L A Wallis

A review of primary and secondary burn services in the Western Cape, South Africa : research

BACKGROUNDnIn 2011, the Department of Health of the Western Cape Province, South Africa, requested a review of current burn services in the province, with a view to formulating a more efficient and cost-effective service. This article considers the findings of the review and presents strategies to improve delivery of appropriate burn care at primary and secondary levels.nnnMETHODSnSurveys were conducted at eight rural and urban hospitals, two outreach workshops on burn care, four regional hospitals and at least 60 clinics in Cape Town and in the Western Cape as far as Ladismith. A survey on community management of paediatric burns was also included in the study.nnnRESULTSnThe incidence of burns was highest in the winter months, more than half of those affected were children, and the majority of burns were scalds from hot liquids. Most burn injuries managed at primary level were minor, with 75% of patients treated by nurse practitioners and discharged. The four regional secondary hospitals managed the majority of moderate to severe burns. There is room for improvement in terms of treatment facilities and consumables at all levels, regional hospitals being particularly restricted in terms of outdated equipment, a shortage of intensive care unit beds, and difficulties in transferring patients with major burns to a burns unit when indicated.nnnCONCLUSIONnThe community management of paediatric burns was satisfactory, although considerable delays in transfer and insufficient pain control hampered appropriate care. A great need for ongoing education at all levels was identified. Ten strategies are presented that could, if implemented, lead to tangible improvements in the management of burn patients at primary and secondary levels in the Western Cape.

Procedural sedation in the emergency centre.

BACKGROUNDnThe performance of safe and effective procedural sedation in the emergency centre has become a core competency in emergency medicine internationally. However, in South Africa clear guidelines are lacking and this guideline attempts to set out the standard for the routine safe use of procedural sedation by clinical staff in emergency centres.nnnMETHODnThe Emergency Medicine Society of South Africa (EMSSA) appointed a task group to analyse the international literature and guidelines, and a draft document was produced which was revised by consensus input from an expert panel.nnnRESULTS AND CONCLUSIONnA simple and clear practice guideline has been developed for health professionals working in emergency centres in South Africa. This guideline will help to improve the provision of emergency procedural sedation, which is an important component of the care provided in emergency centres.

The Emergency Management of Severe Burns Course in South Africa

The Emergency Management of Severe Burns (EMSB) Course is an important component of the South African Burn Society’s commitment to improving the standard of burn care in South Africa. A one-day course in the ATLS mould, it has proved to be an extremely helpful aid to healthcare practitioners faced with major burns in any setting. This paper outlines the history of the EMSB course since its introduction to South Africa in 2005, under license from the Australia and New Zealand Burn Association (ANZBA).

The epidemiology of major incidents in the Western Cape Province, South Africa

BACKGROUNDnMajor incidents put pressure on any health system. There are currently no studies describing the epidemiology of major incidents in South Africa (SA). The lack of data makes planning for major incidents and exercising of major incident plans difficult.nnnOBJECTIVEnTo describe the epidemiology of major incidents in the Western Cape Province, SA.nnnMETHODSnA retrospective analysis of the Western Cape Major Incident database was conducted for the period 1 December 2008-30 June 2014. Variables collected related to patient demographics and incident details. Summary statistics were used to describe all variables.nnnRESULTSnSeven hundred and seventy-seven major incidents were reviewed (median n=11 per month). Most major incidents occurred in the City of Cape Town (57.8%, n=449), but the Central Karoo district had the highest incidence (11.97/10 000 population). Transport-related incidents occurred most frequently (94.0%, n=730). Minibus taxis were involved in 312 major incidents (40.2%). There was no significant difference between times of day when incidents occurred. A total of 8,732 patients were injured (median n=8 per incident); ten incidents involved 50 or more victims. Most patients were adults (80.0%, n=6 986) and male (51.0%, n=4,455). Of 8,440 patients, 630 (7.5%) were severely injured. More than half of the patients sustained minor injuries (54.6%, n=4,605).nnnCONCLUSIONnMajor incidents occurred more often than would have been expected compared with other countries, with road traffic crashes the biggest contributor. A national database will provide a better perspective of the burden of major incidents.

Introduction to algorithms for managing the common trauma patient

It has been four years since I wrote an editorial in the SAMJ relating to the problems of trauma in South Africa (SA). I was more optimistic, naive perhaps, and looking for meaningful change. In the face of the daily carnage from road accidents and interpersonal violence, I asked, ‘is 2011 the year we will stand up and do something?’ – apparently not. We continue to face the same onslaught, the same 1 200 deaths on our roads each month, and the same number of violent attacks of one man (it is usually men) on another human being. Trauma is an epidemic and, as with any other epidemic, demands policy intervention, preventive measures and provision of care.

Emergency care research priorities in South Africa

BACKGROUNDnEmergency care research is rarely undertaken in low- and middle-income countries. A manageable road map for research in South African (SA) emergency care is needed to address research gaps.nnnOBJECTIVEnTo identify, collate and prioritise research topics from identified knowledge gaps in emergency care in SA.nnnMETHODSnSeventy-six individuals were invited to participate in a modified Delphi study. Participants were requested to suggest important research topics before rating them. Consensus was achieved when >75% of participants strongly agreed or disagreed. Participants then ranked the agreed statements before selecting the most appropriate methodology relating to study design, funding and collaboration.nnnRESULTSnThree hundred and fifty topics were suggested by 31 participants. Topics were collated into 123 statements before participants rated them. Consensus was achieved for 39 statements. The highest-ranked priority in the prehospital group was to determine which prehospital interventions improve outcomes in critically ill patients. The competence of emergency care providers in performing common lifesaving skills was deemed the most important in clinical emergency care. Implementing and reviewing quality improvement systems scored the highest under general systems and safety management. Only 22 statements achieved consensus regarding study design. The National Department of Health was the preferred funding source, while private organisations and emergency care societies were identified as possible collaborative partners.nnnCONCLUSIONnThis study provides expert consensus on priority research areas in emergency care in SA as a guide for emergency care providers to ensure evidence-based care that is relevant to the SA population.

Burns disasters - a plan for South Africa

7Analysis of major terrorist attacks has revealed that up to 15% of the total live casualties sustained severe burn injuries; but the arrival of even 10 new major burns would overwhelm most burns units in South Africa. 3,5,6,8