Anest Trisha, Stewart de Ramirez Sarah, Balhara Kamna S, Hodkinson Peter, Wallis Lee, Hansoti Bhakti
Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Emerg Med J. 2016 Aug;33(8):557-61. doi: 10.1136/emermed-2015-205177. Epub 2016 Feb 4.
Low and middle income countries bear a disproportionate burden of paediatric morbidity and mortality. South Africa, a middle income country, has unacceptably high mortality in children less than 5 years of age. Many factors that contribute to the child mortality rate are time sensitive and require efficient access to emergency care. Delays and barriers within the emergency medical services (EMS) system increase paediatric morbidity and mortality from time sensitive illnesses.
This study is a qualitative evaluation of the prehospital care system for paediatric patients in Cape Town, South Africa. A purposive sample of healthcare personnel within and interacting with the EMS system were interviewed. A structured interview form was used to gather data. All interviews were audio recorded and transcribed; two independent reviewers performed blinded content analysis of the transcribed script.
33 structured interviews were conducted over a 4 week period. Eight broad themes were identified during coding, including: access, communication, community education, equipment, infrastructure, staffing, training and triage. Subcategories were used to identify areas for targeted intervention. Overall agreement between the two independent coders was 93.36%, with a κ coefficient of 0.69.
The prehospital system is central to delivering time sensitive care for paediatric patients. In a single centre middle income setting, communication barriers between dispatch personnel and medical facilities/EMS personnel were deemed to be a high priority intervention in order to improve care delivery. Other areas for targeted interventions should include broadening the advanced life support provider base and introducing basic medical language in dispatch staff training.
低收入和中等收入国家承受着不成比例的儿科发病率和死亡率负担。南非作为一个中等收入国家，5岁以下儿童的死亡率高得令人无法接受。许多导致儿童死亡率的因素具有时间敏感性，需要高效地获得紧急护理。紧急医疗服务（EMS）系统中的延误和障碍会增加因时间敏感型疾病导致的儿科发病率和死亡率。
本研究是对南非开普敦儿科患者院前护理系统的定性评估。对EMS系统内部及与之互动的医护人员进行了有目的抽样访谈。使用结构化访谈表格收集数据。所有访谈都进行了录音和转录；两名独立评审员对转录脚本进行了盲态内容分析。
在4周内进行了33次结构化访谈。编码过程中确定了8个主要主题，包括：可及性、沟通、社区教育、设备、基础设施、人员配备、培训和分诊。使用子类别来确定有针对性干预的领域。两名独立编码员之间的总体一致性为93.36%，κ系数为0.69。
院前系统对于为儿科患者提供时间敏感型护理至关重要。在单一中心的中等收入环境中，调度人员与医疗设施/EMS人员之间的沟通障碍被视为改善护理服务的高度优先干预措施。其他有针对性干预的领域应包括扩大高级生命支持提供者基础，并在调度人员培训中引入基础医学语言。
