Evaluating the prerequisites for adapting a paediatric nighttime telemedicine and medication delivery service to a setting with high malarial burden: A cross-sectional pre-implementation study.

OBJECTIVE: We sought to evaluate the prerequisites (demand, interest, feasibility) for adapting a paediatric nighttime telemedicine and medication delivery service (TMDS) to Ghana. METHODS: A cross-sectional survey of households and associated healthcare providers was conducted in urban and rural Ghana. Households were identified through randomised geospatial sampling; households with at least one child <10 years were enrolled. Household surveys collected information relating to demographics, household resources, standardised case scenarios, recent paediatric health events, satisfaction with healthcare access, and interest in TMDS intervention models. Providers were identified by households and enrolled. Provider surveys collected provider type, hours of operation, services, and opinions of a TMDS model. RESULTS: A total of 511 (263 urban, 248 rural) households and 18 providers (10 urban, 8 rural) were surveyed. A total of 262 health events involving children <10 years were reported, of which 47% occurred at night. Care was sought for >70% of health events presenting at night; however, care-seeking was delayed until morning or later for >75% of these events; 54% of households expressed dissatisfaction with their current access to paediatric care at night; 99% of households expressed that a nighttime TMDS service for children would be directly useful to their families. Correspondingly, 17 of 18 providers stated that a TMDS was needed in their community; >99% of households had access to a cellular phone. All households expressed willingness to use their phones to call a TMDS and allow a TMDS provider into their homes at night. Willingness to pay and provider-recommended price points varied by setting. CONCLUSIONS: Prerequisites for adapting a TMDS to Ghana were met. A nighttime paediatric TMDS service was found to be needed, appealing, and feasible in Ghana. These data motivate the adaptation of a TMDS to urban and rural Ghana.

Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January - December 2014).

BACKGROUND: Every year, about 1.2 million people die through road traffic crashes worldwide. Majority of these deaths occur in Africa where most of their emergency medical services are underdeveloped. In 2004, Ghana established the National Ambulance Council to provide timely and efficient pre-hospital emergency medical care to the sick and injured. Pre-hospital emergency medical service is essential for accident victims since it has the potential of saving lives. The study sought to determine the relationship between pre-hospital trauma survival rate and response time to emergencies and factors associated to pre-hospital trauma survival  in Accra, Ghana. METHODS: The study was a cross sectional study which reviewed pre-hospital care forms of trauma patients from the fourteen ambulance stations in the Greater Accra region from January to December 2014. Data were extracted from these forms and the response time estimated. Conscious patients who were alert were categorized as responsive under the AVPU scale. The proportion of patients who survived pre-hospital trauma and  the time pre-hospital trauma cases were responded to was estimated. Multiple logistic regression analysis was conducted to determine which variables were associated with survival. RESULTS: A total of 652 pre-hospital care forms were reviewed. About 87% survived pre-hospital trauma. The average response time to patients was (16.9 ± 0.7) minutes and the median transportation time of the patient was 82 min. Level of consciousness of a patient and response time of patients transported was found to be significantly associated with pre-hospital trauma survival. CONCLUSION: There was a high trauma patient survival rate among victims attended to by an NAS. The average response time in Greater Accra region in the 14 ambulance stations is 16.9 min which is not different from the 17 min recorded in 2013 by NAS. Factors that were associated with pre-hospital survival were alertness in the level of consciousness and response time less than 17 min.

The state of emergency medical technician education in Ghana.

OBJECTIVE: The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. METHODS: A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. RESULTS: Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). CONCLUSION: The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.

The state of emergency medical technician education in Ghana

Objective: The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. Methods: A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. Results: Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). Conclusion: The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning