Assessment of Emergency Medical Services in the Ashanti Region of Ghana.

BACKGROUND: We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. DESIGN: A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. PARTICIPANTS: All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. INTERVENTION: This was an observational study using qualitative and quantitative assessment techniques. MAIN OUTCOME MEASURES: The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. RESULTS: NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. CONCLUSIONS: The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.

Unusual presentation of atrial fibrillation.

A case is reported of atrial fibrillation in a young healthy man after head injury and the possible causes are discussed. The atrial fibrillation reverted spontaneously to normal rhythm in two days. The authors are not aware of a similar report in the literature.

Case report: lower limb arterial blood supply arising from the renal artery with congenital absence of the ipsilateral iliac arteries.

A case of a young male who developed left lower limb claudication following left nephrectomy is presented. Investigations, including an exploratory laparotomy, demonstrated the absence of left common and internal iliac arteries. An abnormal left external iliac artery arose from the left renal artery and, with collaterals, formed the arterial supply to the lower limb. This anomalous vascular pattern may have caused the pelvi-ureteric junction obstruction which necessitated the nephrectomy. Division of the renal artery at nephrectomy compromised the circulation to the ipsilateral lower limb. Recognition of this anomaly dictates extra caution when dividing the renal artery at nephrectomy performed through a posterolateral approach.