Objectives: To establish the level of knowledge and skill in basic resuscitation among medical pr... more Objectives: To establish the level of knowledge and skill in basic resuscitation among medical practitioners and to determine the differences in characteristics between those with and those without knowledge and skills. Design: Cross-sectional study. Setting: Public hospitals in Northern Province. Subjects: All the doctors in full-time employment, except interns and those in full-time administration. Outcome measures: Practice on manikins using structured interview/evaluation sheet. Results: Of 152 participants, 7 (4.6%) scored 80% and above and 37 (24.3%) scored 50% and above. The medical practitioners who performed better were younger and more likely to have received undergraduate and postgraduate resuscitation training, and resuscitation training within the last 2 years. The country of qualification, sex, postgraduate qualification, frequency of continuing medical education and past experience of resuscitating cardiac arrest patients were not associated with a performance on the evaluation. Conclusion: Medical practitioner skills and knowledge of basic resuscitation were poor and resuscitation experience without training was not found to be beneficial. It is therefore recommended that formal training in resuscitation be mandatory at undergraduate and postgraduate level, with refresher courses held every 2 years.
Successful management of a cardiac arrest demands immediate and appropriate action. Numerous diff... more Successful management of a cardiac arrest demands immediate and appropriate action. Numerous different techniques for cardiopulmonary resuscitation (CPR) have been described, resulting in confusion among health care providers with respect to the use of different methods under different circumstances. Lack of adequate resuscitation skills and the need for proper training are well recognised. The Heart Foundation of Southern Africa, in recognising this need, organised this country's first National Basic CPR Symposium, followed by a National Workshop where official representatives of major CPR-promoting organisations critically analysed and reviewed contentious issues in basic CPR with a view to providing national guidelines. It was unanimously agreed that the recommendations of the National Workshop, as reported here, would stand as the consensus of opinion of the 33 major CPR-promoting organisations in this country.
A simple 10-step ‘zigzag’ approach to identifying the 10 common causes of pulseless electrical ac... more A simple 10-step ‘zigzag’ approach to identifying the 10 common causes of pulseless electrical activity (electro-mechanical dissociation) is presented in the form of an easy to remember training mnemonic.
Richard 0. Cummins and Douglas A. Chamberlain, Cochairmen; Norman S. Abramson, Mervyn Allen, Pete... more Richard 0. Cummins and Douglas A. Chamberlain, Cochairmen; Norman S. Abramson, Mervyn Allen, Peter J. Baskett, Lance Becker, Leo Bossaert, Herman H. Delooz, Wolfgang F. Dick, Mickey S. Eisenberg, ThomasR. Evans, Stig Holmberg, Richard Kerber, Arne Mullie, Joseph P. ...
Basic and advanced care of trauma patients has always been an important aspect of prehospital and... more Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po
Objectives: To establish the level of knowledge and skill in basic resuscitation among medical pr... more Objectives: To establish the level of knowledge and skill in basic resuscitation among medical practitioners and to determine the differences in characteristics between those with and those without knowledge and skills. Design: Cross-sectional study. Setting: Public hospitals in Northern Province. Subjects: All the doctors in full-time employment, except interns and those in full-time administration. Outcome measures: Practice on manikins using structured interview/evaluation sheet. Results: Of 152 participants, 7 (4.6%) scored 80% and above and 37 (24.3%) scored 50% and above. The medical practitioners who performed better were younger and more likely to have received undergraduate and postgraduate resuscitation training, and resuscitation training within the last 2 years. The country of qualification, sex, postgraduate qualification, frequency of continuing medical education and past experience of resuscitating cardiac arrest patients were not associated with a performance on the evaluation. Conclusion: Medical practitioner skills and knowledge of basic resuscitation were poor and resuscitation experience without training was not found to be beneficial. It is therefore recommended that formal training in resuscitation be mandatory at undergraduate and postgraduate level, with refresher courses held every 2 years.
Successful management of a cardiac arrest demands immediate and appropriate action. Numerous diff... more Successful management of a cardiac arrest demands immediate and appropriate action. Numerous different techniques for cardiopulmonary resuscitation (CPR) have been described, resulting in confusion among health care providers with respect to the use of different methods under different circumstances. Lack of adequate resuscitation skills and the need for proper training are well recognised. The Heart Foundation of Southern Africa, in recognising this need, organised this country's first National Basic CPR Symposium, followed by a National Workshop where official representatives of major CPR-promoting organisations critically analysed and reviewed contentious issues in basic CPR with a view to providing national guidelines. It was unanimously agreed that the recommendations of the National Workshop, as reported here, would stand as the consensus of opinion of the 33 major CPR-promoting organisations in this country.
A simple 10-step ‘zigzag’ approach to identifying the 10 common causes of pulseless electrical ac... more A simple 10-step ‘zigzag’ approach to identifying the 10 common causes of pulseless electrical activity (electro-mechanical dissociation) is presented in the form of an easy to remember training mnemonic.
Richard 0. Cummins and Douglas A. Chamberlain, Cochairmen; Norman S. Abramson, Mervyn Allen, Pete... more Richard 0. Cummins and Douglas A. Chamberlain, Cochairmen; Norman S. Abramson, Mervyn Allen, Peter J. Baskett, Lance Becker, Leo Bossaert, Herman H. Delooz, Wolfgang F. Dick, Mickey S. Eisenberg, ThomasR. Evans, Stig Holmberg, Richard Kerber, Arne Mullie, Joseph P. ...
Basic and advanced care of trauma patients has always been an important aspect of prehospital and... more Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po
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Papers by Walter Kloeck