Global health and the Royal College of Emergency Medicine: a cross-sectional survey of members and fellows.

BACKGROUND: There is growing interest in global health participation among emergency care doctors in the UK. The aim of this paper was to describe the demographics of members and fellows of the Royal College of Emergency Medicine involved in global health, the work they are involved in, as well as the benefits and barriers of this work. METHODS: We conducted a survey to include members and fellows of the Royal College of Emergency Medicine describing the context of their global health work, funding arrangements for global health work and perceived barriers to, and benefits of, global health work. RESULTS: The survey collected 1134 responses of which 439 (38.7%) were excluded. The analysis was performed with the remaining 695 (61.3%) responses. Global health involvement concentrated around South Asia and Africa. Work contexts were mainly direct clinical service (267, 38%), curriculum development (203, 29%) and teaching short courses (198, 28%). Activity was largely self-funded, both international (539, 78%) and from UK (516, 74%). Global health work was not reported to contribute to appraisal by many participants (294, 42.3%). Funding (443, 64%) and protected time (431, 62%) were reported as key barriers to global health productivity. DISCUSSION: Participants largely targeted specialty development and educational activities. Lack of training, funding and supported time were identified as barriers to development. Galvanising support for global health through regional networks and College support for attracting funding and job plan recognition will help UK-based emergency care clinicians contribute more productively to this field.

A descriptive study of the use of cardiac point of care ultrasound (PoCUS) in public emergency centres in Cape Town.

INTRODUCTION: The indications for cardiac point of care ultrasound (PoCUS) vary somewhat in different parts of the world, and training programs may also differ. We set out to describe the self-reported cardiac PoCUS indications and imaging windows used at a selection of secondary-level, public hospital emergency centres in Cape Town. METHODS: A descriptive study with prospective data collected from emergency centres of Mitchells Plain District, Victoria and New Somerset Hospitals in Cape Town were used. Data were collected over a three-month period by providers who have completed a basic emergency ultrasound course, using a purpose-designed data collection tool for all cardiac PoCUS scans. RESULTS: Fifteen PoCUS providers recorded 267 data entries over the three-month study period; there were 17 exclusions, leaving 250 entries for analysis. The most common indication for performing cardiac PoCUS was electrocardiogram abnormalities, 27% (n = 112); dyspnoea, 25% (n = 102); chest pain, 16% (n = 65); cardiomegaly on chest x-ray, 12% (n = 51); new murmur, 6% (n = 23); and chest trauma, 5% (n = 22). Other indications made up the remaining 10% (n = 40). Parasternal long and short axis were the predominantly used views. CONCLUSION: Cardiac PoCUS is used for a wide range of indications beyond the recommended training guidelines. Some indications may be more useful in low- to middle-income settings. Further research needs to be done to ascertain the extent of the use of cardiac PoCUS, and possibly the need for a more comprehensive training program with adequate training in these clinical conditions, to ensure safe practice.

Effect of hospital interventions to improve patient flow on emergency department clinical quality indicators.

INTRODUCTION: The Royal College of Emergency Medicine highlights poor flow through hospitals as a major challenge to improving emergency department flow. We describe the effect of several hospital-wide flow interventions on Yeovil District Hospital's emergency department flow. METHODS: During 2016, a design science research study addressed several areas disproportionally contributing to exit block within Yeovil District Hospital. In this follow-up study, we used a retrospective, before/after design, to describe the effect of these interventions on the ED. We used the Royal College of Emergency Medicine's clinical quality indicators (4-hour standard, time to decision-maker, 7-day unplanned reattendance, left without being seen, ambulatory patient care and patient experience). Pearson correlation coefficient (r) was used to compare variables. Wilcoxon signed-rank test was used to compare performance before and after the intervention. RESULTS: Yeovil District Hospital emergency department was attended by 160 373 patients between August 2015 and October 2018. Mean monthly attendance was 4112 (±342) patients, mean age was 43 (±28) years with equal male/female split (49/51%). The 4-hour standard made a recovery from 92% to 97% (p=0.01) that did not correlate with a recovery in national data (r=0.09); this despite rising attendances both at Yeovil and nationally (r=0.75). All clinical quality indicators improved significantly (except unplanned reattendance and patient feedback which improved but not significantly). DISCUSSION: The positive effect on emergency department clinical quality indicators reveals the beneficial impact of improving in-patient flow. Qualitative research is needed to better understand facilitators and barriers to flow improvement work. .

