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Introduction:The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra, Ghana, to determine quality improvement needs. Methods: A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006. Results: Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control, advanced airway management, and ophthalmologic or gynaecological examinations. Several additional items, such as glucometers and pulse oximeters, were available and often used for patient care. Conclusion: Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and 'ready-to-hand'. Consequently, key factors in determining readiness to provide quality emergency care include supplychain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.

Background Patients with altered level of consciousness secondary to alcohol use disorders (AUDs) often undergo imaging in the emergency department (ED), although the frequency and yield of this practice over time are unknown. Study Objectives We describe the use of imaging, the associated ionizing radiation exposure, cumulative costs, and identified acute and chronic injuries and abnormalities among frequent users of the ED with AUDs. Methods This is a retrospective case series of individuals identified through an administrative database having 10 or more annual ED visits in 2 consecutive years who were prospectively followed for a third year. International Classification of Diseases, 9th Revision, Clinical Modification and Current Procedural Terminology codes were used to select individuals with alcohol-related diagnoses, track imaging procedures, and calculate cost. Diagnoses, imaging results, and radiation exposure per computed tomography (CT) study were abstracted from the medical record. Results Fifty-one individuals met inclusion criteria and had a total of 1648 imaging studies over the 3-year period. Subjects had a median of 5 (interquartile range [IQR] 2–10) CT scans, 20 (IQR 10–33) radiographs, 28.3 mSv (IQR 8.97–61.71) ionizing radiation, 0.2% (IQR 0.07–0.4) attributable risk of cancer, and $2979 (IQR 1560–5440) in charges using a national rate. The incidence of acute fracture or intracranial head injury was 55%, and 39% of the cohort had a history of moderate or severe traumatic brain injury. Conclusion The remarkable use of imaging and occurrence of injury among these highly vulnerable and frequently encountered individuals compels further study to refine clinical practices through the development of evidence-based, effective interventions.