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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces</text>
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                <text>Helicopter emergency medical service Critical care transport Emergency care systems Trauma Interfacility transport</text>
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                <text>Introduction: Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. Methods: A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 –June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. Results: A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n = 548, 59.8%) and suffered blunt trauma (n = 379, 41.4%). Medical pathol- ogy (n = 247, 27%) and neonatal transfers (n = 184, 20.1%) follows. Flights occurred mainly in daylight hours (n = 729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n = 428, 46.7%), with a large number receiving no respiratory support (n = 414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intra- venous fluid therapy (n = 867, 94.7%) was almost universal, with common administration of sedation (n = 430, 46.9%) and analgesia (n = 329, 35.9%). Conclusion: Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements</text>
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                <text>Neville Vlok, Craig Wylie , Willem Stassen</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>14 May 2023</text>
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                <text>peri irawan</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
A qualitative assessment of stakeholder perspectives on barriers and facilitators to emergency care delays in Northern Tanzania through the Three Delays</text>
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                <text>Emergency care Three Delays Model Tanzania Access to care EMS Emergency medicine</text>
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                <text>Introduction: Emergency conditions cause a significant burden of death and disability, particularly in developing countries. Prehospital and Emergency Medical Services (EMS) are largely nonexistent throughout Tanzania and little is known about the community’s barriers to accessing emergency care. The objective of this study was to better understand local community stakeholder perspectives on barriers, facilitators, and potential solutions surrounding emergency care in the Kilimanjaro region through the Three Delays Model framework. Methods: A qualitative assessment of local stakeholders was conducted through semi-structured focus group discussions (FGDs) from February to June 2021 with five separate groups: hospital administrators, emergency hospital workers, police personnel, fire brigade personnel, and community health workers. FGDs were conducted in Kiswahili, audio recorded, and translated to English verbatim. Two research analysts separately coded the first two FGDs using both inductive and deductive thematic analysis. A final codebook was then created to analyze the remaining FGDs. Results: A total of 24 participants were interviewed. Thematic analysis revealed that participants identified sig- nificant barriers within the Three Delays Model as well as identified an additional delay centered on community members and first aid provision. Perceived delays in the decision to seek care, the first delay, were financial constraints and the lack of community education on emergency conditions. Limited infrastructure and reduced transportation access were thought to contribute to the second delay. Potential barriers to receiving timely appro- priate care, the third delay, included upfront payments required by hospitals and emergency department intake delays. Suggested solutions focused on increasing education and improving communication and infrastructure. Conclusion: The findings outline barriers to accessing emergency care from a stakeholder perspective. These themes can support recommendations for further strengthening of the prehospital and emergency care system. Due to logistical constraints, emergency care workers interviewed were all from one hospital and patients were not included.</text>
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                <text>Leah Hosaka , Anna Tupetz , Francis M. Sakita , Frida Shayo, Catherine Staton, Blandina T. Mmbaga , Anjni Patel Joiner</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>peri irawan</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Accuracy of two-rescuer adult CPR performed by medical registrars at a South African university&#13;
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          <element elementId="49">
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                <text>Cardiopulmonary resuscitation Accuracy of CPR Two rescuer CPR</text>
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                <text>Background: Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient’s spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation. Objectives: This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci- Anne®manikin performed by registrars from the University of the Free State, South Africa. Methods: A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. Dur- ing a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne®manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association’s tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded. Results: The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C tech- nique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars. Conclusion: The study found that registrars were not consistently performing high-quality CPR on a Resusci- Anne®manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars</text>
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            <description>An entity primarily responsible for making the resource</description>
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                <text>Bianca Hartslief, Carmen Janse van Rensburg, Alicia Maartens, Pieter G. Marais, Erwain T. Meyer, Joleen P. Cairncross, Gina Joubert, Wilhelm Johannes Steinberg</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>25 June 2023</text>
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                <text>peri irawan</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
An investigation into the use of Full-body Low Dose X-rays Imaging system in South Africa: Radiographer’s perspective</text>
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                <text>Lodox Ionising radiation Trauma imaging Conventional x-ray system patient referral emergency unit image quality</text>