Strengthening prehospital clinical practice guideline implementation in South Africa: a qualitative case study.

BACKGROUND: Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG adaptation) - a specific issue for guideline development groups in low- and middle-income countries - is sparse. There are only a few examples showcasing the pragmatic application of such alternative approaches in settings with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen the methods of developing prehospital CPGs using alternative guideline development methods through a case study design. METHODS: We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points. RESULTS: Key challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions. CONCLUSION: The cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.

An international, interprofessional investigation of the self-reported podcast listening habits of emergency clinicians: A METRIQ Study.

OBJECTIVES: Podcasts are increasingly being used for medical education. A deeper understanding of usage patterns would inform both producers and researchers of medical podcasts. We aimed to determine how and why podcasts are used by emergency medicine and critical care clinicians. METHODS: An international interprofessional sample (medical students, residents, physicians, nurses, physician assistants, and paramedics) was recruited through direct contact and a multimodal social media (Twitter and Facebook) campaign. Each participant completed a survey outlining how and why they utilize medical podcasts. Recruitment materials included an infographic and study website. RESULTS: 390 participants from 33 countries and 4 professions (medicine, nursing, paramedicine, physician assistant) completed the survey. Participants most frequently listened to medical podcasts to review new literature (75.8%), learn core material (75.1%), and refresh memory (71.8%). The majority (62.6%) were aware of the ability to listen at increased speeds, but most (76.9%) listened at 1.0 x (normal) speed. All but 25 (6.4%) participants concurrently performed other tasks while listening. Driving (72.3%), exercising (39.7%), and completing chores (39.2%) were the most common. A minority of participants used active learning techniques such as pausing, rewinding, and replaying segments of the podcast. Very few listened to podcasts multiple times. CONCLUSIONS: An international cohort of emergency clinicians use medical podcasts predominantly for learning. Their listening habits (rarely employing active learning strategies and frequently performing concurrent tasks) may not support this goal. Further exploration of the impact of these activities on learning from podcasts is warranted.

Utilisation of emergency blood in a cohort of South African emergency centres with no direct access to a blood bank.

INTRODUCTION: The transfusion of emergency blood is an essential part of haemostatic resuscitation. Locally, where direct access to a blood bank is limited, emergency blood is stored within emergency centres. It was previously suggested that stored blood provides inadequate volumes compared to what is needed. Minimal data are available regarding indications for emergency blood usage. We aimed to describe the utilisation of emergency blood in selected Cape Town emergency centres. MATERIALS AND METHODS: A cross-sectional study was carried out at three secondary level emergency centres (no blood bank), and one tertiary centre (with a blood bank). Data from emergency blood recipients were recorded over a three-month study period. Indications for transfusion, number of units and location of transfusion were recorded. Indications and usage location were described in numbers and proportions. RESULTS: A total of 329 emergency blood units were transfused to 210 patients. Trauma accounted for 39% (n = 81) of cases and other surgical conditions for 22% (n = 47), particularly upper gastrointestinal 11% (n = 24) and perioperative bleeding 8% (n = 16). Medical conditions accounted for 15% (n = 31), with anaemia 13% (n = 27), the most prevalent indication. Gynaecological conditions accounted for 15% (n = 32), mostly ectopic pregnancy 8% (n = 17). The majority of emergency blood, 77% (n = 253) were used in the emergency centres or operating theatres, 6% (n = 21). CONCLUSION: Trauma remains a major indication for emergency blood transfusion in this setting. This study questions the use of emergency blood for certain non-urgent diagnoses (i.e. anaemia). Given the scarcity of this resource and limitations to access, appropriate use of emergency blood needs to be better defined locally. Ongoing monitoring of the indications for which emergency blood is used, improved transfusion stewardship and better systems to access emergency blood should be a priority in this setting.

