Emergency Medicine Commons^™

Explosive Weapons Trauma Care Collective (Extracct) Clinical Practice Guideline: Transfer Of Critically Injured Casualties, Emma Butterfield, Gavin Wooldridge, Solomon Asfaw, Mervat Alhilal, Mardi Steere, Benjamin Wachira, Paul Reavley, Roman Shtybel, Marius Rehn

Emergency Medicine, East Africa

Introduction Blast-injured patients often present to healthcare facilities which cannot definitively meet their clinical needs. This clinical practice guideline (CPG) reviews and describes best practice for inter-facility transfer of casualties in resource limited and conflict-afflicted contexts where there may not be a formal referral pathway or specialized inter-facility transfer service.

Methods A narrative literature review and synthesis of expert opinion were used to develop this CPG.

Results The guideline describes current standards and best practice in inter-facility transfer in a low resource context—particularly during conflict when referral and transfer pathways may be overwhelmed—and advises on the selection and preparation of …

The 'Golden Hour': A Geospatial Analysis Of Travel Time To Public Emergency Departments In Kenya, Tushara Surapaneni, Nancy Kinyua, Benjamin Wachira

Emergency Medicine, East Africa

Introduction In Kenya and many other low- and middle-income countries, prehospital care systems are underdeveloped or entirely non-existent, leaving emergency departments (EDs) as the primary point of care for medical emergencies. The aim of this cross-sectional observational study was to use a geographic information system (GIS) to comprehensively analyse access to public EDs in Kenya within 1-hour and 2-hour travel times.

Methods Using open-source GIS software, population, land cover, elevation and road network data were analysed to create maps of 1-hour and 2-hour travel time catchment areas around public EDs in Kenya. Travel time analysis was calculated using AccessMod with …

Future Directions For Emergency Medical Services Development In Low- And Middle-Income Countries, Peter Delaney, Jon Moussally, Benjamin Wachira

Emergency Medicine, East Africa

The lack of prehospital care access in low- and middle-income countries is one of the greatest unmet needs and, therefore, one of the most urgent priorities in global health. Establishing emergency medical services in low- and middle-income countries poses significant challenges and complexities, requiring solutions tailored to prevailing conditions, informed by needs assessments, and adapted to meet local demands in a culturally appropriate and sustainable manner. In areas without existing emergency medical services, patients must rely on informal networks of untrained bystanders and community members to provide first aid and transport to definitive care. Since 2005, training lay first responders …

Feasibility Of Project Echo Telementoring To Build Capacity Among Non-Specialist Emergency Care Providers, Grace Wanjiku, Lindsay Dreizler, Gregory Bell, Benjamin Wachira

Emergency Medicine, East Africa

The COVID-19 pandemic has led to global disruptions in emergency medicine (EM) teaching and training and highlighted the need to strengthen virtual learning platforms. This disruption coincides with essential efforts to scale up training of the emergency healthcare workforce, particularly in low-resource settings where the specialty is not well developed. Thus, there is growing interest in strengthening virtual platforms that can be used to support emergency medicine educational initiatives globally. These platforms must be robust, context specific and sustainable in low-resource environments. This report describes the implementation of Project ECHO (Extension for Community Healthcare Outcomes), a telementoring platform originally designed …

Authorship Representation In Global Emergency Medicine: A Bibliometric Analysis From 2016 To 2020, Stephanie Chow Garbern, Gimbo Hyuha, Catalina González Marqués, Noor Baig, Jennifer L. Chan, Sanjukta Dutta, Masuma A. Gulamhussein, Gloria Paulina López Terán, Hussein Karim Manji, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the …

The Status And Future Of Emergency Care In The Republic Of Kenya, J. Austin Lee, Grace Wanjiku, Naomi Nduku, Adam R. Aluisio, Ramu Kharel, John Tabu Simiyu, Benjamin Wachira

Emergency Medicine, East Africa

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the …

Systematic Review On Epidemiology, Interventions And Management Of Noncommunicable Diseases In Acute And Emergency Care Settings In Kenya, Christine Ngaruiya, Annrita Kawira, Florence Mali, Faith Kambua, Beatrice Mwangi, Mbatha Wambua, Denise Hersey, Laventa Obare, Rebecca Leff, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: Mortality and morbidity from Non-Communicable Diseases (NCDs) in Africa are expected to worsen if the status quo is maintained. Emergency care settings act as a primary point of entry into the health system for a spectrum of NCD-related illnesses, however, there is a dearth of literature on this population. We conducted a systematic review assessing available evidence on epidemiology, interventions and management of NCDs in acute and emergency care settings in Kenya, the largest economy in East Africa and a medical hub for the continent.

Methods: All searches were run on July 15, 2015 and updated on December 11, …

The Last Frontier For Global Non-Communicable Disease Action: The Emergency Department—A Cross-Sectional Study From East Africa, Christine Ngaruiya, Mbatha Wambua, Thomas Kedera Mutua, Daniel Owambo, Morgan Muchemi, Kipkoech Rop, Kaitlin R. Maciejewski, Rebecca Leff, Mugane Mutua, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients to inform interventions targeting patients with NCDs in emergency care settings.