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                <text>Introduction: A low dose x-rays alias Lodox©statscan was originally developed in South Africa to detect smuggled diamonds in the mines. Later, hospital trauma units began to use it as a screening tool for gross pathology on trauma patients. This imaging system became popular because of its use of low radiation doses and its ability to perform anterior posterior (head to toe image) image in under 13 seconds. Anecdotal evidence confirms that patients were referred for additional regional images on conventional x-ray systems after Lodox imaging. Thus, patients were subjected to additional ionising radiation, long waiting times as well as additional charges for secondary radiological examinations. Objective: This research aimed at investigating the extent to which Lodox was used in trauma units (n = 28) in South Africa. Method: In this descriptive cross-sectional research. researcher invited one radiographer from each of the 28 hospitals in South Africa that were using Lodox. Results: Out of twenty radiographers who responded, it was found that most hospitals were referring patients for additional conventional x-ray images (Figure 1); for example, for chest x-rays. This was done despite the patient having undergone radiological procedures and examinations by the Lodox imaging system that was similar to those performed by conventional x-ray systems. Conclusion: Lodox was used for a successful diagnosis Thus, researcher recommends an imaging protocol for Lodox to be developed for guiding the referral of patients after the Lodox scanning has been performed</text>
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                <text>Muchui Julius Thambura</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>24 May 2023</text>
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                <text>peri irawan</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Analgesia use in trauma patients at a university teaching hospital in Kigali, Rwanda</text>
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                <text>Trauma Pain management Analgesia Rwanda</text>
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                <text>Introduction: While trends in analgesia have been identified in high-income countries, little research exists re- garding analgesia administration in low- and middle-income countries (LMIC). This study evaluates analgesia administration and clinical characteristics among patients seeking emergency injury care at University Teaching Hospital-Kigali in Kigali, Rwanda. Methods: This retrospective, cross-sectional study utilized a random sample of emergency center (EC) cases ac- crued between July 2015 and June 2016. Data was extracted from the medical record for patients who had an injury and were ≥ 15 years of age. Injury-related EC visits were identified by presenting complaint or final dis- charge diagnosis. Sociodemographic information, injury mechanism and type, and analgesic medications ordered and administered were analyzed. Results: Of the 3,609 random cases, 1,329 met eligibility and were analyzed. The study population was predom- inantly male (72%) with a median age of 32 years and range between 15 and 81 years. In the studied sample, 728 (54.8%) were treated with analgesia in the EC. In unadjusted logistic regression, only age was not a signifi- cant predictor of receiving pain medication and was excluded from the adjusted analysis. In the adjusted model, all predictors remained significant, with being male, having at least one severe injury, and road traffic accident (RTA) as injury mechanism being significant predictors of analgesia administration. Conclusion: In the study setting of injured patients in Rwanda, being male, involved in RTA or having more than one serious injury was associated with higher odds of receiving pain medication. Approximately half of the patients with traumatic injuries received pain medications, predominantly opioids with no factors predicting whether a patient would receive opioids versus other medications. Further research on implementation of pain guidelines and drug shortages is warranted to improve pain management for injured patients in the LMIC setting.</text>
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                <text>Jean Muragizi , Mindi Guptill , Bogdan G. Dumitriu , Michael B. Henry, Adam R. Aluisio , Jean Paul Nzabandora , Appolinaire Manirafasha , Janette Baird , Katelyn Morretti , Naz Karim</text>
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                <text>www.elsevier.com/locate/afjem</text>
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                <text>11 May 2023</text>
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                <text>peri irawan</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda</text>
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          <element elementId="49">
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              <elementText elementTextId="21886">
                <text>Obstetric emergencies Ambulance Transfer Kawempe National Referral Hospita Uganda</text>
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                <text>Introduction: In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies. Objective: The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities Methods: The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital’s ambulance log book for each case. The sample size was 215. Results: The median age was 27 years and the majority of patients were referred because of hypertensive dis- orders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50 min, from ambulance activation until the mother was received at KNRH. Dif- ferences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Am- bulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken . Conclusions: Recommendations are to develop an integrated ambulance system for both government and non- government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.</text>
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                <text>Okong Doreen Alaleit , Jonathan Kajjimu , Kalanzi Joseph , Magara Stella Namirembe , Peter K. Agaba , Andrew Kintu</text>
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              <elementText elementTextId="21889">
                <text>www.elsevier.com/locate/afjem</text>
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              <elementText elementTextId="21890">
                <text>9 June 2023</text>
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            <elementTextContainer>
              <elementText elementTextId="21891">
                <text>peri irawan</text>
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            <description>A language of the resource</description>
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              <elementText elementTextId="21893">
                <text>english</text>
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              <description>A name given to the resource</description>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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            <description>A name given to the resource</description>
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              <elementText elementTextId="21905">
                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Disaster response readiness assessment of public hospitals in Addis Ababa City, Addis Ababa, Ethiopia</text>
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          <element elementId="49">
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              <elementText elementTextId="21906">
                <text>Disaster Emergency Readiness Trauma Ethiopia</text>
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            <description>An account of the resource</description>
