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1.
PLoS One ; 17(12): e0279074, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36516176

RESUMO

BACKGROUND: Low- and middle-income countries bear a disproportionate amount of the global burden of disease from emergency conditions. To improve the provision of emergency care in low-resource settings, a multifaceted World Health Organization (WHO) intervention introduced a toolkit including Basic Emergency Care training, resuscitation area guidelines, a trauma registry, a trauma checklist, and triage tool in two public hospital sites in Uganda. While introduction of the toolkit revealed a large reduction in the case fatality rate of patients, little is known about the cost-effectiveness and affordability. We analysed the cost-effectiveness of the toolkit and conducted a budget analysis to estimate the impact of scale up to all regional referral hospitals for the national level. METHODS: A decision tree model was constructed to assess pre- and post-intervention groups from a societal perspective. Data regarding mortality were drawn from WHO quality improvement reports captured at two public hospitals in Uganda from 2016-2017. Cost data were drawn from project budgets and included direct costs of the implementation of the intervention, and direct costs of clinical care for patients with disability. Development costs were not included. Parameter uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. Our model estimated the incremental cost-effectiveness of implementing the WHO emergency care toolkit measuring all costs and outcomes as disability-adjusted life-years (DALYs) over a lifetime, discounting both costs and outcomes at 3.5%. RESULTS: Implementation of the WHO Toolkit averted 1,498 DALYs when compared to standard care over a one-year time horizon. The initial investment of $5,873 saved 34 lives (637 life years) and avoided $1,670,689 in downstream societal costs, resulted in a negative incremental cost-effectiveness ratio, dominating the comparator scenario of no intervention. This would increase to saving 884 lives and 25,236 DALYs annually with national scale up. If scaled to a national level the total intervention cost over period of five years would be $4,562,588 or a 0.09% increase of the total health budget for Uganda. The economic gains are estimated to be $29,880,949 USD, the equivalent of a 655% return on investment. The model was most sensitive to average annual cash income, discount rate and frequency survivor is a road-traffic incident survivor, but was robust for all other parameters. CONCLUSION: Improving emergency care using the WHO Toolkit produces a cost-savings in a low-resource setting such as Uganda. In alignment with the growing body of literature highlighting the value of systematizing emergency care, our findings suggest the toolkit could be an efficient approach to strengthening emergency care systems.


Assuntos
Análise de Custo-Efetividade , Serviços Médicos de Emergência , Humanos , Análise Custo-Benefício , Uganda , Hospitais , Encaminhamento e Consulta , Organização Mundial da Saúde
2.
Afr J Emerg Med ; 10(Suppl 1): S23-S28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33318898

RESUMO

BACKGROUND: The burden of trauma in low and middle-income countries (LMICs) is disproportionately high: LMICs account for nearly 90% of the global trauma deaths. Lack of trauma data has been identified as one of the major challenges in addressing the quality of trauma care and informing injury-preventing strategies in LMICs. This study aimed to explore the barriers and facilitators of current trauma documentation practices towards the development of a national trauma registry (TR). METHODS: An exploratory qualitative study was conducted at five regional hospitals between August 2018 and December 2018. Five focus group discussions (FGDs) were conducted with 49 participants from five regional hospitals. Participants included specialists, medical doctors, assistant medical officers, clinical officers, nurses, health clerks and information communication and technology officers. Participants came from the emergency units, surgical and orthopaedic inpatient units, and they had permanent placement to work in these units as non-rotating staff. We analysed the gathered information using a hybrid thematic analysis. RESULTS: Inconsistent documentation and archiving system, the disparity in knowledge and experience of trauma documentation, attitudes towards documentation and limitations of human and infrastructural resources in facilities we found as major barriers to the implementation of trauma registry. Health facilities commitment to standardising care, Ministry of Health and medicolegal data reporting requirements, and insurance reimbursements criteria of documentation were found as major facilitators to implementing trauma registry. CONCLUSIONS: Implementation of a trauma registry in regional hospitals is impacted by multiple barriers related to providers, the volume of documentation, resource availability for care, and facility care flow processes. However, financial, legal and administrative data reporting requirements exist as important facilitators in implementing the trauma registry at these hospitals. Capitalizing in the identified facilitators and investing to address the revealed barriers through contextualized interventions in Tanzania and other LMICs is recommended by this study.