Materials and methods: Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a …

A Baseline Review Of The Ability Of Hospitals In Kenya To Provide Emergency And Critical Care Services For Covid-19 Patients, Benjamin Wachira, Margarita Mwai

Emergency Medicine, East Africa

Introduction: As the Coronavirus Disease 2019 (COVID-19) cases in Kenya begin to rise, the number of severe and critical COVID-19 patients has the potential to quickly overload the local healthcare system beyond its capacity to treat people.

Objective: The purpose of this study was to gather information about the ability of hospitals in Kenya to provide emergency and critical care services and to identify priority actions for use by policymakers and other stakeholders as a roadmap toward strengthening the COVID-19 response in the country.

Methods: This was a comprehensive review of the published and grey literature on emergency and critical …

Getting Accepted – Successful Writing For Scientific Publication: A Research Primer For Low- And Middle-Income Countries, Erin L. Simon, Maxwell Osei-Ampofo, Benjamin Wachira, James Kwan

Emergency Medicine, East Africa

Clear and precise writing is a vital skill for healthcare providers and those involved in global emergency care research. It allows one to publish in scientific literature and present oral and written summaries of their work. However, writing skills for publishing are rarely part of the curriculum in the healthcare education system. This review gives you a step-by-step guide on how to successfully write for scientific publication following the IMRaD principle (Introduction, Methods, Results, and Discussion) with every part supporting the key message. There are specific benefits of writing for publication that justify the extra work involved. Any lessons learned …

Social Media And The Modern Scientist: A Research Primer For Low- And Middle-Income Countries, Junghwan Kevin Dong, Colleen Saunders, Benjamin Wachira, Brent Thoma, Teresa M. Chan

Emergency Medicine, East Africa

Social media has changed the way we communicate. Wherever you are in the world, various forms of social media are being used by individuals to share information and connect without borders. Due to its ubiquity, social media holds great promise in linking clinicians, scientists, investigators, and the public to change the way we conduct scientific discourse. In this paper, we present a step-by-step guide on optimizing your social media strategy with regards to: research/scholarly practice (discourse, collaboration, recruitment), knowledge translation, dissemination, and education. This guide also highlights key readings that provide guidance to those interested in incorporating social media into …

Impact Of Traffic, Poverty And Facility Ownership On Travel Time To Emergency Care In Nairobi, Kenya, Maya S. Fraser, Benjamin Wachira, Abraham D. Flaxman, Aaron Y. Lee, Herbert C. Duber

Emergency Medicine, East Africa

Background: In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world.

Methods: We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between …

Advancing Research On Emergency Care Systems In Low-Income And Middle-Income Countries: Ensuring High-Quality Care Delivery Systems, Rachel T. Moresky, Junaid Razzak, Teri Reynolds, Lee A. Wallis, Benjamin Wachira, Mulinda Nyirenda, Waldemar A. Carlo, Janet Lin, Shama Patel, Sanjeev Bhoi, Nicholas Risko, Lily A. Wendle, Emilie J. Calvello Hynes

Emergency Medicine, East Africa

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on …

Characterizing Injury At A Tertiary Referral Hospital In Kenya, Hannah Janeway, Gerard O’Reilly, Florian Schmachtenberg, Nimai Kharva, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: Injury accounts for more than 5.8 million deaths globally with an increasing burden in the developing world. In Kenya, trauma is one of the top 10 leading causes of death. However, no formal continuous injury surveillance systems are in place to inform injury prevention, pre-hospital care or emergency department management. The aim of this study was to implement a hospital-based trauma registry to characterize high acuity injuries presenting to a private tertiary, teaching and referral hospital in Kenya.

Methods: From January to December 2015, data was prospectively collected at a private tertiary, teaching and referral hospital in Nairobi, Kenya. …

Assessing A Novel Point-Of-Care Ultrasound Training Program For Rural Healthcare Providers In Kenya, Grace W. Wanjiku, Gregory Bell, Benjamin Wachira

Emergency Medicine, East Africa

Background: A novel point-of-care ultrasound (PoCUS) training program was developed to train rural healthcare providers in Kenya on the Focused Assessment with Sonography for Trauma (FAST), thoracic ultrasound, basic echocardiography, and focused obstetric ultrasonography. The program includes a multimedia manual, pre-course testing, 1-day hands-on training, post-testing, 3-month post-course evaluation, and scheduled refresher training. This study evaluates the impact of the course on PoCUS knowledge and skills. Competency results were compared based on number of previous training/refresher sessions and time elapsed since prior training.

Methods: Trainees were evaluated using a computer-based, 30 question, multiple-choice test, a standardized observed structured clinical exam …

International Scope Of Emergency Ultrasound: Barriers In Applying Ultrasound To Guide Central Line Placement By Providers In Nairobi, Kenya, Fareen Zaver, Keith Boniface, Benjamin Wachira, Grace Wanjiku, Hamid Shokoohi

Emergency Medicine, East Africa

Background: While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US.

