Preparedness of Dammam primary health care centers to deal with emergency cases

Barriers faced by primary healthcare providers in addressing emergencies in the Northern region of Palestine before and during the Gaza war

INTRODUCTION

Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict.

METHODS

A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability.

RESULTS

The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases.

CONCLUSION

Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations.

Non-hospital healthcare center's preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study

BACKGROUND

Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs' preparedness to provide initial emergency care.

METHODS

This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach's alpha, Intra-class Correlation Coefficient, and Kendal's Tau-b. All the statistical analyses were performed using Stata 14.

RESULTS

In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: "Environmental Infrastructures of Centers", "Protocols, Guidelines and Policies", "Medical Supplies and Equipment", "Emergency Medicines", "Human Resources", "Clinical Interventions", "Maintenance of equipment", "Medicine Storage Capability", and "Management Process". The toolbar had acceptable validity and reliability.

CONCLUSIONS

This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.

The Emergency Preparedness of Level-Four Primary Health Care Centers in the Gaza Strip, the Occupied Palestinian Territory: An Assessment of Primary Care Providers' Competencies and Facilities Preparedness

INTRODUCTION

The Gaza Strip lives in a protracted emergency crisis and experienced several Israeli escalations. These escalations have overwhelmed the hospitals and highlighted the need to optimize Primary Health Care Centers (PHCCs) to form part of the emergency response system. This study, therefore, aimed to assess the emergency preparedness of the Ministry of Health (MoH)-run level-four PHCCs in the Gaza Strip (where Emergency Medical Services are provided along with preventive and curative services).

METHODS

The study was cross-sectional, used quantitative methods, and utilized two tools. The first tool was a self-administered structured questionnaire exploring Primary Care Providers' ([PCPs]; doctors and nurses) experiences, perceived capabilities, and training needs. The second tool was an observational checklist used to assess the preparedness of the emergency rooms (ERs) at level-four PHCCs in the Gaza Strip.

RESULTS

Two hundred and thirty-eight PCPs (34.5% doctors and 65.5% nurses) working in 16 level-four PHCCs were included. Overall, 64.4% of the participants had experience working in PHCCs during Israeli escalations, though 35.3% of them were unaware of the contingency plan (CP) of PHCCs. More nurses were aware of CPs than doctors (66.9% versus 42.7%; P <.001). Moreover, 65.7%, 46.7%, and 42.5% of the participants were trained in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Primary Trauma Care (PTC), respectively. However, many had received the training for more than two years, and none of the PHCCs had all its staff trained. Only 36.8% of the participants were trained in Post-Trauma/Post-Operative Care (wound care and dressing), and the percentage of trained nurses was significantly higher than those of doctors (36.8% versus 13.9%; P <.001). The majority of the participants admitted they need ACLS training (89.2%), PTC training (89%), BLS training (81.1%), and Post-Trauma/Post-Operative Care training (76.8%). Only 29.63% of emergency drugs and 37.5% of the equipment and disposables were available in the ERs of all PHCCs, and none of the PHCCs had all the essential emergency drugs, equipment, and disposables available.

CONCLUSION

Level-four PHCCs in the Gaza Strip are not adequately prepared to respond to emergencies. Generally, PCPs lack appropriate competencies for emergency response, and many PHCCs lack the infrastructure to support Primary Emergency Care (PEC). Thus, PCPs need continuous education and training in disaster preparedness and response and PEC.

Types of Primary Healthcare Emergencies in Muscat, Oman: A retrospective cross-sectional study of five primary care centres

Objectives

Emergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman.

Methods

This retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care.

Results

The proportion of emergency cases was <2.5% (range: 1–2.5%). The most common type of emergency was musculoskeletal issues/trauma (34.3%) followed by gastroenterological (15.1%) and genitourinary (10.0%) emergencies. Most patients were either 21–39 or 5–12 years old (35.0% and 21.6%, respectively). The majority (59.6%) were treated directly at the health centre, while the remaining patients (40.4%) were referred to tertiary care. At referral, only 12.1% were transported by ambulance and the rest via private transport.

Conclusion

Musculoskeletal issues/trauma was the most common type of emergency seen at the selected PHC centres in Muscat. Further research is needed to determine whether PHC centres have the capability and resources necessary to appropriately manage emergency cases.

Family medicine residents' skill levels in emergency chest X-ray interpretation

Background

Family medicine physicians may encounter a wide variety of conditions, including acute and urgent cases. Considering the limited access to diagnostic investigations in primary care practice, chest X-ray remains the imaging modality of choice. The current study assessed the competency of family medicine residents in the interpretation of chest X-rays for emergency conditions and to compare it with that of diagnostic radiology residents, general practitioners, and medical interns.

