In October 2024, exceptional flooding along the Senegal River, exacerbated by unusual rainfall and dam releases from the Manantali and Diama infrastructures, directly affected approximatively 55,600 people across the Matam, Saint-Louis and Tambacounda regions and severely disrupted healthcare access in dozens of inundated communities. The Senegalese Armed Forces deployed a World Health Organization Type 1 Emergency Medical Team (EMT) to Orkadiéré, a strategic locality in the Matam region selected through a joint pre-deployment assessment with local civilian health and administrative authorities. Over 16 days (16–31 October 2024), a ten-member team comprising three physicians, a senior nurse, two nurses, two nursing assistants, an administrative officer and a driver—supported by dedicated military logistics and security units—delivered 360 documented medical consultations, conducted field missions to riverine communities accessible only by pirogue, and maintained active epidemiological surveillance for epidemic-prone diseases. This commentary reflects on four operational lessons derived through formal after-action reporting within the military chain of command: joint pre-deployment assessment for site selection; multidisciplinary team composition; separation of logistical from clinical functions; and epidemiological surveillance from mission day one. It also examines the civil-military coordination model and implications for institutionalising military humanitarian medical capacity within the Senegalese Armed Forces.
Introduction Patient transfers aim to ensure continuity of care, but referral-transfer pathway processes are often time-consuming and encounter various delays. This study determined healthcare workers’ perceptions of clinical and non-clinical factors contributing to delays in the transfer process of critically injured trauma patients from the Otjozondjupa District Hospitals to the Windhoek Referral Hospitals and explored mitigation strategies. Methods A cross-sectional online survey was conducted in 2023 at three district hospitals, private and parastatal ambulance services in the Otjozondjupa region, Namibia. Healthcare workers employed in Emergency Centres and Prehospital Emergency Care Providers, working in the setting for 6 months or longer, were eligible to participate. We used convenience and snowball sampling. Results Of the 50 respondents, 64.0% (n = 32) worked in Emergency Centres. Thirty-nine (n = 39, 78.0%) perceived referral/transfer delays. Diagnostic imaging and medical procedures were perceived clinical factors contributing to delays. Non-clinical/system-related factors included bed, ambulance, and medical doctor availability, a lack of human resources and management protocols, and limited knowledge of existing policies and procedures. Suggested mitigating strategies centred on targeted training needs, improved resource allocation, and enhanced Information Technology systems. Conclusion Healthcare workers perceived diagnostic processes, stabilisation procedures, and system-related constraints as barriers to timely interfacility transfer of critically injured trauma patients. Improving time to definitive care may benefit critically injured trauma patients while easing pressure on facilities caring for other urgent patients. These findings may inform local reviews of trauma-transfer processes and support future prospective studies that measure actual transfer times and objectively confirmed causes of delay.
Emergency medicine is rapidly evolving across Africa, yet the field continues to face significant gaps in research quality, particularly in study design and implementation. To generate actionable evidence that reflects the acute care needs of African populations, it is critical to embed quality management measures within clinical research processes. This commentary describes the use of the Plan-Do-Study-Act (PDSA), a simple and reproducible quality improvement (QI) tool, as a mid-study quality audit strategy during the implementation of the “Pathways to Care for Patients with Acute Infectious Illnesses in Ghana” (PATHCARE) study. Over two weeks, trained evaluators conducted structured observations and interviews with research assistants (RAs) across five study sites in Kumasi, Ghana. The audit revealed protocol deviations related to patient screening, recruitment, informed consent, and data collection that threatened data integrity and participant protection. Based on these findings, a targeted refresher training was conducted, leading to measurable improvements in RA knowledge of study protocol. This experience highlights the feasibility and impact of embedding low-cost, iterative quality audits within emergency care research. Especially in resource-constrained settings with limited research infrastructure, tools like the PDSA can serve as pragmatic solutions to enhance data reliability, safeguard ethical standards, and ultimately, improve the quality and utility of clinical research in African emergency medicine.
Introduction Emergency Centre crowding is a persistent challenge, particularly in low- and middle-income countries, where resource constraints exacerbate mismatches between demand and capacity. Clinician productivity is central to EC flow and is typically measured using patients per hour (PPH), but this does not capture concurrent workload. The active queue (AQ), operationally defined as unresolved clinician-attributed patient episodes at any point during a shift, may complement PPH by capturing the concurrent nature of EC clinical work. This study aimed to describe AQ dynamics at a district-level EC and identify the clinician, shift, and flow factors associated with variation in queue size. Methods A retrospective cross-sectional secondary analysis was conducted using data from 1 289 clinician shifts across three four-week periods in 2019 at a South African district-level EC. AQ was derived from timestamped patient flow data. Associations with clinician, shift, and system-level factors were assessed using one-way ANOVA and Spearman's rank correlation. Results Median AQ was 1.50 (IQR 1.00–2.25), with a median peak AQ of 3.00 (IQR 2.00–4.00). AQ varied significantly by clinician category, employment type, and shift type (all p < 0.001), with higher values among senior clinicians and during night shifts. AQ remained stable at a median of 2.00 during the active working period before declining in the final shift quarter, while PPH declined progressively throughout. AQ and PPH were moderately correlated (rho = 0.43, p < 0.001). AQ was positively associated with patients waiting at shift start (rho = 0.19, p < 0.001) but not with patient acuity, despite acuity strongly suppressing PPH (rho = −0.44, p < 0.001). Conclusions Emergency clinicians routinely manage concurrent patient loads, with AQ demonstrating a consistent mid-shift plateau. AQ complements PPH by capturing the concurrent dimension of clinician workload that throughput measures alone cannot reflect, with relevance to staffing and operational planning in district-level EC settings.
Background While helmet use among motorcyclists in Africa remains low, an equally critical issue is the quality of helmets in use. In many African countries, such as Ghana, poor-quality helmets are widely available in local markets, mainly due to a lack of helmet standards, weak import regulations, and poor enforcement. This study, therefore, explores the determinants and enablers of access to quality motorcycle helmets in Ghana. Methods We conducted a qualitative inquiry between January and April 2024. We purposively sampled participants across three interest groups: motorcyclists, helmet vendors/retailers, and road safety practitioners. We collected data through in-depth, face-to-face interviews using semi-structured interview guides. We analysed the data using inductive thematic analysis. Results We interviewed 41 participants: 16 motorcyclists, 19 helmet vendors/retailers, and 6 road safety practitioners. The analysis highlighted four interconnected system gaps and potential enablers: limited knowledge and awareness of helmet quality, limited availability of quality helmets, economic constraints, and the absence of regulations and enforcement. Enablers include public education and awareness of quality helmets, improved market availability, price controls and incentives for motorcyclists, and stronger regulation and enforcement. Together, these factors limit access to quality helmets, and a systemic regulatory gap in standards and enforcement exacerbates the problem. Conclusion Improving access to quality helmets requires a coordinated approach. The first step is to address the regulatory gap by developing helmet standards. Without this, it is difficult to ensure market availability, raise public awareness, and make helmets more affordable.