3.
PLoS One ; 15(10): e0240503, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035244

RESUMO

BACKGROUND: In this paper, we predict the health and economic consequences of immediate investment in personal protective equipment (PPE) for health care workers (HCWs) in low- and middle-income countries (LMICs). METHODS: To account for health consequences, we estimated mortality for HCWs and present a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model with Bayesian multivariate sensitivity analysis and Monte Carlo simulation. Data sources included inputs from the World Health Organization Essential Supplies Forecasting Tool and the Imperial College of London epidemiologic model. RESULTS: An investment of $9.6 billion USD would adequately protect HCWs in all LMICs. This intervention would save 2,299,543 lives across LMICs, costing $59 USD per HCW case averted and $4,309 USD per HCW life saved. The societal ROI would be $755.3 billion USD, the equivalent of a 7,932% return. Regional and national estimates are also presented. DISCUSSION: In scenarios where PPE remains scarce, 70-100% of HCWs will get infected, irrespective of nationwide social distancing policies. Maintaining HCW infection rates below 10% and mortality below 1% requires inclusion of a PPE scale-up strategy as part of the pandemic response. In conclusion, wide-scale procurement and distribution of PPE for LMICs is an essential strategy to prevent widespread HCW morbidity and mortality. It is cost-effective and yields a large downstream return on investment.


Assuntos
Infecções por Coronavirus/patologia , Análise Custo-Benefício , Mão de Obra em Saúde/economia , Equipamento de Proteção Individual/economia , Pneumonia Viral/patologia , Teorema de Bayes , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Países em Desenvolvimento , Pessoal de Saúde/estatística & dados numéricos , Humanos , Método de Monte Carlo , Pandemias/economia , Equipamento de Proteção Individual/provisão & distribuição , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
4.
BMJ Glob Health ; 4(Suppl 6): e001768, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406603

RESUMO

Emergency care and the emergency care system encompass an array of time-sensitive interventions to address acute illness and injury. Research has begun to clarify the enormous economic burden of acute disease, particularly in low-income and middle-income countries, but little is known about the cost-effectiveness of emergency care interventions and the performance of health financing mechanisms to protect populations against catastrophic health expenditures. We summarise existing knowledge on the economic value of emergency care in low resource settings, including interventions indicated to be highly cost-effective, linkages between emergency care financing and universal health coverage, and priority areas for future research.

5.
Emerg Med J ; 36(10): 620-624, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31292206

RESUMO

OBJECTIVES: The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation's healthcare system. METHODS: The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia's 10 provinces in March 2016. Data were collected regarding hospitals' perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care. RESULTS: Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies. CONCLUSION: Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento , Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/organização & administração , Humanos , Zâmbia
6.
BMJ Glob Health ; 3(5): e001138, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30364370