Methods

An online survey was distributed to 600 physicians, including family medicine residents, medical interns, general practitioners, and diagnostic radiology residents. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of chest X-rays. The survey had 10 chest X-ray cases with brief clinical information. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the chest X-ray for each case.

Results

The survey was completed by 205 physicians (response rate = 34.2%). The overall diagnostic accuracy was 63.1% with a significant difference between family medicine and radiology residents (58.0% vs. 90.5%; P < 0.001). The COVID-19 pneumonia (85.4%) and pneumoperitoneum (80.5%) cases had the highest diagnostic accuracy scores. There was a significant correlation between the diagnostic confidence and accuracy (r_s = 0.39; P < 0.001). Multivariable regression analysis revealed that being diagnostic radiology residents (odds ratio [OR]: 13.0; 95% confidence interval [CI]: 2.5–67.7) and having higher diagnostic confidence (OR: 2.2; 95% CI: 1.3–3.8) were the only independent predictors of achieving high diagnostic accuracy.

Conclusion

The competency of family medicine residents in the interpretation of chest X-ray for emergency conditions was far from optimal. The introduction of radiology training courses on emergency conditions seems imperative. Alternatively, the use of tele-radiology in primary healthcare centers should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01390-3.

Preparedness of non-hospital health centers to manage patients with life-threatening emergency conditions: findings from a qualitative study

BACKGROUND

Management of Life-threatening Emergency (LTE) patients in urban and rural areas is an important challenge, which can affect pre-hospital mortality rate. Therefore, Non-hospital Health Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The aim of this study was to explore domains related to the preparedness of NHHCs to manage LTE patients through resorting to healthcare providers' and experts' perspectives.

METHODS

A qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus Group Discussions (FGDs). Prior to beginning data collection, the study and its objectives were explained to the participants and their informed consents were obtained. Then, SSIs and FGDs were conducted by two trained researchers using an interview guide, which was developed through literature review and consulting experts. In total, 12 SSIs were done with the providers at different NHHCs in Tabriz. In addition, 2 FGDs were conducted with the specialists in Emergency Medicine (EM) and Primary Health Care (PHC), and the executives of health centers, with over 5 years of work experience, and Emergency Medical Services (EMS) experts. Purposive sampling method was used in this study. All SSIs and FGDs were audio recorded and subsequently transcribed. Framework Analysis was employed to manually analyze the interview transcripts from all the SSIs and FGDs.

RESULTS

The interview transcripts analysis resulted in the emergence of 3 themes and 11 sub-themes, categorized according to Donabedian's triple model. 5 sub-themes were related to input, including medical equipment and supplies, environmental infrastructures of the centers, emergency medicines, human resource, and protocols, guidelines and policies. 4 sub-themes were related to process, including providing clinical services, medicine storage capacity, maintenance of equipment, and management process. Finally, 2 sub-themes were related to outcome, which were patients' satisfaction with the quality of care and improved survival of LTE patients.

CONCLUSIONS

The results of this study can provide a new perspective for health managers and policy makers on how to evaluate the preparedness of NHHCs in managing LTE patients. In addition, it will be used to develop instruments to measure the preparedness of these centers.

Perception of tertiary care clients toward the availability of physical therapy service at primary health care centers in Saudi Arabia: a cross-sectional survey

[Purpose] To explore the views of clients referred for physical therapy in a tertiary care setting regarding the integration of physical therapy service at primary health care centers. [Participants and Methods] A self-administered questionnaire was distributed to eligible Saudi clients. The questionnaire consisted of three sections including demographic information section; closed-ended section with 6 Likert scale items on the perceptions of potential advantages of physical therapy service at the primary health care level; and open-ended section on potential disadvantages and barriers of implementing physical therapy service. The surveys were described and analyzed quantitatively and qualitatively. [Results] A total of 412 participants were included in the analysis (56.8% females). Participants’ mean age was 35.7 ± 21.9 years; 67.2% were Riyadh city residents; and 38.1% had musculoskeletal conditions. Seventy-five percent responded in support for the availability of physical therapy service at the primary health care level. Demographic characteristics had no effect on the level of support to the service availability. [Conclusion] The results of this survey demonstrated high positive support for the integration of physical therapy service at primary health care centers in Saudi Arabia. However, challenges and barriers identified by the study results require attention when physical therapy services are to be established.

