The AfJEM blog
Access to emergency care research is an important enabler for building a strong, resilient knowledge economy. It is simple really: in order to generate research, a researcher needs to tap into the existing research base and use this to find the gaps to plug with more research. However, when the research base is inaccessible, there is no telling which gaps are still up for grabs.
Fig. 1. A global health researcher’s guide to open access publishing and self-archiving (source: http://saem.org/gema/publications/gema-member-blogs). *I use http://www.scimagojr.com/ as it allows filtering by subspecialty and region. **The Directory of Open Access Journals, https://doaj.org/. ***http://sherpa.ac.uk/romeo/index.php.
Cervical collars and immobilisation: a South African best practice recommendation
In this op-ed piece the authors provide a best practice statement on the use of cervical collars for spinal immobilisation, with an endorsement by the Trauma Society of South Africa and the International Trauma Life Support group (Southern Africa Chapter). Their recommendations follows the trend seen internationally where the evidence behind the use of cervical collars has come under intense scrutiny. A sensible approach that includes an assessment of risks using a validated tool, individualising immobilisation provided to suit the situation as well as selection of immobilisation aids marks a deviation from the previously advocated blanket recommendation to apply cervical collars to all. It would be interesting to see how real practice is affected by this best practice recommendation, as the traditional use of cervical collars are likely to be a challenging culture to change.
African emergency care providers’ attitudes and practices towards research
Wow, where to begin? This is a very important paper with much more to it than what is contained in the formal publication. I would like to invite all readers to also consider the very rich data supplement that has been published alongside the paper. The survey (commissioned by the African Federation of Emergency Medicine) included 188 replies of whom a whopping 127 were African trained. I am not aware of any survey of this size, including this many African voices, published in African Emergency Medicine anywhere. My favourite parts are the comparisons between African and non-African respondents; you’ll have to access the data supplement for the real jewels such as African respondents stating that they are motivated to do research to improve research skills and non-African respondents stating that they are motivated to do research to have research published, or that 59% of African respondents regularly struggles with access to research versus 11% of non-African respondents. A really super read that will need more than a single sitting.
Emergency care capabilities in the Kingdom of Swaziland, Africa
Continuing the survey theme, Chowa, et al. undertook this one to develop a better understanding of the emergency care capabilities in Swaziland, a small landlocked country on Mozambique’s Southern border. The numbers are not very encouraging despite a good response rate representing all but one of the emergency centres in Swaziland. Only 53% had access to monitoring in the emergency centre, and only 69% had access to round the clock laboratory tests. Just one emergency centre had access to a CT scanner. Given the survey reports around 53,399 attendances per year, split between the 17 participating emergency centres with a median of four beds per centre, it is little wonder that three quarters of respondents reported centres functioning way over capacity. No mention is made of the prehospital access system. The latter is no doubt likely to further hindrance access to emergency care. A very sobering read from one of the world’s last remaining absolute monarchies.
Case mix of patients managed in the resuscitation area of a district-level public hospital in Cape Town
If you were thinking that this is just a run-of-the-mill paper describing case mixes you would be wrong. Hidden in the methods section is the novel way in which the authors crowd sourced the data using a novel smart phone application, instantly turning every clinician into a point-of-care data collector. With all the hard work done, data were compared with paper registries for completeness and supplemented from the clinical record which is electronically stored. It is important to note that Khayelitsha employs first and foremost a paper-based clerking system. References to electronic record is way overstated as these are simply scanned copies of the clinical records – an improvement indeed, but not so much in terms of interrogating data as can be done through a database. The methodology used by Hunter, et al. empowers the whole clinical team to become part of the research effort. The question is whether such a system can be sustainable in the long run given the huge turn-over of staff in South African emergency centres and large patient loads.
A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
If we cannot do anything else, we can at least provide pain relief. South Africa likely has one of the best prehospital services on the continent, yet Matthews, et al. showed pain management to be a bit of a non-event. To me the central message of this paper is summarised in one figure: the 4 mg median dose of morphine provided. Unless I am mistaken, the loading dose for morphine is 0.1 mg/kg; I am therefore fairly certain that this figure represents systematic underdosing. Furthermore, if underdosing exists, then it is fairly likely that non-dosing also exists, although this was not covered in by the paper’s methodology. What is needed now is an understanding of why patients are underdosed and how we can make these numbers look better. Issues related to experience, training and confidence should be considered. No one likes to be in pain.
A systematic review of burn injuries in low- and middle-income countries: epidemiology in the WHO-defined African Region
A good read, which would come as no surprise to anyone working in sub-Saharan Africa. Burns affect children more than adults, it tends to happen more at home than anywhere else, and is mostly caused by hot liquids or open flames. All of these issues can likely be addressed through better prevention, but for prevention one needs education and for education one needs access. The authors rightfully comment that population-based studies are required to identify the various risk factors prevalent in different parts of the continent. I would hate to think that Matthews’ paper above might give us a peak into early pain management of these burnt kids. It probably does and finding ways to avoid anyone – especially children – suffering such a devastating injury should be a local priority. This topic will be addressed in our forthcoming paediatric special issue scheduled for mid-2017 and our injury special issue scheduled for early 2018.