A cross-sectional description of open access publication costs, policies and impact in emergency medicine and critical care journals.

INTRODUCTION: Finding journal open access information alongside its global impact requires access to multiple databases. We describe a single, searchable database of all emergency medicine and critical care journals that include their open access policies, publication costs, and impact metrics. METHODS: A list of emergency medicine and critical care journals (including citation metrics) was created using Scopus (Citescore) and the Web of Science (Impact Factor). Cost of gold/hybrid open access and article process charges (open access fees) were collected from journal websites. Self-archiving policies were collected from the Sherpa/RoMEO database. Relative cost of access in different regions were calculated using the World Bank Purchasing Power Parity index for authors from the United States, Germany, Turkey, China, Brazil, South Africa and Australia. RESULTS: We identified 78 emergency medicine and 82 critical care journals. Median Citescore for emergency medicine was 0.73 (interquartile range, IQR 0.32-1.27). Median impact factor was 1.68 (IQR 1.00-2.39). Median Citescore for critical care was 0.95 (IQR 0.25-2.06). Median impact factor was 2.18 (IQR 1.73-3.50). Mean article process charge for emergency medicine was $2243.04, SD = $1136.16 and for critical care $2201.64, SD = $1174.38. Article process charges were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish and Brazilian authors respectively than United States authors, but neutral for German and Australian authors (1.02 and 0.81 respectively). The database can be accessed here: http://www.emct.info/publication-search.html. CONCLUSIONS: We present a single database that captures emergency medicine and critical care journal impact rankings alongside its respective open access cost and green open access policies.

Disparity in conference registration cost for delegates from low- and middle-income backgrounds.

BACKGROUND: Better access for clinicians from low- and middle-income countries to international conferences can improve collaborative opportunities and subsequently address the knowledge gap between the weaker and stronger knowledge economies. A better understanding of the cost of international conferences may help conference organisers improve access to their conferences. This study aimed to describe the expense-associated barriers to a selection of international emergency medicine and critical care conferences, in terms of registration cost and out-of-pocket expense. METHODS: A cross sectional, retrospective design was used. Registration cost variables (cost, waivers, discounts and scholarships) were collected from a cohort of international emergency medicine and critical care conferences held during 2016. The World Health Organization Purchasing Power Parity index was then applied to calculate an equitable registration cost for delegates from South Africa, Brazil, Turkey, China, Australia, Germany and the United States for each conference. RESULTS: Twenty conferences were included. Eight conferences (36%) offered discounted rates, and another eight offered scholarships for low- and middle-income country delegates. Calculated, equitable registration rates were 2.6, 1.9, 1.9, 1.7, 0.9, 1.1 times lower than quoted respectively for South Africa, Brazil, Turkey, China, Australia and Germany compared to the rate in United States dollar. Only one conference provided equitable registration rates for all test-countries. DISCUSSION: Current international conference registration costs (despite discounts, waivers and scholarships) are likely a barrier to including low- and middle-income delegates in the educational, networking and promotional opportunities that conferences provide. Conference organisers should consider restructuring registration costs to encourage more representative international audiences.

The variables perceived to be important during patient handover by South African prehospital care providers.

INTRODUCTION: High-acuity patients are typically transported directly to the emergency centre via ambulance by trained prehospital care providers. As such, the emergency centre becomes the first of many physical transition points for patients, where a change of care provider (or handover) takes place. The aim of this study was to describe the variables perceived to be important during patient handover by a cohort of South African prehospital care providers. METHODS: A purpose-designed questionnaire was used to gather data related to prehospital emergency care provider opinions on the importance of certain patient variables. RESULTS: We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%) ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important, followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations and patient allergies. CONCLUSION: This study has provided some interesting results related to which handover elements prehospital care providers consider as most important to include in handover. More research is required to correlate these findings with the opinions of emergency centre staff.

Dissemination patterns of scientific abstracts presented at the first and second African Conference of Emergency Medicine.