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                <text>Introduction: Due to its diverse geography, climate, and political instability, Ethiopia is one of the countries most affected by disasters. However, there is a lack of evidence-based assessments of disaster preparedness, especially in Addis Ababa, where most tertiary-level referral hospitals are located. This study aims to evaluate disaster readiness in public hospitals in Addis Ababa using WHO standards, focusing on hospital characteristics, disaster plans, infrastructure, and human resources availability. Ultimately, the findings are expected to provide actionable recommendations for improving disaster preparedness in public hospitals in the city. Methods: A cross-sectional study design was utilized using quantitative and qualitative methods to assess disaster response readiness among public hospitals in Addis Ababa, the capital city of Ethiopia. Results: This study assessed ten public referral hospitals in Addis Ababa. In the last two years, all but one of the ten public referral hospitals in Addis Ababa have experienced a disaster. Road traffic accidents are responsible for half of all disasters. While 50% of the hospitals have trauma-specific plans, there are no disaster-specific guidelines for the remaining hospital. Moreover, all facilities and ambulances lack communication networks to receive assistance during disasters. A total of 88.8% of emergency and disaster facility level representatives (n = 18) stated that their emergency care areas need improvement to be able to manage patients during disasters more effectively. While seven hospitals (70%) have separate disaster medication and equipment storage, only three (43%) are regularly restocked. Furthermore, nearly half of the respondents (44%) reported that their hospital does not have a functional disaster management team, and 61% are unprepared to handle a disaster. Lastly, 33% of the respondents mentioned the Ministry of Health and hospital leaders’ commitment as an enabling factor to improve future disaster response readiness. Conclusion: Public referral hospitals in Addis Ababa have significant gaps in disaster management preparedness and response. A comprehensive disaster response plan, including stafftraining, regular restocking of medication and equipment, and functional communication networks, should be implemented in every public referral hospital. It is imperative that all stakeholders work together, including local government authorities, emergency response teams, and community members, to ensure hospitals are well-equipped to deal with disasters.</text>
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              <elementText elementTextId="21908">
                <text>Yared Boru Firissa, Menbeu Sultan , Mahdi Abdelwahab , Fitsum Kifle Belachew</text>
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            <description>A related resource from which the described resource is derived</description>
            <elementTextContainer>
              <elementText elementTextId="21909">
                <text>www.elsevier.com/locate/afjem</text>
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              <elementText elementTextId="21910">
                <text>25 June 2023</text>
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          <element elementId="37">
            <name>Contributor</name>
            <description>An entity responsible for making contributions to the resource</description>
            <elementTextContainer>
              <elementText elementTextId="21911">
                <text>peri irawan</text>
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              <elementText elementTextId="21913">
                <text>english</text>
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                  <text>Jurnal Internasional Afrika vol. 13 issue 3 2023</text>
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Emergency preparedness capacity of a university hospital in Ghana: a cross-sectional study</text>
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          <element elementId="49">
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            <elementTextContainer>
              <elementText elementTextId="21916">
                <text>Emergency Preparedness Resources Emergency plan Casualty services Medical services</text>
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            <description>An account of the resource</description>
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                <text>Background: The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana. Methods: A facility-based cross-sectional study was conducted between December 2018 and February 2019 using three guidelines developed respectively by the World Health Organization, the Ministry of Health-Ghana, and the Ghana Health Service. The hospital’s emergency preparedness was assessed regarding the emergency policies, plan, protocol, equipment, and medications. Results: Overall, the hospital’s emergency preparedness level was weak (57.36%). Findings revealed that the hos- pital had inadequate emergency equipment, and supplies for emergency care delivery, especially during upsurge. It also did not have an emergency planning committee. There were noticeable deficiencies in some emergency resources such as chest tubes, basic airway supplies, and many emergency drugs. Other vital emergency tools such as pulse oximeter, thermometer, and emergency medications were inadequate. The hospital had a strong emergency plan and policies on assessment (77.8% and 78%) respectively. Conclusion: The Kwame Nkrumah University of Science and Technology hospital is not prepared sufficiently for an emergency surge, and this poses a major health challenge. Emergency items must be made available, and the organization and planning of emergency service provisions must be improved to avoid preventable deaths during an emergency surge</text>
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            <description>An entity primarily responsible for making the resource</description>
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                <text>Estella Antoinette Boateng-Osei, Isaac Osei , Abigail Kusi-Amponsah Diji, Bernice Agyeman Pambour , Rejoice Wireko-Gyebi , Portia Okyere , Alberta Yemotsoo Lomotey</text>
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            <description>A related resource from which the described resource is derived</description>
            <elementTextContainer>
              <elementText elementTextId="21919">
                <text>www.elsevier.com/locate/afjem</text>
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                <text>11 May 2023</text>
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              <elementText elementTextId="21921">
                <text>peri irawan</text>
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              <elementText elementTextId="21923">
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                <text>Jurnal Internasional Afrika vol. 13 issue 3 2023&#13;
African Journal of Emergency Medicine&#13;
Global health research abstracts: April ‘23</text>
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