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| Uganda National Ambulance Service Ambulances |
As was described in our previous article,
Emergency and critical care is an important healthcare specialty/field that is
critically lacking in Uganda’s healthcare system. In spite of this significant
deficit, one thing remains clear, emergency and critical care needs to develop
and do so exponentially.
Many things could be proposed to
achieve these outcomes, however, this discussion needs to begin sooner rather than
later. We hope with the synopses of research
that is relevant to the Uganda context, we can begin to drive these discussions
towards filling this gap.
Our first article published in the African Journal of Emergency Medicine, is by Mould-Millman,
Stein & Wallis (2016). As they postulate, standardisation of levels of care
for out-of-hospital emergency care providers in Africa is a good start. This
begins with a number of definitions:
- Out-of-Hospital Emergency Care (OHEC)
– the full spectrum of emergency care that occurs outside of healthcare
facilities.
- OHEC Systems:
- Tier-one
systems – care is provided by bystanders and volunteers.
- Tier-two
systems – care is provided by professional medical responders.
- Emergency Medical Services (EMS) –
is a tier-two system where formalised prehospital care is provided by
emergency care professionals who respond to emergencies with a
well-defined jurisdiction.
As Mould-Millman,
et al. (2016) describe, across the African continent there is significant
disparity in definitions as well as scope of practice in emergency medical
services. The need to standardise for quality and safe practice is therefore an
important area of intervention.
LEVELS OF CARE
OF OHEC IN AFRICA
1.
FIRST AID – comprises
basic assessments and interventions that may be provided by a bystander (or the
victim) with minimal or no medical equipment.
2.
BASIC LIFE SUPPORT (BLS) – A level of care provided primarily by tier-two providers (i.e. professional medical responders).
Non-invasive life-saving procedures including:
·
Cardiopulmonary resuscitation (CPR) with an AED
(automated external defibrillator)
·
Basic airway management, administration of
oxygen (with or without a manual bag valve mask),
·
Control of bleeding,
·
Basic treatment of shock and poisoning,
·
Stabilisation of injuries and or wounds,
·
Provision of more advanced first aid until the
patient can be given more advanced care or be transported to an appropriate healthcare
facility.
3.
INTERMEDIATE LIFE SUPPORT (ILS) – includes
all BLS with additional advanced knowledge, skills, and administration of a
limited selection of medications determined by local guidelines.
Medications
authorised to ILS providers
may include those already prescribed to patients for managing acute medical
events, including inhaled bronchodilators, oral non-narcotic analgesics,
intramuscular or rectal diazepam, intramuscular epinephrine, intramuscular
glucagon, intramuscular naloxone, and oral narcotics.
4.
ADVANCED LIFE SUPPORT (ALS) – includes all ILS consists of invasive
life-saving procedures including,
but not limited to:
·
advanced airway management and mechanical ventilation,
·
intravenous (IV) or intraosseous (IO) access, IV or IO fluid administration,
·
emergency cardiovascular care (i.e.
electrocardiogram (ECG) interpretation and
management of life-threatening arrhythmias),
·
administration of a broad spectrum of
medications according to predetermined local guidelines via the oral, inhaled,
intranasal, intramuscular,
IV or IO routes.
With this kind of framework in
mind, we will endeavor to bring you the various training initiatives and direction
that Emergency Medicine Uganda is taking.
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| The UNAS Team |
Mould-Millman
NK et al. Time to standardise levels of care amongst Out-of-Hospital Emergency
Care providers in Africa, Afr J Emerg Med (2016), http://dx.doi.org/10.1016/j.afjem.2015.12.002
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