INTRODUCTION: Evidence based medicine is the standard of modern health care practices. Ongoing biomedical research is needed to expand existing knowledge and improve quality of care, but it needs to reach clinicians to drive change. Journal articles and conference presentations are dissemination tools. The aim of the study was to establish the publication rate of scientific abstracts presented at the first and second African Conference of Emergency Medicine. The secondary objectives were establishing non-publication dissemination and the factors associated with publication and non-publication. Determining non-publication dissemination patterns and the factors associated with reasons for publishing or non-publication were also investigated. METHODS: Presenters of the 129 scientific abstracts from the first and second African Conference of Emergency Medicine were invited to participate in an online survey. The survey was followed by a manual literature search to identify published manuscripts of authors that did not complete the survey, to determine the most accurate publication rate. RESULTS: Thirty-one presenters responded (24%), of which 18 published in a peer-reviewed journal. An additional 25 publications were identified by the literature search. The overall publication rate was 33.3% (26.9% from 2012 and 40.3% from 2014). Oral presentations were more likely to be published (p = 0.09). Sixteen manuscripts (37.2%) were published in the African Journal of Emergency Medicine. Presentations at local academic meetings were the most used platform beyond publication (43%). The main reason to publish was to add to the body of knowledge (100%), while lack of time (57%) was the major obstacle for not publishing. CONCLUSION: The overall publication rate for the first and second Africa Conferences of Emergency Medicine is comparable to other non-African Emergency Medicine conferences. The increasing publication trend between conferences might reflect the development of regional research capacity. Emergency Medicine providers in Africa need to be encouraged to participate in high quality, locally relevant research and to distribute those findings through accessible formats.

Access to acute care resources in various income settings to treat new-onset stroke: A survey of acute care providers.

INTRODUCTION: Stroke affects 15 million people annually and is responsible for 5 million deaths per annum globally. In contrast to the trend in low- and middle-income countries (LMICs), stroke mortality is on the decline in high-income countries (HICs). Even though the availability of resources varies considerably by geographic region and across LMICs and HICs, evidence suggests that material resources in LMICs to implement recommendations from international guidelines are largely unmet. This study describes and compares the availability of resources to treat new-onset stroke in countries based on the World Bank's gross national incomes, using recommendations of the American Heart Association and the American Stroke Association 2013 update. METHODS: A self-reported cross-sectional survey was conducted of delegates that attended the April 2016 International Conference on Emergency Medicine using the web-based e-Survey client, Survey Monkey Inc. The survey assessed both pre-hospital and in-hospital settings and was piloted before implementation. RESULTS: The survey was distributed and opened by 955 delegates and 382 (40%) responded. Respondents from LMICs reported significantly less access to a prehospital service (p < 0.001) or a national emergency number (p < 0.001). Access to specialist neurology services (p < 0.001) and radiology services (p < 0.001) were also significantly lower in LMICs. CONCLUSION: The striking finding from this study was that there was essentially very little difference between the responses between LMIC and HIC respondents with a few notable exceptions. The findings also propose a universal lack of adherence to the 2013 AHA/ASA stroke management guideline by both groups, in contrast to the good reported knowledge thereof. Carefully planned qualitative research is needed to identify the barriers to achieving the 2013 AHA/ACA recommendations.

Access to Top-Cited Emergency Care Articles (Published Between 2012 and 2016) Without Subscription.

INTRODUCTION: Unrestricted access to journal publications speeds research progress, productivity, and knowledge translation, which in turn develops and promotes the efficient dissemination of content. We describe access to the 500 most-cited emergency medicine (EM) articles (published between 2012 and 2016) in terms of publisher-based access (open access or subscription), alternate access routes (self-archived or author provided), and relative cost of access. METHODS: We used the Scopus database to identify the 500 most-cited EM articles published between 2012 and 2016. Access status was collected from the journal publisher. For studies not available via open access, we searched on Google, Google Scholar, Researchgate, Academia.edu, and the Unpaywall and Open Access Button browser plugins to locate self-archived copies. We contacted corresponding authors of the remaining inaccessible studies for a copy of each of their articles. We collected article processing and access costs from the journal publishers, and then calculated relative cost differences using the World Bank purchasing power parity index for the United States (U.S.), Germany, Turkey, China, Brazil, South Africa, and Australia. This allows costs to be understood relative to the economic context of the countries from which they originated. RESULTS: We identified 500 articles for inclusion in the study. Of these, 167 (33%) were published in an open access format. Of the remaining 333 (67%), 204 (61%) were available elsewhere on the internet, 18 (4%) were provided by the authors, and 111 (22%) were accessible by subscription only. The mean article processing and access charges were $2,518.62 and $44.78, respectively. These costs were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish, and Brazilian authors, respectively, than for U.S. authors (p<0.001 all). CONCLUSION: Despite the advantage of open access publication for knowledge translation, social responsibility, and increased citation, one in five of the 500 EM articles were accessible only via subscription. Access for scientists from upper-middle income countries was significantly hampered by cost. It is important to acknowledge the value this has for authors from low- and middle-income countries. Authors should also consider the citation advantage afforded by open access publishing when deciding where to publish.

