TY - JOUR
T1 - Defining and improving the role of emergency medical services in Cape Town, South Africa
AU - Anest, Trisha
AU - Stewart De Ramirez, Sarah
AU - Balhara, Kamna S.
AU - Hodkinson, Peter
AU - Wallis, Lee
AU - Hansoti, Bhakti
N1 - Publisher Copyright:
© Published by the BMJ Publishing Group Limited.
PY - 2016/8
Y1 - 2016/8
N2 - Introduction Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses. Methods This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script. Results 33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a ΰ coefficient of 0.69. Conclusions The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training.
AB - Introduction Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses. Methods This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script. Results 33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a ΰ coefficient of 0.69. Conclusions The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training.
KW - Emergency ambulance systems
KW - Global health
KW - Paediatrics
KW - Prehospital care
KW - Qualitative research
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U2 - 10.1136/emermed-2015-205177
DO - 10.1136/emermed-2015-205177
M3 - Article
C2 - 26848162
AN - SCOPUS:84958092705
SN - 1472-0205
VL - 33
SP - 557
EP - 561
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
IS - 8
ER -