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Faculty of Health Sciences

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Subject: search.filters.subject.Emergency medical care

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    A validated tool for assessing task-oriented physical preparedness of South African emergency medical care students
    (2023) Mühlbauer, Dagmar; Vincent-Lambert, Craig; Coopoo, Yoga
    ABSTRACT Introduction This study focused on the development of new knowledge and the delivery of a scientifically defendable, pragmatic tool for the assessment of the physical preparedness of South African emergency medical care (EMC) students. The study was premised on the understanding that emergency care and rescue environments (both operational and training) can be physically demanding, potentially hazardous and are consequently associated with a risk of work-related injuries and illnesses. During their training, EMC students are exposed to a number of different disciplines and learning environments such as mountain rescue; water rescue; confined space rescue; rope rescue; and fire search and rescue. These diverse exposures in turn mean that EMC students require physical abilities and attributes that would allow them to participate successfully in each of the diverse learning experiences and environments they would encounter during the course of their training. For this reason, universities offering emergency care programmes require a suitable assessment tool that is recognised as both a valid and pragmatic way of assessing the physical preparedness of their students. Aim of the study The central aim, and unique contribution, of this doctoral study was the development of a valid tool for the assessment of physical preparedness of South African EMC students enrolled in an undergraduate professional Bachelor of Health Science Degree in Emergency Medical Care (BHSc EMC). Methodology The study followed an exploratory, sequential mixed methods design, beginning with a literature review that included a review of existing published literature and documentation to contextualise and frame the research. The findings from the literature review were used to inform the development of a purpose designed survey questionnaire which consisted mainly of closed ended questions generating mostly quantitative data. The survey questionnaire was pre-piloted before being distributed to respondents who were emergency medical care students registered for either their third or fourth year of study in the BHSc EMC programme, as well as academic staff members engaged in the teaching of the Medical Rescue and/or Physical Preparedness modules at the participating higher education institutions (HEIs). The quantitative data from the survey questionnaire was then analysed and the outcomes were used to develop an agenda for follow-on focus group interviews. These, in turn, produced qualitative data to develop a deeper understanding of the research problem and current context. A critical reflection on the findings constructed from the literature review, the questionnaire, and the focus group discussions allowed the researcher to design a specific battery of tests. These tests focused on comparing existing elements and approaches used by the universities for the assessment of physical preparedness to already accepted and validated tests. The final phase of the study involved a sample of students from the participating universities completing the battery of tests that were specifically selected for the study. Analysis of, and critical reflection on the students’ performance in the testing phase of the study as well as pragmatic considerations relating to the setting up and conducting of each test in the EMC student education context were then used to develop, refine and defend the final physical preparedness tool proposed by the researcher. Results The research found that there is support from both the academic staff and emergency medical care students for universities offering emergency care programmes to develop, maintain and assess an EMC student’s level of task-oriented physical preparedness using a standardised validated tool. Out of the 117 emergency medical care students who completed the survey questionnaire, 73/117 (62.4%) strongly agreed and 40/117 (34.2%) agreed that it is important for a BHSc EMC student to be physically fit. Similarly, 10/12 (83.3%) of the academic staff strongly agreed that the BHSc EMC student must be physically fit, and 2/12 (16.7%) agreed. The focus group interviews allowed the researcher the opportunity to explore three important concepts that had been identified during the survey questionnaires in more detail. It was agreed by both the academic staff and emergency medical care student participants that the physical preparedness assessment should be standardised and that the tool should be “user friendly” and pragmatic considering the EMC education context. The study found that a physical performance test with absolute standards is best suited to assess the level of task-oriented physical preparedness of BHSc EMC students in the context of general physical fitness. Cardiovascular endurance (aerobic capacity); muscular endurance; muscular strength; flexibility, and swimming aerobic capacity were identified as the components of fitness essential for an EMC student to engage successfully with the physically strenuous content of the BHSc EMC programme. The tool that was developed and validated by the researcher to assess the essential components of fitness for EMC students includes a modified sit-and-reach test; a flexed-arm hang test; the maximum push-up test; the seven-stage abdominal strength test; a grip strength test; a 5km run test and a 200m swim test. Conclusion EMC students are exposed to a number of different rescue disciplines and learning environments during the course of their undergraduate education and training. A minimum level of physical preparedness is required to support successful participation in the associated learning activities. Universities offering emergency care programmes are therefore required to formally assessment the level of physical preparedness of their students. The tool used for such an assessment should be shown to be valid and pragmatic. A physical performance test with absolute standards comprising a battery of tests that include a modified sit-and-reach test; a flexed-arm hang test; the maximum push-up test; the seven-stage abdominal strength test; a grip strength test; a 5km run test and a 200m swim test is a pragmatic, scientifically validated tool for the assessment physical preparedness of EMC students. Further research needs to be conducted to develop norms and standards for each of the tests making up the developed tool, including studies that explore the impact and success of different approaches relating to the use of physical fitness testing as a selection/entry requirement for EMC programmes including the approaches to facilitation of physical fitness education and training within local BHS EMC programmes.
