The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis.

BACKGROUND: In South Africa (SA), injuries are the second leading cause of years of healthy life lost, and interpersonal violence dominates the SA injury profile. Half of all injury-related deaths in SA are intentional, and firearms contribute to a quarter of these deaths. Injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. OBJECTIVES: To describe the burden of patients with firearm injuries and their outcomes at district-level emergency centres in the Western Cape. METHODS: This study was a retrospective analysis of a prospectively collected database. All patients who presented to two district-level emergency centres with a firearm injury over a 12-month period (1 January 2019 - 31 December 2019) were eligible for inclusion. RESULTS: Firearm injuries represented 5.7% of the trauma burden at the two district emergency centres. Of the 776 patients with firearm injuries who were included, the median age was 27 years, and 91% were male. A total of 520 (67%) patients self-presented, and there were 18 (2.3%) deaths in the emergency centre and a further 23 (3%) as inpatients. Of the total where wound location was determined (n=595), 30.4% sustained more than one firearm injury, and 112 out of the 167 admitted to Mitchells Plain Hospital required at least one visit to theatre. This accounted for 413 theatre hours and 1 376 inpatient bed days at Mitchells Plain Hospital. A significant proportion of patients (n=219, 29%) were transferred from the emergency centres to a tertiary service for further care. CONCLUSION: Firearm injuries represent a substantial proportion of the trauma burden at district emergency centres in the Western Cape Province. Managing patients with firearm injuries is resource intensive, as evident by their high acuity, the need for operative care, the long length of stay, the high burden on emergency medical services with interfacility transfers and the high demand for tertiary care. Data from this study aid our understanding of the prevalence and burden of firearm injuries at district level emergency centres, and multisectoral action, supported by evidence-based primary and secondary preventive strategies, is required to reduce the burden of firearm injuries, and mitigate their effects.

Effect of push handle height on net moments and forces on the musculoskeletal system during standardized wheelchair pushing tasks.

The aim of this investigation was to analyze the external forces and biomechanical loading on the musculoskeletal system during wheelchair pushing, in relation to different push handle heights. In addition, recommendations for wheelchair pushing in accordance with push handle height are made. Eight young, female subjects carried out three different wheelchair transport tasks at five different push handle heights in a standardized laboratory setting. Five pushing heights were selected as a percentage of the subjects shoulder height (61, 69.5, 78, 86.5 and 95%). All three wheelchair transport tasks investigated required higher pushing handles in order to minimise net shoulder moments and external vertical forces on the hands. When pushing a wheelchair on to a pavement, net moments around wrists, elbows, shoulders compression and shear forces at L5-S1 and external vertical forces were lower using higher pushing heights. When low pushing handles are used, elderly female attendants are at risk of L5-S1 low back pain when lifting and pushing the wheelchair on to a pavement. A recommendation is made to reconsider height and position of the pushing handles of attendant propelled wheelchairs. For the investigated tasks, a pushing height of 86.5% (1.191 +/- 0.034 m) was most favourable.