RESUMO

Healthcare facilities in low-income and middle-income countries lack an objective measurement tool to assess emergency care capacity. The African Federation for Emergency Medicine developed the Emergency Care Assessment Tool (ECAT) to fulfil this function. The ECAT assesses the provision of key medical interventions (signal functions) that emergency units (EUs) should be able to perform to adequately treat six common, life-threatening conditions (sentinel conditions). We describe the piloting and refinement of the ECAT, to improve usability and context-appropriateness. We undertook iterative, multisite refinement of the ECAT. After pilot testing at a South African referral hospital, subsequent studies occurred at district, regional and central facilities across four countries representing the major regions of Africa: Cameroon, Uganda, Egypt and Botswana. At each site, the tool was administered to three participants: one senior physician, one senior nurse and one other clinical provider. Feedback informed refinements of the ECAT, and an updated tool was used in the next-studied country. Iteratively implementing refined versions of the tool in various contexts across Africa resulted in a final ECAT that uses signal functions, categorised by sentinel conditions and evaluated against discrete barriers to emergency care service delivery, to assess EUs. It also allowed for refinement of administration and data analysis processes. The ECAT has a total of 71 items. Advanced facilities are expected to perform all 71 signal functions, while intermediate facilities should be able to perform 53. The ECAT is the first tool to provide a standardised method for assessing facility-based emergency care in the African context. It identifies where in the maturation process a hospital or system is and what gaps exist in delivery of care, so that a comprehensive roadmap for development can be established. Although validity and feasibility testing have now occurred, reliability studies must be conducted prior to amplification across the region.

7.
Emerg Med J ; 33(12): 870-875, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27317587

RESUMO

BACKGROUND: In Zambia, an increasing burden of acute illness and injury emphasised the necessity of strengthening the national emergency care system. OBJECTIVE: The objective of this study was to identify critical interventions necessary to improve the Zambian emergency care system by determining the current pattern of emergency care delivery as experienced by members of the community, identifying the barriers faced when trying to access emergency care and gathering community-generated solutions to improve emergency care in their setting. METHODS: We used a qualitative research methodology to conduct focus groups with community members and healthcare providers in three Zambian provinces. Twenty-one community focus groups with 183 total participants were conducted overall, split equally between the provinces. An additional six focus groups were conducted with Zambian healthcare providers. Data were coded, aggregated and analysed using the content analysis approach. RESULTS: Community members in Zambia experience a wide range of medical emergencies. There is substantial reliance on family members and neighbours for assistance, commonly with transportation. Community-identified and provider-identified barriers to emergency care included transportation, healthcare provider deficiencies, lack of community knowledge, the national referral system and police protocols. CONCLUSIONS: Creating community education initiatives, strengthening the formal prehospital emergency care system, implementing triage in healthcare facilities and training healthcare providers in emergency care were community-identified and provider-identified solutions for improving access to emergency care.


Assuntos
Serviços Médicos de Emergência/organização & administração , Necessidades e Demandas de Serviços de Saúde , Melhoria de Qualidade , Feminino , Grupos Focais , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Zâmbia
8.
BMJ Open ; 5(11): e009208, 2015 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-26586324

RESUMO

OBJECTIVES: We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members' thoughts regarding high impact solutions to expand access to essential emergency services. DESIGN: We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. SETTING: Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. RESULTS: Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care-a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. CONCLUSIONS: Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/economia , Grupos Focais , Pessoal de Saúde/educação , Acessibilidade aos Serviços de Saúde/economia , Humanos , Entrevistas como Assunto , Quênia , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Características de Residência , População Rural , Adulto Jovem
9.
Bull World Health Organ ; 93(6): 417-23, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-26240463

RESUMO

Over the last few decades, maternal health has been a major focus of the international community and this has resulted in a substantial decrease in maternal mortality globally. Although, compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality, there has been less focus on global efforts to improve comprehensive emergency systems. The thoughtful and specific application of the concepts used in the effort to decrease maternal mortality could lead to major improvements in global emergency health services. The so-called three-delay model that was developed for maternal mortality can be adapted to emergency service delivery. Adaptation of evaluation frameworks to include emergency sentinel conditions could allow effective monitoring of emergency facilities and further policy development. Future global emergency health efforts may benefit from incorporating strategies for the planning and evaluation of high-impact interventions.


