A resuscitation systems analysis for South Africa: A narrative review.

With a growing incidence in cardiovascular diseases in Africa, including South Africa, and with it a greater incidence of out-of-hospital cardiac arrest (OHCA) there is a need to understand the readiness of these emergency care systems to support a response. Yet, OHCA is expensive and requires comprehensive development across an entire chain of survival in order to gain any benefit in mortality or morbidity. In this narrative review, we provide a resuscitation systems analysis using the Global Resuscitation Alliance's Frame of Survival. We provide evidence or commentary on the elements of the outer frame and inner frame, and make an assessment of the South African system's readiness to support OHCA care, and provide suggestions for priority areas that need to be developed. The South African resuscitation system demonstrates reasonable readiness to respond to OHCA but is characterised by considerable variation and fragmentation. Given the cost ineffectiveness of many interventions and the anticipated rise in OHCA incidence, there is a pressing need for context-specific strategies in South Africa. These strategies should focus on enhancing both outcomes and resource efficiency, while respecting community ethics and sociocultural dynamics.

The lay descriptors of out-of-hospital cardiac arrest in the Western Cape province, South Africa.

INTRODUCTION: Out-of-Hospital Cardiac Arrest (OHCA) is a time-sensitive emergency requiring prompt identification and emergency care to reduce morbidity and mortality. The first step in managing OHCA is rapid identification by the emergency dispatch centre. Identification of these patients remains challenging in South Africa due to multiple languages and widely differing levels of education. This study aimed to identify the key descriptors (words and phrases) of OHCA used by callers in the Western Cape when contacting the provincial Emergency Medical Services' emergency call centre. METHODOLOGY: Computer-aided dispatch data with a corresponding "patient unresponsive" incident type were drawn for a 12-month period (January-December 2018). Corresponding patient care records were extracted to verify OHCA. The original voice recordings between the caller and emergency call taker at the time of the emergency were extracted and transcribed verbatim. Transcriptions were subjected to inductive, qualitative content analysis to the manifest level. Descriptors of OHCA in isiXhosa, English and Afrikaans calls were coded, categorised, and quantified. RESULTS: A total of 729 confirmed OHCA cases were identified, of which 38 (5.2%) Afrikaans, 24 (3.3%) isiXhosa and a random sample of 50 (6.8%) English calls were transcribed. Following content analysis, five distinct categories were identified. The most prevalent categories were descriptors related to ill health (medical history and suspected diagnosis; 35.5%), level of consciousness (unresponsive; 18.6%) and cardiac activity (pulselessness and suspected death; 17.2%). CONCLUSION: The vast majority of callers within the Western Cape province of South Africa use consistent descriptors across languages when requesting an ambulance for OHCA. Future studies should focus on the development and validation of OHCA recognition algorithms, based on these findings.