A descriptive analysis of endotracheal intubation in a South African Helicopter Emergency Medical Service
- Stassen, Willem, Lithgow, Alastair, Wylie, Craig, Stein, Christopher
- Authors: Stassen, Willem , Lithgow, Alastair , Wylie, Craig , Stein, Christopher
- Date: 2018
- Subjects: Helicopter Emergency Medical Services , Endotracheal intubation , Airway management
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/289318 , uj:31389 , Citation: Stassen, W. et al. 2018. A descriptive analysis of endotracheal intubation in a South African Helicopter Emergency Medical Service.
- Description: Abstract: Introduction: Helicopter Emergency Medical Services (HEMS) exists to supplement the operations of groundbased emergency care providers, mainly in high acuity cases. One of the important procedures frequently carried out by HEMS personnel is endotracheal intubation. Several HEMS providers exist in South Africa, with a mix of advanced life support personnel, however intubation success rates and adverse events have not been described in any local HEMS operation. Methods: This was a retrospective chart review of intubation-related data collected by a HEMS operation based in Johannesburg over a 16-month period. First-pass and overall success rates were described, in addition to perceived airway difficulty, adverse events and other data. Results: Of the 49 cases recorded in the study period, one was excluded leaving 48 cases for analysis. Most cases (n=34, 71%) involved young male trauma patients who were intubated with rapid sequence intubation. The first pass success rate was 79% (n=38) with an overall success rate of 98% (n=47). At least one factor suggesting airway difficulty was present in 29% (n=14) of cases, with most perceived airway difficulty related to the high prevalence of trauma cases. At least one adverse event occurred in 27% (n=13) of cases with hypoxaemia, hypotension and bradycardia most prevalent. Discussion: In this small sample of South African HEMS intubation cases, we found overall and first-pass success rates comparable to those reported in similar contexts.
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- Authors: Stassen, Willem , Lithgow, Alastair , Wylie, Craig , Stein, Christopher
- Date: 2018
- Subjects: Helicopter Emergency Medical Services , Endotracheal intubation , Airway management
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/289318 , uj:31389 , Citation: Stassen, W. et al. 2018. A descriptive analysis of endotracheal intubation in a South African Helicopter Emergency Medical Service.
- Description: Abstract: Introduction: Helicopter Emergency Medical Services (HEMS) exists to supplement the operations of groundbased emergency care providers, mainly in high acuity cases. One of the important procedures frequently carried out by HEMS personnel is endotracheal intubation. Several HEMS providers exist in South Africa, with a mix of advanced life support personnel, however intubation success rates and adverse events have not been described in any local HEMS operation. Methods: This was a retrospective chart review of intubation-related data collected by a HEMS operation based in Johannesburg over a 16-month period. First-pass and overall success rates were described, in addition to perceived airway difficulty, adverse events and other data. Results: Of the 49 cases recorded in the study period, one was excluded leaving 48 cases for analysis. Most cases (n=34, 71%) involved young male trauma patients who were intubated with rapid sequence intubation. The first pass success rate was 79% (n=38) with an overall success rate of 98% (n=47). At least one factor suggesting airway difficulty was present in 29% (n=14) of cases, with most perceived airway difficulty related to the high prevalence of trauma cases. At least one adverse event occurred in 27% (n=13) of cases with hypoxaemia, hypotension and bradycardia most prevalent. Discussion: In this small sample of South African HEMS intubation cases, we found overall and first-pass success rates comparable to those reported in similar contexts.
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A prehospital randomised controlled trial in South Africa : challenges and lessons learnt
- Stassen, Willem, Wallis, Lee, Castren, Maaret, Vincent-Lambert, Craig, Kurland, Lisa
- Authors: Stassen, Willem , Wallis, Lee , Castren, Maaret , Vincent-Lambert, Craig , Kurland, Lisa
- Date: 2019
- Subjects: ST-elevation myocardial infarction , South Africa , Telemedicine
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/405554 , uj:34060 , Citation: Stassen, W. et al. 2019. A prehospital randomised controlled trial in South Africa : challenges and lessons learnt. African Journal of Emergency Medicine 9 (2019) 145–149 , DOI: https://doi.org/10.1016/j.afjem.2019.02.002
- Description: Abstract: The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care.
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- Authors: Stassen, Willem , Wallis, Lee , Castren, Maaret , Vincent-Lambert, Craig , Kurland, Lisa
- Date: 2019
- Subjects: ST-elevation myocardial infarction , South Africa , Telemedicine
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/405554 , uj:34060 , Citation: Stassen, W. et al. 2019. A prehospital randomised controlled trial in South Africa : challenges and lessons learnt. African Journal of Emergency Medicine 9 (2019) 145–149 , DOI: https://doi.org/10.1016/j.afjem.2019.02.002
- Description: Abstract: The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care.