Au cours des dernières décennies, la santé maternelle a figuré en bonne place dans les priorités de la communauté internationale et cela s'est traduit par une baisse considérable de la mortalité maternelle au niveau mondial. Or, même si la morbidité et la mortalité liées aux urgences médicales et chirurgicales sont bien plus élevées comparativement à celles associées aux pathologies maternelles, les efforts menés au niveau mondial pour améliorer les systèmes de soins d'urgence dans leur intégralité attirent beaucoup moins d'attention. Une application réfléchie et spécifique des concepts employés dans l'effort de réduction de la mortalité maternelle pourrait entraîner des améliorations notables au sein des services de santé d'urgence au niveau mondial. Le modèle dit « des trois retards ¼, conçu pour la mortalité maternelle, peut être transposé à la prestation des soins d'urgence. L'adaptation des cadres d'évaluation pour y inclure des critères-sentinelles évocateurs des cas d'urgence vitale pourraient permettre une surveillance efficace des centres d'urgences et la conception de politiques complémentaires. Les futurs efforts consacrés aux systèmes de soins d'urgence au niveau mondial pourraient également bénéficier de l'intégration de stratégies pour la planification et l'évaluation d'interventions à fort impact.


A lo largo de las últimas décadas, la salud materna ha sido un foco importante de la comunidad internacional y esto ha llevado a una disminución considerable de la mortalidad materna a nivel mundial. Aunque, en comparación con las enfermedades de la madre, las emergencias médicas y quirúrgicas son una causa mucho más importante de morbilidad y mortalidad, se ha puesto menos atención en los esfuerzos mundiales para mejorar los sistemas integrales de emergencia. La aplicación profunda y específica de los conceptos utilizados en el intento de disminuir la mortalidad materna puede llevar a mejoras importantes de los servicios sanitarios de emergencia mundiales. El denominado modelo de tres retrasos que se desarrolló para la mortalidad materna se puede adaptar a la prestación de servicios de emergencia. La adaptación de los marcos de evaluación para incluir condiciones centinela de emergencia podría permitir una supervisión efectiva de las instalaciones de emergencia y la elaboración de políticas adicionales. Los esfuerzos futuros en la sanidad de emergencia mundial podrían beneficiarse de la incorporación de estrategias para la planificación y evaluación de intervenciones de gran impacto.


Assuntos
Serviços Médicos de Emergência/métodos , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Materna , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Feminino , Saúde Global , Humanos , Mortalidade Materna , Bem-Estar Materno , Gravidez , Complicações na Gravidez/mortalidade , Fatores de Tempo
10.
Injury ; 45(1): 31-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22917929

RESUMO

Resource-constrained countries are in extreme need of pre-hospital emergency care systems. However, current popular strategies to provide pre-hospital emergency care are inappropriate for and beyond the means of a resource-constrained country, and so new ones are needed-ones that can both function in an under-developed area's particular context and be done with the area's limited resources. In this study, we used a two-location pilot and consensus approach to develop a strategy to implement and support pre-hospital emergency care in one such developing, resource-constrained area: the Western Cape province of South Africa. Local community members are trained to be emergency first aid responders who can provide immediate, on-scene care until a Transporter can take the patient to the hospital. Management of the system is done through local Community Based Organizations, which can adapt the model to their communities as needed to ensure local appropriateness and feasibility. Within a community, the system is implemented in a graduated manner based on available resources, and is designed to not rely on the whole system being implemented first to provide partial function. The University of Cape Town's Division of Emergency Medicine and the Western Cape's provincial METRO EMS intend to follow this model, along with sharing it with other South African provinces.


Assuntos
Agentes Comunitários de Saúde/educação , Serviços Médicos de Emergência , Primeiros Socorros , Recursos em Saúde/estatística & dados numéricos , Ferimentos e Lesões/terapia , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/organização & administração , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/organização & administração , Estudos de Viabilidade , Feminino , Primeiros Socorros/economia , Recursos em Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Modelos Teóricos , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , África do Sul/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/mortalidade
11.
S Afr Med J ; 103(9): 628-31, 2013 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-24300680