Poor access to acute care resources to treat major trauma in low- and middle-income settings: A self-reported survey of acute care providers.

INTRODUCTION: Injury and violence are neglected global health concerns, despite being largely predictable and therefor preventable. We conducted a small study to indirectly describe and compare the perception of availability of resources to manage major trauma in high-income, and low- and middle-income countries using evidence-based guidance (as per the 2016 National Institute of Clinical Excellence guidelines), as self-reported by delegates attending the 2016 International Conference on Emergency Medicine held in South Africa. METHODS: A survey was distributed to delegates at the International Conference on Emergency Medicine 2016. The survey instrument captured responses from participants working in both pre- and in-hospital settings. Responses were grouped according to income group (either high-income, or low- and middle-income) based on the respondent's nationality (using the World Bank definition for income group). A Fisher's Exact test was conducted to compare responses between different income groups. RESULTS: The survey was distributed to 980 delegates, and 392 (40%) responded. A total of 206 (53%) respondents were from high-income countries and 186 (47%) were from low- to middle-income countries. Respondents described significantly less access to resources and services for low- and middle-income countries to adequately care for major trauma patients both pre- and in-hospital when compared to high-income countries. Shortages ranged from consumables to analgesia, imaging to specialist services, and pre-hospital to in-hospital care. CONCLUSION: Major trauma care requires a chain of successful, evidence-based events for outcomes to benefit. This small study suggests that many of the links of this chain are either missing or broken within low- and middle-income countries. These settings simply do not benefit from the currently available evidence-base in major trauma care. It is important that this evidence-base also be evaluated within low- and middle-income countries. The capacity of low- and middle-income country emergency care systems also needs better describing.

The variables perceived to be important during patient handover by South African prehospital care providers

Introduction:High-acuity patients are typically transported directly to the emergency centre via ambulance by trained prehospital care providers. As such, the emergency centre becomes the first of many physical transition points for patients, where a change of care provider (or handover) takes place. The aim of this study was to describe the variables perceived to be important during patient handover by a cohort of South African prehospital care providers.Methods:A purpose-designed questionnaire was used to gather data related to prehospital emergency care provider opinions on the importance of certain patient variables. Results: We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%) ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important, followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations and patient allergies.Conclusion :This study has provided some interesting results related to which handover elements prehospital care providers consider as most important to include in handover. More research is required to correlate these findings with the opinions of emergency centre staff

Utilisation of emergency blood in a cohort of South African emergency centres with no direct access to a blood bank

