Browsing by Author "Wallis, L. A."
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- ItemThe Cape Triage Score : a triage system for South Africa(Health and Medical Publishing Group (HMPG), 2006-01) Wallis, L. A.; Gottschalk, S. B.; Wood, D.; Bruijns, S.; De Vries, S.; Balfour, C.; Cape Triage GroupThe Cape Triage Score (CTS) has been derived by the Cape Triage Group (CTG) for use in emergency units throughout South Africa. It can also be used in the pre-hospital setting, although it is not designed for mass casualty situations. The CTS comprises a physiologically based scoring system and a list of discriminators, designed to triage patients into one of five priority groups for medical attention. Three versions have been developed, for adults, children and infants. As part of the ongoing assessment process the CTG would value feedback from the readers of this Journal.
- ItemComparison of mean on-scene times : road versus air transportation of critically ill patients in the Western Cape of South Africa(BMJ Publishing Group, 2007-12) Van Hoving, D. J.; Smith, W. P.; Wallis, L. A.Background: The South African setting lends itself to the extensive use of air transport. There is a perception with healthcare providers that flight crews spend too much time with a patient before departure. The main advantage of aero medical transport is to minimise the delay to definitive care and prolonged on-scene time defies this objective. A study was carried out to examine the mean on-scene times of aero medical and road transport of critically ill patients in the Western Cape of South Africa. Methods: In this retrospective observational study, all critically ill patients transported in the Western Cape between September 2005 and May 2006 were evaluated. The mean on-scene time for each transport mode was calculated. Road transport was compared with air transport (rotor and fixed wing). Every transport mode was further divided into mission types: ‘‘scene’’ missions (scene to a healthcare facility) or ‘‘inter-facility’’ missions (from one healthcare facility to another). Results: A total of 7924 transports were included in the study, 7580 of which (95.7%) were road transports. The air transport group spent 53.2 min (95% CI 51.1 to 55.4) at the scene compared with 27.9 min (95% CI 27.5 to 28.4) for the road transport group. There was a significant difference between scene and inter-facility missions in the air transport group (mean 31.7 min for scene missions vs 58.7 min for inter-facility missions; p,0.001). A significant difference was also found in the road transport (mean 24.6 min for scene missions vs 31.9 min for interfacility missions; p,0.001). Conclusion: The on-scene time for transport missions by road is significantly less than for those done by air. There are significant differences between scene and inter-facility missions in both transport modes. Capacity building programmes with ongoing education and training of staff at referring facilities should be implemented.
- ItemEmergency centre investigation of first-onset seizures in adults in the Western Cape, South Africa(Health & Medical Publishing Group, 2013-08-21) Smith, A. B.; Van Hoving, D. J.; Wallis, L. A.Background. Patients with first-onset seizures commonly present to emergency centres (ECs). The differential diagnosis is broad, potentially life-threatening conditions need to be excluded, and these patients need to be correctly diagnosed and appropriately referred. There are currently no data on adults presenting with first-onset seizures to ECs in South Africa. Objective. To review which investigations were performed on adults presenting with first-onset seizures to six ECs in the Western Cape Province. Methods. A prospective, cross-sectional study was conducted from 1 July 2011 to 31 December 2011. All adults with first-onset seizures were included; children and trauma patients were excluded. Subgroup analyses were conducted regarding HIV status and inter-facility variation. Results. A total of 309 patients were included. Computed tomography (CT) scans were planned in 218 (70.6%) patients, but only performed in 169; 96 (56.8%) showed abnormalities judged to be causative (infarction, intracerebral haemorrhage and atrophy being the most common). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar puncture (LP) was performed in 67 (21.7%) patients, with normal cerebrospinal fluid findings in 51 (76.1%). Only 27 (8%) patients had an electroencephalogram, of which 5 (18%) were abnormal. There was a statistically significant difference in the number of CT scans (p=0.002) and LPs (p<0.001) performed in the HIV-positive group (n=49). Conclusion. This study demonstrated inconsistency and wide local variance for all types of investigations done. It emphasises the need for a local guideline to direct doctors to appropriate investigations, ensuring better quality patient care and potential cost-saving.
- ItemInjury severity in relation to seatbelt use in Cape Town, South Africa : a pilot study(Health & Medical Publishing Group, 2014-07) Van Hoving, D. J.; Hendrikse, C.; Gerber, R. J.; Sinclair, M.; Wallis, L. A.Background. Injuries and deaths from road traffic collisions present an enormous challenge to the South African (SA) healthcare system. The use of restraining devices is an important preventive measure. Objective. To determine the relationship between seatbelt use and injury severity in vehicle occupants involved in road traffic collisions in Cape Town, SA. Methods. A prospective cohort design was used. Occupants of vehicles involved in road traffic collisions attended to by EMS METRO Rescue were included during the 3-month data collection period. Triage categories of prehospital patients were compared between restrained and unrestrained groups. Patients transferred to hospital were followed up and injury severity scores were calculated. Disposition from the emergency centre and follow-up after 1 week were also documented and compared. Results. A total of 107 patients were included in the prehospital phase. The prevalence of seatbelt use was 25.2%. Unrestrained vehicle occupants were five times more likely to have a high triage score (odds ratio (OR) 5.4; 95% confidence interval (CI) 1.5 - 19.5). Fifty patients were transferred to study hospitals. Although seatbelt non-users were more likely to be admitted to hospital (p=0.002), they did not sustain more serious injuries (OR 0.44; 95% CI 0.02 - 8.8). Conclusion. The prevalence of seatbelt use in vehicle occupants involved in road traffic collisions was very low. The association between seatbelt non-use and injury severity calls for stricter enforcement of current seatbelt laws, together with the development and implementation of road safety interventions specifically focused on high-risk groups.
- ItemPenetrating the acoustic shadows : emergency ultrasound in South African emergency departments(Health and Medical Publishing Group (HMPG), 2008-12) Bruijns, S. R.; Engelbrecht, D.; Lubinga, W.; Wallis, L. A.
- ItemProcedural sedation in the emergency centre(Health and Medical Publishing Group (HMPG), 2013) Stander, M.; Wallis, L. A.Background. The performance of safe and effective procedural sedation in the emergency centre has become a core competency in emergency medicine internationally. However, in South Africa clear guidelines are lacking and this guideline attempts to set out the standard for the routine safe use of procedural sedation by clinical staff in emergency centres. Method. The Emergency Medicine Society of South Africa (EMSSA) appointed a task group to analyse the international literature and guidelines, and a draft document was produced which was revised by consensus input from an expert panel. Results and conclusion. A simple and clear practice guideline has been developed for health professionals working in emergency centres in South Africa. This guideline will help to improve the provision of emergency procedural sedation, which is an important component of the care provided in emergency centres.