RESUMO

UNLABELLED: BACKGROUND; Road traffic injuries are a leading cause of death and may be related to social inequality. OBJECTIVE: To establish whether patterns of seatbelt use vary between different socioeconomic communities in the Cape Town Metropole, South Africa. METHODS: Vehicles and their occupants at 7 high-volume crossings (3 in high-income areas) were placed under surveillance for 2 hours each during November 2010. All occupants were eligible for inclusion except occupants of non-motorised vehicles, two-wheel motorised vehicles, buses, taxis, heavy goods vehicles and emergency vehicles. Child seatbelt use was recorded only for children who appeared older than 3 years. RESULTS: A total of 4 651 vehicles with 6 848 occupants were surveyed. Rates of seatbelt use were 45.1% (n=3 090) for all occupants, 54.0% (n=2 513) for drivers, 33.1% (n=521) for front-seat passengers (adults 33.2%, n=452; children 32.7%, n=69) and 9.0% (n=56) for rear-seat passengers (adults 4.0%, n=13; children 14.4%, n=43). Occupants from high-income areas were more likely to wear seatbelts (odds ratio (OR) 4.35; 95% confidence interval (CI) 3.89 - 4.88). Use of child restraints was poor overall (22.3%, n=114), but also varied according to income areas (high income 40.9%, n=99; low income 0.03%, n=6; OR 26.77; 95% CI 11.44 - 62.63). DISCUSSION: The impact of road traffic injuries is significant, but can be decreased by using appropriate restraining devices. Seatbelt use in South Africa, although compulsory, is neither strictly adhered to nor enforced. Their use is proportionally lower in lower-income areas. Specific interventions are required to target these communities directly.


Assuntos
Prevenção de Acidentes , Acidentes de Trânsito , Sistemas de Proteção para Crianças , Cintos de Segurança , Ferimentos e Lesões , Prevenção de Acidentes/métodos , Prevenção de Acidentes/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Sistemas de Proteção para Crianças/economia , Sistemas de Proteção para Crianças/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Masculino , Veículos Automotores/normas , Pobreza , Estudos Retrospectivos , Fatores de Risco , Cintos de Segurança/economia , Cintos de Segurança/estatística & dados numéricos , Fatores Socioeconômicos , África do Sul/epidemiologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
12.
Emerg Med J ; 29(8): 673-8, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22011973

RESUMO

BACKGROUND: As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity. METHODS: A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage. RESULTS: The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately. CONCLUSION: The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Serviços Médicos de Emergência/organização & administração , Primeiros Socorros , Ferimentos e Lesões/terapia , Competência Clínica , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/educação , Serviços Médicos de Emergência/economia , Primeiros Socorros/economia , Primeiros Socorros/normas , Humanos , Modelos Teóricos , Avaliação das Necessidades , África do Sul
13.
Emerg Med J ; 29(11): 882-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22186013

RESUMO

BACKGROUND: Ninety percent of emergency incidents occur in developing countries, and this is only expected to get worse as these nations develop. As a result, governments in developing countries are establishing emergency care systems. However, there is currently no widely-usable, objective method to monitor or research the rapid growth of emergency care in the developing world. METHODS: Analysis of current quantitative methods to assess emergency care in developing countries, and the proposal of a more appropriate method. RESULTS: Currently accepted methods to quantitatively assess the efficacy of emergency care systems cannot be performed in most developing countries due to weak record-keeping infrastructure and the inappropriateness of applying Western derived coefficients to developing country conditions. As a result, although emergency care in the developing world is rapidly growing, researchers and clinicians are unable to objectively measure its progress or determine which policies work best in their respective countries. We propose the TEWS methodology, a simple analytical tool that can be handled by low-resource, developing countries. CONCLUSIONS: By relying on the most basic universal parameters, simplest calculations and straightforward protocol, the TEWS methodology allows for widespread analysis of emergency care in the developing world. This could become essential in the establishment and growth of new emergency care systems worldwide.