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    An exploratory inquiry into the implementation of prehospital thrombolysis in the treatment of acute myocardial infarction : a case study of a private emergency medical service within South Africa
    (2019-09-05) Lynch, Andrew Clifford; Sobuwa, Simpiwe; Castle, Nicholas
    Introduction Patency and the restoration of an occluded artery both during and after ST-segment myocardial infarction or STEMI remains the highest priority in acute coronary care. The gold standard of reperfusion therapy is percutaneous coronary intervention, which represents the internationally recommended practice for STEMI. Although technically a non-surgical procedure, percutaneous coronary intervention constitutes a specialised practice, and therefore remains subjective to the limitations of existing clinical resource capacity. Facilities supporting this procedure require specialised equipment and highly trained medical personnel, both of which are often unavailable in the developing and/or underdeveloped regions of South Africa. Thrombolysis, however, also plays a critical role in the management of STEMI, and is recommended in instances where percutaneous coronary intervention is inaccessible or when time delays are present. In 2009, the Health Professions Council of South Africa (HPCSA) allocated thrombolysis to emergency care practitioners in a move which, it was hoped, would improve patient access to reperfusion therapy for STEMI and, ultimately, the country’s national healthcare profile. Unfortunately, since its approval for use by emergency care practitioners, thrombolysis has yet to be integrated effectively into prehospital practice. The current study aimed to analyse the factors associated with the implementation or lack thereof regarding prehospital thrombolysis, despite the evidence and principles supporting its application. Methodology The research used a case study based on data that was obtained through individual, semi- structured interviews. Participants in various positions in a private emergency medical service were purposefully selected to participate in the study. The requisite data was collected through the interviews with participants, and was grounded in their perspectives, observations, knowledge and experience regarding the implementation of prehospital thrombolysis. Collected data was analysed through both a theoretical and data-driven approach, with the consolidated framework for implementation research conceptualising the data, and thematic analysis facilitating data coding procedures. Findings This study identified four primary themes, eight sub-themes and ultimately a total of 14 discussion points relating to the barriers to prehospital thrombolysis. The primary themes comprised interventional characteristics, inner-organisational settings, outer-organisation settings as well as the characteristics of the individuals involved. Within these primary themes, eight sub-themes recognised barriers relating to cost, complexity, cosmopolitanism, implementation climate, readiness for implementation, leadership engagement, knowledge or beliefs and self-efficacy. The 14 discussion points were focused specifically on these topics and, in a broader sense, also acknowledged the patterns as well as interrelationships between the themes. Conclusions and recommendations Implementation, as a process and science, continues to be underestimated, and within healthcare, affects populations who may have otherwise benefited from new, evidence-based practices, guidelines or policies. Healthcare implementation requires strategic planning, and until key pieces of this process are realised, and implementation gaps filled, the potential to improve outcomes through new practices such as early thrombolytic therapy, will continue to be lost. To narrow implementation gaps, the science, which constitutes this domain, requires further merit, not only from prehospital healthcare providers, but across all healthcare disciplines, especially when attempting change. Greater capacity is required for implementation research and special focus should be dedicated towards extending existing relationships between healthcare deliverance systems, specifically in terms of the continuum of care. To formulate the safest and most cost-effective means of delivering prehospital thrombolysis, South African emergency medical service providers as well as allied and even other healthcare organisations need to consider at least one or more implementation strategies to foster a stepwise progression towards this ideal.
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    A comparative study of emergency service response intervals in Johannesburg, South Africa and the North West Ambulance Service, United Kingdom
    (2019-09-05) Van Der Net, Wynand; Vincent-Lambert, Craig; Kevin, Govender
    Background: The primary role of an Emergency Medical Service (EMS) is to respond to an emergency incident within the shortest possible time. As a consequence, response times have historically been used as a key indicator of EMS performance. The City of Johannesburg Emergency Management Services (CoJEMS) provides an EMS to the citizens of the greater Johannesburg metropolitan area in South Africa. The CoJEMS are expected to respond to emergency incidents within 15 minutes, which is the national norm. Before this study there was no complete up-to-date data set or literature describing the extent to which the CoJEMS were meeting this target. The absence of accurate data relating to responsetime intervals was seen as problematic as it limits EMS managers’ abilities to make informed decisions concerning quality management, benchmarking and improvement strategies. Aim: The aim of the study was to investigate, document and describe the time taken by the CoJEMS to complete activities routinely associated with the activation of and response to an emergency incident and to compare these with the response times achieved by the North West Ambulance Services (NWAS) in the United Kingdom. Methods: The research methods included a literature review to identify generic activities that occur from the moment an emergency happens until the patient arrives at a medical facility for treatment. Following this a spreadsheet that was designed to capture the time taken to complete each of the identified activities. Data from 784 calls for the CoJEMS and 786 calls for NWAS were recorded onto the spreadsheet and analysed descriptively. Results: The NWAS had a median overall response time of just 10 min 45 seconds. The median overall time for COJEMs was over twice as long, at 23 min 16 seconds. Conclusion: The NWAS outperformed the CoJEMS in the majority of response-time intervals and the CoJEMS median of 23 min 16 seconds exceeded the national norm and standard of 15 min. Many of the extended CoJEMS response times could be linked to delays in communication between the calltaking department and the EMS dispatch, coupled with a lack of availability of EMS vehicles. Further studies are recommended to determine the reason for the lack of available CoJEMS vehicles, as well as ways to encourage a closer relationship between the different departments within the CoJEMS central communications centre