of community amongst our readers, authors and contributors, and encourage ownership of the journal. Welcome to the AfJEM family.
An assessment of nurse-led triage at Connaught Hospital, Sierra Leone in the immediate post-Ebola period
The South African Triage Scale is likely one of the most externally validated triage tools in existence. It has been around since the early millennium and continues to grow in low- and middle-income countries. This study considers accuracy of the tool as applied in the Sierra Leone emergency centre setting. Sierra Leone is a small low-income country on the coast of West Africa and was one of the hardest hit during the Ebola epidemic. The benefits of a reliable triage scale in this resource-limited setting cannot be emphasised enough.
Student paramedic rapid sequence intubation in Johannesburg, South Africa: a case series
Prehospital care appears to have a love-hate relationship with endotracheal intubation when it comes to non-clinician operators. Not so in South Africa, where a lack of staff in the out of hospital setting means that prehospital care providers are often the only skilled airway operators around. And the results are quite interesting: over 99% of patients that required an airway were successfully intubated (using direct laryngoscopy to boot). The author does however, highlight the concern around the 5% of patients that suffered cardiac arrest following intubation. What this study tells us is that local prehospital care providers are very successful at intubating. It does not tell us whether intubation was appropriate or could have been delayed. Given the rough terrain and long distances that patients need to be transported in South Africa (and many other low- and middle-income countries) this work needs further exploring.
Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital
It seems odd that a cheap, proven intervention be so ignored in such a deserving setting. As pointed out by the author, Africa has a high injury burden; however, not long after the CRASH-2 trial, using data from the World Health Organisation it was shown that tranexamic acid use can probably save an additional thousand plus South African lives if it was given within three hours of an injury. But it was not given in the vast majority of cases. The study did not particularly describe availability of the drug or time from injury to attendance in the emergency centre. We know from previous research that there are often delay in care within this setting and this may be one of the reasons why tranexamic acid was not given. In any event, this study provides a good narrative for readers to evaluate the use of tranexamic acid in their own emergency centres.
Describing the categories of people that contribute to an Emergency Centre crowd at Khayelitsha hospital, Western Cape, South Africa
This study is interesting because it provides a breakdown of who is in the emergency centre during the time intervals described. The study however does not directly address the causes of crowding, but what it does do is describe what the crowd in the emergency centre consists of. The study does not directly describe the volume of boarders either, but indirectly refers to it by describing the large number of non-emergency centre clinicians present during office hours in the emergency centre. It is an interesting study which does not require many resources to replicate. Although better crowding metrics would be useful to know alongside these findings, many low- and middle-income settings do not electronically collect the data required to easily describe these – mainly due to the absence of an electronic record. With some sensible changes to the collection tool (most suggested by the authors), this could provide a reasonable view of crowding within the African setting at a low cost.
Poisoning cases and their management in emergency centres of government hospitals in northwest Ethiopia
Pesticides account for a significant burden of self-poisoning globally. Sadly most data sources from Africa remain poor, which leaves the true prevalence to guess work and estimates. This study provides insight into a local poison registry over a four year period. More than half of poisoning cases were due to just two substances – organophosphate poisoning appeared most often (35% of cases), with bleaching agents in second place (25% of cases). From this registry it appears as if patients simply took what was around the house and with it perhaps a suggestion for a public health intervention? Given the resource limitations of the study setting, the findings will help the authors prioritise the resources required to treat the commonest ingestions. It will also contribute to the data sources describing the burden of pesticides in self-poisoning.
A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks
Peripheral nerve blocks, much like ultrasound, is one of those cheap and useful innovations that has the potential to work well in resource-limited settings. It requires less resources, less staff and a less complex monitoring environment (both during and after its application). A positive attitude towards the use of nerve blocks are likely to have benefits on many levels, not only for patients, but also for facilities. Sadly, despite many agreeing on its usefulness, many lacked the skill to perform blocks. Training in the use of nerve blocks is not challenging and the benefits of having providers that can apply this skill likely outweighs the resources required to do the training. This is an interesting study that should prompt readers to consider whether they should consider employing this skill in their own emergency centres.