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Percutaneous coronary intervention still not accessible for many South Africans
- Stassen, Willem, Wallis, Lee, Lambert, Craig, Castren, Maaret, Kurland, Lisa
- Authors: Stassen, Willem , Wallis, Lee , Lambert, Craig , Castren, Maaret , Kurland, Lisa
- Date: 2017
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/244477 , uj:25280 , Citation: Stassen, W. et al. 2017. Percutaneous coronary intervention still not accessible for many South Africans
- Description: Abstract: Please refer to full text to view abstract
- Full Text:
- Authors: Stassen, Willem , Wallis, Lee , Lambert, Craig , Castren, Maaret , Kurland, Lisa
- Date: 2017
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/244477 , uj:25280 , Citation: Stassen, W. et al. 2017. Percutaneous coronary intervention still not accessible for many South Africans
- Description: Abstract: Please refer to full text to view abstract
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The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility
- Stassen, Willem, Wallis, Lee, Vincent-Lambert, Craig, Castren, Maaret, Kurland, Lisa
- Authors: Stassen, Willem , Wallis, Lee , Vincent-Lambert, Craig , Castren, Maaret , Kurland, Lisa
- Date: 2018
- Subjects: Myocardial infarction , Healthcare disparities , Percutaneous coronary intervention
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/260563 , uj:27440 , Citation: Stassen, W. et al. 2018. The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility.
- Description: Abstract: Introduction: Timely reperfusion (preferably via percutaneous coronary intervention (PCI)) following myocardial infarction improves mortality. Emergency medical services play a pivotal role in recognising and transporting patients with ST-elevation myocardial infarction directly to a PCI facility to avoid delays to reperfusion. Access to PCI is, in-part, dependant on the geographic distribution of patients around PCI facilities. The aim of this study was to determine the proportion of South Africans living within 60 and 120 minutes to a PCI facility. Methods: PCI facility and population data were subjected to proximity analysis to determine the average drive times from municipal ward centroids to PCI facilities for each province in South Africa. Thereafter, the population of each ward living within 60 and 120 minutes of a PCI facility was extrapolated. Results: Approximately, 53.8% and 71.53% of the South African population lives within 60 and 120 minutes of a PCI facility. The median (IQR, range) drive times and distances to a PCI facility are 100 minutes (120.4 min, 0.7 min – 751.8 min) across 123.6km (157.6km, 0.3km – 940.8km).. Conclusion: Based on the proximity of South Africans to PCI facilities, it seems possible that most patients could receive timely PCI within 120 minutes of first medical contact. However, this may be unlikely for some due to a lack of medical insurance, under-developed referral networks or other system delays. Coronary...
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- Authors: Stassen, Willem , Wallis, Lee , Vincent-Lambert, Craig , Castren, Maaret , Kurland, Lisa
- Date: 2018
- Subjects: Myocardial infarction , Healthcare disparities , Percutaneous coronary intervention
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/260563 , uj:27440 , Citation: Stassen, W. et al. 2018. The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility.
- Description: Abstract: Introduction: Timely reperfusion (preferably via percutaneous coronary intervention (PCI)) following myocardial infarction improves mortality. Emergency medical services play a pivotal role in recognising and transporting patients with ST-elevation myocardial infarction directly to a PCI facility to avoid delays to reperfusion. Access to PCI is, in-part, dependant on the geographic distribution of patients around PCI facilities. The aim of this study was to determine the proportion of South Africans living within 60 and 120 minutes to a PCI facility. Methods: PCI facility and population data were subjected to proximity analysis to determine the average drive times from municipal ward centroids to PCI facilities for each province in South Africa. Thereafter, the population of each ward living within 60 and 120 minutes of a PCI facility was extrapolated. Results: Approximately, 53.8% and 71.53% of the South African population lives within 60 and 120 minutes of a PCI facility. The median (IQR, range) drive times and distances to a PCI facility are 100 minutes (120.4 min, 0.7 min – 751.8 min) across 123.6km (157.6km, 0.3km – 940.8km).. Conclusion: Based on the proximity of South Africans to PCI facilities, it seems possible that most patients could receive timely PCI within 120 minutes of first medical contact. However, this may be unlikely for some due to a lack of medical insurance, under-developed referral networks or other system delays. Coronary...
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