Development of Emergency Care in Zambia

Dr. Calvello Hynes, Dr. Bellows, Dr. Dixon, Dr. Mould-Millman, Dr. Richards

Sustainably improve the emergency health outcomes of populations by increasing capacity for emergencies at district hospitals by implementing an interventional package including the WHO Basic Emergency Care course, clinical pathways and triage. Project will expand from one exemplary province in Zambia to other provinces in partnership with the Ministry of Health and key Zambian stakeholder agencies

AFEM Clinical & Operational Protocols 

Dr. Calvello Hynes, Dr. Bellows, Dr. Dixon, Dr. Mould-Millman, Dr. Richards

Development of clinical and operational pathways for common emergency chief complaints. Pathways provide guidance appropriate to the African region, ultimately placing critical decision tools in the hands of frontline providers.

Collaborating Institutions: African Federation for Emergency Medicine

Emergency Care Outcomes Project (ECOP)

Bagamoyo and Kisarwe Tanzania; Mubende and Kawolo Uganda

Dr. Dixon

Implementation of a simple emergency care educational and process improvement package including the WHO Basic Emergency Care course, standardized triage and medical and trauma checklists for emergency patients. Implementation effectiveness includes evaluation of mortality for five sentinel clinical conditions as the primary outcome.

Collaborating Institutions: World Health Organization, African Federation for Emergency Medicine, University of Cape Town, South Africa, Brigham and Women’s Harvard

Improving Outcomes in Prehospital Hemorrhagic Shock

Dr. Mould-Millman, Dr. Dixon

Implementation of a novel trauma care curriculum for EMS providers in Cape Town, South Africa for critically injured patients in haemorrhagic shock. Training is delivered by peers, in ambulances on shift and was developed with the WCG EMS quality and continuing education staff. The education platform can be filled with new content for future trainings. The training is being evaluated by all participants, mini-OSCE assessments and patient outcome data from clinical charts.

Collaborating Institutions: Western Cape Government EMS, University of Cape Town, South Africa

Quality Indicators for Emergency Care in Africa

Dr. Calvello Hynes, Dr. Dixon

Determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. Utilized a multiphase expert consensus process to identify, rank and refine quality indicators.

Collaborating Institutions: African Federation for Emergency Medicine

Evaluation of the South Africa Elective at the University of Colorado School of Medicine 

Dr. Richards

Survey evaluation of past participants of the South Africa Elective at CU SOM.  Two manuscripts have been submitted for publication demonstrating the effectiveness of this specific global health experience in career development of medical students.  Starting in 2017 in-country partners have played a major role in the selection of students for this highly competitive experience.  Using in-country partners in the selection of students is a novel concept with significant interest from the global health education community.

Collaborating Institution: Khayelitsha District Hospital

Assessing use of the South African Triage Scale (SATS) in the Prehospital Environment

Dr. Mould-Millman, Dr. Dixon

Evaluation of how WCG EMS providers triage patients in the field and use the South African Triage Scale, through focus groups and a written assessment. Aim is to refine and improve the use and performance of a prehospital triage tool that addresses the unique needs of the prehospital environment.

Collaborating Institutions: WCG EMS, University of Cape Town, South Africa

Emergency Medicine Bootcamp for Panamanian Medical Students

Dr. Dixon

Two course series consisting of Emergency Medicine Fundamentals and Emergency Medicine Processes and Procedures. Course taught in Spanish to medical students near graduation, many of whom will practice solo in rural communities less than two years after graduation with minimal exposure to emergency care.

Collaborating Institutions: University of Panama, School of Medicine

Understanding Knowledge, Attitudes and Practices of Exclusive Breastfeeding (EBF) at Dhulikel Hospital, Nepal 

Dr. Bellows

Survey study of pregnant women presenting for prenatal care at clinics in the Kavre District in Nepal regarding their understanding and practice of EBF.

Standardizing EM Chief Complaints

Dr. Mould-Millman

Creating an internationally standardized and validated set of chief complaints and definitions for African EM and EMS research. Standardized chief complaints will improve data collection and future comparative analysis to further EM development.

15 Year Review of African Emergency Care Literature

Dr. Mould-Millman, Dr. Dixon, Dr. Burkholder

Systematic review of emergency care literature relevant to the African context using publication trends (type, content, year) as a proxy for depth of development of emergency care within countries.

Cultural and Religious Barriers to Emergency Ultrasound Use in Africa

Dr. Richards

Investigating results of previous surveys of barriers to ultrasound use in Africa.  Specifically evaluating factors related to fetal sex determination, elective abortion, and religious beliefs through qualitative analysis of small group discussions and a literature review guided by stakeholders.

Simulation for improved preparation and performance in inexperienced global health provider

Dr. Richards

Developing a pre-departure simulation based curriculum to better prepare US medical students for work in resource limited settings.  A literature review and white-paper style manuscript are in the final stages of development and are being used in an iterative process to improve University of Colorado medical student performance on global health rotations.

Past Projects

Adherence to Universal Travel Screening in the ED

Dr. Burkholder
Assessing the overall adherence to the travel screening protocol during the Ebola 2014 epidemic and identifying factors associated with non-adherence

Survey on Emergency Medical Service (EMS) Agencies and Systems in Africa

Dr. Mould-Millman, Dr. Dixon

Multi-phase survey of local experts to categorize and characterize current African EMS systems.

Collaborating Institutions: African Federation for Emergency Medicine (AFEM)

Optic Nerve Sheath Ultrasound Training and Performance

Dr. Richards

Continuing previously published work to develop a method of teaching accurate and reliable measurements of optic nerve sheath diameter as proxy for intracranial pressure to providers in resource limited settings.  A phantom allowing quality ultrasound teaching was created and validated and is currently being used to teach providers the proper technique. 

Collaborating Institutions: University of Washington, Stellenbosch University

Pediatric Resuscitation Outcomes at Khayelitsha District Hospital Cape Town, South Africa

Dr. Richards

Assessing characteristics and outcomes of pediatric patients requiring resuscitation and evaluating implications for resource distribution.  A peer-reviewed manuscript has been accepted for publication and the results will be used to argue for additional resources to support pediatric resuscitation. 

Collaborating Institutions: Stellenbosch University, Provincial Government of the Western Cape