Clinical Interventions Account for Scene Time in a Helicopter Emergency Medical Service in South Africa

Niekerk, Garth van; Welzel, Tyson; Stassen, Willem

doi:10.1016/j.amj.2018.07.027

Cited by 6 publications

(8 citation statements)

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“…It is a logical conclusion that the requirement for multiple intubation attempts may prolong scene time, while successfully securing the airway on first attempt will limit the time spent on scene for stabilisation. This was demonstrated in a South African HEMS-based study where the number of clinical interventions were correlated with scene time, and every 1 additional intervention increased scene time by approximately 4 min [ 1 ]. Importantly though, interventions (with ETI being one of the most prevalent) did not result in a significantly more stable patient.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

et al. 2022

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Introduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research.

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Section: Discussionmentioning

confidence: 99%

“…Prehospital advanced airway management is one of the most commonly performed invasive interventions in the out-of-hospital setting [ 1 – 3 ]. Protecting the airway of a critically ill or injured patient and facilitating adequate ventilation and oxygenation is an essential part of prehospital emergency care [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

et al. 2022

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“…86,[96][97][98] Advanced transport systems like HEMS and Urgent Medical Aid Service (SAMU) have reduced transportation time and played a crucial role in reducing mortality. 80,99,100 A study conducted by Sobuwa, et al 101 showed that prehospital intubations performed among traumatic brain injury patients did not demonstrate improved outcomes, however, another study conducted in South Africa reported a 98% success rate of prehospital endotracheal intubation 102 (Table 4 80,81,86,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] ).…”

Section: Status Of Prehospital Emergency Care Servicesmentioning

confidence: 99%

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

Bhattarai

Bhusal²,

Barone-Adesi

et al. 2023

Prehosp. Disaster med.

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Background: An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. Methods: This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle–Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. Conclusions: The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.

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“…Recently, an increase in South African HEMS publications addressing controversies regarding mortality benefit, outcomes, staffing and interventions are noted, but remains observational in nature [ 7 , [17] , [18] , [19] , [20] , [21] , [22] ]. In one retrospective study, Stassen et.…”

Section: Introductionmentioning

confidence: 99%

“…report a similar intubation success rate by South African HEMS paramedics, when compared to similar settings elsewhere in the world [17] . Van Niekerk reports that although HEMS is not necessarily faster than ground EMS in South Africa, that time spent on scene is used to perform useful interventions and has a positive effect on patient stability [18] .With the inherent significant burden of expenditure, risk, and debateable mortality benefit, it becomes paramount that patient selection should be a critical discussion in HEMS. In order to evaluate this, the current practices first need to be described.…”

Section: Introductionmentioning

confidence: 99%

A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces

Vlok

Wylie

Stassen

2023

African Journal of Emergency Medicine

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Clinical Interventions Account for Scene Time in a Helicopter Emergency Medical Service in South Africa

Cited by 6 publications

References 25 publications

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces

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