Introduction: The transfusion of emergency blood is an essential part of haemostatic resuscitation. Locally, where direct access to a blood bank is limited, emergency blood is stored within emergency centres. It was previously suggested that stored blood provides inadequate volumes compared to what is needed. Minimal data are available regarding indications for emergency blood usage. We aimed to describe the utilisation of emergency blood in selected Cape Town emergency centres. Materials and methods :A cross-sectional study was carried out at three secondary level emergency centres (no blood bank), and one tertiary centre (with a blood bank). Data from emergency blood recipients were recorded over a three-month study period. Indications for transfusion, number of units and location of transfusion were recorded. Indications and usage location were described in numbers and proportions. Results : A total of 329 emergency blood units were transfused to 210 patients. Trauma accounted for 39% (n = 81) of cases and other surgical conditions for 22% (n = 47), particularly upper gastrointestinal 11% (n = 24) and perioperative bleeding 8% (n = 16). Medical conditions accounted for 15% (n = 31), with anaemia 13% (n = 27), the most prevalent indication. Gynaecological conditions accounted for 15% (n = 32), mostly ectopic pregnancy 8% (n = 17). The majority of emergency blood, 77% (n = 253) were used in the emergency centres or operating theatres, 6% (n = 21).Conclusion :Trauma remains a major indication for emergency blood transfusion in this setting. This study questions the use of emergency blood for certain non-urgent diagnoses (i.e. anaemia). Given the scarcity of this resource and limitations to access, appropriate use of emergency blood needs to be better defined locally. Ongoing monitoring of the indications for which emergency blood is used, improved transfusion stewardship and better systems to access emergency blood should be a priority in this setting

A cross-sectional description of open access publication costs, policies and impact in emergency medicine and critical care journals

Introduction :Finding journal open access information alongside its global impact requires access to multiple databases. We describe a single, searchable database of all emergency medicine and critical care journals that include their open access policies, publication costs, and impact metrics.Methods:A list of emergency medicine and critical care journals (including citation metrics) was created using Scopus (Citescore) and the Web of Science (Impact Factor). Cost of gold/hybrid open access and article process charges (open access fees) were collected from journal websites. Self-archiving policies were collected from the Sherpa/RoMEO database. Relative cost of access in different regions were calculated using the World Bank Purchasing Power Parity index for authors from the United States, Germany, Turkey, China, Brazil, South Africa and Australia.Results:We identified 78 emergency medicine and 82 critical care journals. Median Citescore for emergency medicine was 0.73 (interquartile range, IQR 0.32­1.27). Median impact factor was 1.68 (IQR 1.00­2.39). Median Citescore for critical care was 0.95 (IQR 0.25­2.06). Median impact factor was 2.18 (IQR 1.73­3.50). Mean article process charge for emergency medicine was $2243.04, SD = $1136.16 and for critical care $2201.64, SD = $1174.38. Article process charges were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish and Brazilian authors respectively than United States authors, but neutral for German and Australian authors (1.02 and 0.81 respectively). The database can be accessed here: http://www.emct.info/publication-search.html.Conclusions:We present a single database that captures emergency medicine and critical care journal impact rankings alongside its respective open access cost and green open access policies

Global emergency care clinical practice guidelines: A landscape analysis.

INTRODUCTION: An adaptive guideline development method, as opposed to a de novo guideline development, is dependent on access to existing high-quality up-to-date clinical practice guidelines (CPGs). We described the characteristics and quality of CPGs relevant to prehospital care worldwide, in order to strengthen guideline development in low-resource settings for emergency care. METHODS: We conducted a descriptive study of a database of international CPGs relevant to emergency care produced by the African Federation for Emergency Medicine (AFEM) CPG project in 2016. Guideline quality was assessed with the AGREE II tool, independently and in duplicate. End-user documents such as protocols, care pathways, and algorithms were excluded. Data were imported, managed, and analysed in STATA 14 and R. RESULTS: In total, 276 guidelines were included. Less than 2% of CPGs originated from low- and middle income-countries (LMICs); only 15% (n = 38) of guidelines were prehospital specific, and there were no CPGs directly applicable to prehospital care in LMICs. Most guidelines used de novo methods (58%, n = 150) and were produced by professional societies or associations (63%, n = 164), with the minority developed by international bodies (3%, n = 7). National bodies, such as the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN), produced higher quality guidelines when compared to international guidelines, professional societies, and clinician/academic-produced guidelines. Guideline quality varied across topics, subpopulations and producers. Resource-constrained guideline developers that cannot afford de novo guideline development have access to an expanding pool of high-quality prehospital guidelines to translate to their local setting. DISCUSSION: Although some high-quality CPGs exist relevant to emergency care, none directly address the needs of prehospital care in LMICs, especially in Africa. Strengthening guideline development capacity, including adaptive guideline development methods that use existing high-quality CPGs, is a priority.