Assuntos
Países em Desenvolvimento , Eficiência Organizacional/normas , Serviços Médicos de Emergência/organização & administração , Triagem/métodos , Serviços Médicos de Emergência/normas , Humanos
14.
Prehosp Disaster Med ; 26(3): 192-5, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22107770

RESUMO

INTRODUCTION: The State University of New York at Downstate (SUNY) conducted a web-based long-distance tabletop drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals preceding the 2010 FIFA World Cup. The tabletop drill simulated a stampede and crush-type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled "Western Cape-Abilities", was conducted between May and September 2009, and encompassed nine hospitals in the Western Cape of South Africa. The main purpose of this drill was to identify strengths and weaknesses in disaster preparedness among nine state and private hospitals in Cape Town, South Africa. These hospitals were tasked to respond to the ill and injured during the 2010 World Cup. METHODS: This LDTT utilized e-mail to conduct a 10-week, scenario-based drill. Questions focused on areas of disaster preparedness previously identified as standards from the literature. After each scenario stimulus was sent, each hospital had three days to collect answers and submit responses to drill controllers via e-mail. RESULTS: Data collected from the nine participating hospitals met 72% (95%CI = 69%-75%) of the overall criteria examined. The highest scores were attained in areas such as equipment, with 78% (95%CI = 66%-86%) positive responses, and development of a major incident plan with 85% (95% CI = 77%-91%) of criteria met. The lowest scores appeared in the areas of public relations/risk communications; 64% positive responses (95% CI = 56%-72%), and safety, supplies, fire and security meeting also meeting 64% of the assessed criteria (95% CI = 57%-70%). Surge capacity and surge capacity revisited both met 76% (95% CI = 68%-83% and 68%-82%, respectively). CONCLUSIONS: This assessment of disaster preparedness indicated an overall good performance in categories such as hospital equipment and development of major incident plans, but improvement is needed in hospital security, public relations, and communications ahead of the 2010 FIFA World Cup.


Assuntos
Planejamento em Desastres/normas , Serviço Hospitalar de Emergência/normas , Capacidade de Resposta ante Emergências/normas , Aniversários e Eventos Especiais , Simulação por Computador , Planejamento em Desastres/organização & administração , Correio Eletrônico , Serviço Hospitalar de Emergência/organização & administração , Pesquisas sobre Atenção à Saúde , Humanos , Internet , Incidentes com Feridos em Massa , New York , Projetos Piloto , Futebol , África do Sul , Capacidade de Resposta ante Emergências/organização & administração
16.
Acad Emerg Med ; 17(7): 765-74, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20653593

RESUMO

OBJECTIVES: Emergency medicine (EM) as a specialty has developed rapidly in the western world, but remains largely immature in developing nations. There is an urgent need for emergency services, but no clear guidelines are available on the priorities for establishing EM in the developing world. This study seeks to establish consensus on key areas of EM development in developing world settings, with respect to scope of EM, staffing needs, training requirements, and research priorities. METHODS: A three-round Delphi study was conducted via e-mail. A panel was convened of 50 EM specialists or equivalent, with experience in or interest in EM in the developing world. In the first round, panelists provided free-text statements on scope, staffing, training, and research priorities for EM in the developing world. A five-point Likert scale was used to rate agreement with the statements in Rounds 2 and 3. Consensus statements are presented as a series of synopsis statements for each of the four major themes. RESULTS: A total of 168 of 208 statements (81%) had reached consensus at the end of the study. Key areas in which consensus was reached included EM being a specialist-driven service, with substantial role for nonphysicians. International training courses should be adapted to local needs. EM research in developing countries should be clinically driven and focus on local issues of importance. CONCLUSIONS: The scope and function of EM and relationships with other specialties are defined. Unambiguous principles are laid out for the development of the specialty in developing world environments. The next step required in this process is translation into practical guidelines for the development of EM in developing world settings where they may be used to drive policy, protocols, and research.


Assuntos
Países em Desenvolvimento , Medicina de Emergência/organização & administração , Pesquisa Biomédica , Consenso , Técnica Delphi , Medicina de Emergência/educação , Prioridades em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Recursos Humanos
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