Objective: We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment.

Methods: Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine …

Uchunguzi (Journal Watch/ Montre De Journal) March 2017, Benjamin Wachira

Emergency Medicine, East Africa

Without the need for expensive videoconferencing equipment or computer networks, doctors in the developing world have found practical use for WhatsApp Messenger in clinical and administrative settings because the service is ubiquitous, free and easy to use. This study reviewed the literature on WhatsApp in clinical practice, to determine how it was used, and users’ satisfaction. It revealed that the service was widely used in intradepartmental communication across a range of aspects, including second opinion, changes in treatment plans, sharing of X-rays and photographs, scheduling of academic meetings, and sharing of educational materials such as papers. There was a report …

Uchunguzi (Journal Watch/ Montre De Journal) June 2017, Benjamin Wachira

Emergency Medicine, East Africa

The purpose of an effective emergency care system is to provide universal emergency care to all regardless of socioeconomic status, to stabilise patients who have a life-threatening illness or injury, and to reduce consequences of preventable mortality, morbidity and disability. Unfortunately, the limited availability of resources remains a significant barrier to the development and implementation of emergency care systems in low- and middle-income countries (LMICs). In this recent study from Cameroon, of 3201 participants from 619 households surveyed, 1113 (34.8%) had experienced one or more emergency conditions in the previous year. Despite this high incidence of emergency conditions, only 7% …

Emergency Medical Services (Ems) Training In Kenya: Findings And Recommendations From An Educational Assessment, Benjamin Nicholson, Chelsea Mccollough, Benjamin Wachira, Nee-Kofi Mould-Millman

Emergency Medicine, East Africa

Background: Over the past twenty years, Kenya has been developing many important components of a prehospital emergency medical services (EMS) system. This is due to the ever-increasing demand for emergency medical care across the country. To better inform the next phase of this development, we undertook an assessment of the current state of EMS training in Kenya.

Methods: A group of international and Kenyan experts with relevant EMS and educational expertise conducted an observational qualitative assessment of Kenyan EMS training institutions in 2016. Three assessment techniques were utilised: semi-structured interviews, document review, and structured observations. Recommendations were reached through a …

Uchunguzi (Journal Watch/Montre De Journal) December 2016, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent

Uchunguzi (Journal Watch/Montre De Journal) September 2016, Benjamin Wachira

Emergency Medicine, East Africa

Most states in the USA have ‘Good Samaritan’ laws that oblige doctors to stop and render emergency treatment under certain circumstances, without incurring legal liability even if they are negligent. Whether doctors are legally obliged to stop and render assistance at road accidents in most countries across the world remains controversial. In 1978, the South African Medical and Dental Council ruled that ‘in cases of emergency a practitioner is obliged to render assistance in all circumstances’. It has therefore been said that ‘where persons are in a situation where their life or health will be seriously endangered unless they receive …

Uchunguzi (Journal Watch/Montre De Journal) June 2016, Benjamin Wachira

Emergency Medicine, East Africa

When someone telephones for an ambulance, an interaction ensues which should be efficient and effective to facilitate a speedy dispatch of the appropriate level of vehicle, equipment and personnel to where it is needed. The process in South Africa begins with a three-part opening sequence which typically identifies the organisation, introduces the call-taker (CT) and invites the caller to proceed with the business of the call. In a recent project conducted in a South African emergency service, the researchers aimed to ascertain the impact of the CT’s identification sequence on the progression of the call and to determine whether there …

Uchunguzi (Journal Watch/Montre De Journal) March 2016, Benjamin Wachira

Emergency Medicine, East Africa

Increasing demand on emergency healthcare systems throughout Africa means there is a need to develop and harmonise standards of emergency care for the benefit of African populations. This can potentially be achieved by developing guidelines for appropriate and high quality education to prepare future generations of emergency healthcare providers for their role in all regions of Africa. With this in mind, the African Emergency Nursing Curriculum was developed by emergency nurses, academics and researchers from Africa and the rest of the world to provide a consensus document to guide the development of harmonised standards of emergency nursing theory and practice …

Community-Based Perceptions Of Emergency Care In Kenya, Morgan C. Broccoli, Emilie J.B Calvello, Alexander P. Skog, Benjamin W. Wachira, Lee A. Wallis

Emergency Medicine, East Africa

Access to quality emergency services is an essential component of the human right to health, but barriers to emergency care are found throughout Africa and the wider world. Data to support the development of emergency care are essential to improve access to care and further infrastructure development. We undertook this study to understand the community's emergency care needs and the barriers they face when trying to access care and to engage community members with developing high impact solutions to expand access to essential emergency services.

To accomplish this, we used a qualitative research methodology to conduct 59 focus groups with …

Westgate Shootings: An Emergency Department Approach To A Mass-Casualty Incident, Benjamin Wachira, Ramadhani Abdalla, Lee Wallis

Emergency Medicine, East Africa

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other …

Uchunguzi (Journal Watch/Montre De Journal) March 2012, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.