Emergency and Disaster Preparedness at a Tertiary Medical City

OBJECTIVE

The aim of this study was to evaluate the readiness of a tertiary medical city's response to a disaster by assessing the hospital resources and knowledge, attitudes, practices, and familiarity of health care providers toward disaster and emergency preparedness.

METHODS

All KFMC (King Fahad Medical City) staff with > 1 year of clinical experience were eligible to participate in a cross-sectional study. Participants responded to the Emergency Preparedness Information Questionnaire (EPIQ), knowledge and practice questionnaires, and a disaster planning attitude checklist. Data about resources were collected using the hospital disaster preparedness self-assessment tool.

RESULTS

The overall mean knowledge score for disaster and emergency preparedness was 4.4 ± 1.1, and the mean overall familiarity score was 3.43 ± 0.97. Most participants knew that disaster drills (90.2%) and training (74.6%) are ongoing. Sixty-six (21.0%) agreed that KFMC is unlikely to experience a disaster. The highest and lowest EPIQ familiarity scores were for decontamination (83.0%) and accessing critical resources and reporting (64.3%), respectively. Most participants (99.4%) have access to work computers; however, only 53.0% used the Internet to access information on bioterrorism and/or emergency preparedness. The hospital is ready to respond in case of a disaster according to the used tool.

CONCLUSIONS

The participants' levels of knowledge, practices, and overall familiarity toward emergency and disaster preparedness were satisfactory; however, participant attitudes and familiarity with where and how to access critical resources in the event of an emergency or disaster situations require reinforcement.

Basic Management of Life-Threatening Emergencies: The Importance of Developing the Instrument to Assess Nonhospital Health Centers' Preparedness

We presented a commentary on published studies on the "preparedness of non-hospital centers in dealing with life-threatening emergencies" to emphasize the importance of developing, validating, and piloting an instrument to assess the preparedness of these centers when life-threatening emergencies occur in their geographic area.

Knowledge, attitudes, and practices of emergency department staff towards disaster and emergency preparedness at tertiary health care hospital in central Saudi Arabia

Objectives:

To assess the knowledge, practices, and attitudes regarding disaster and emergency preparedness among Emergency Department (ED) staff.

Methods:

This cross-sectional study was conducted at Tertiary health care hospital in central Riyadh, Kingdom of Saudi Arabia. A self-administered survey was utilized to collect data from ED physicians and nurses. The questionnaire was divided into 5 sections viz; demographics, knowledge about disaster management and preparedness, attitudes about disaster planning, current role and practices, and familiarity towards emergency.

Results:

A 189 participants have completed the questionnaire. Two-third of the participants were below 30 years, and more than 85% were female. One hundred and eleven (58.7%) had a clinical experience of more than 5 years, while 78 (41.3%) participants had more than 3 years of clinical service at the Tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. Correct responses of knowledge towards disaster and emergency preparedness score was 6.2±2.5. Participants with more than 5-years of experience had a statistically significant (p=0.009) knowledge scale score for disaster and emergency preparedness. Overall, 186 (98.4%) patients believed that training is necessary for all healthcare workers. Approximately 153 (81%) participants reported the conduct of disaster drill at their hospital. The mean score (Mean±SD) for the overall familiarity of the study participants with emergency preparedness information questionnaire (EPIQ) scale was 3.2±1.3.

Conclusion:

The level of knowledge was satisfactory among healthcare providers with neutral level of attitude, practice, and familiarity regarding disaster preparedness. Follow-up research is necessary for maximizing ED preparedness.

Assessing Preparedness of Non-Hospital Health Centers to Provide Primary Emergency Care; A Systematic Review

Objectives

To identify prevalent domains related to the concept of assessing preparedness of non-hospital centers to provide primary emergency care in order to develop a comprehensive framework.

Methods

Five databases including PubMed, Scopus, Web of science, Barakat Knowledge Network Systems (BKNS) and Scientific Information Database (SID) were searched in English and/or Persian languages with no time limit until March, 2018. Manual search and grey literature were also done. According to the eligibility criteria, all the studies were independently tracked by two researchers. Studies were appraised using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesized through directed content analysis method.

Results

Out of 3014 studies, 15 studies were included for data synthesis. The synthesis of literature resulted in the emergence of 13 domains and 25 sub-domains. Then, they were categorized based on Donabedian's triple model and a conceptual framework was developed. In this framework, 6 domains were put in input, 6 in processes, and 1 domain in outcome. Of the 15 included studies, 1 study considered 10 domains and 14 other studies considered 4 to 8 domains out of 13 synthesized domains. The most prevalent synthesized domains were "medical supplies and equipment" and "human resources", which were considered in 15 studies.

Conclusion

In this study, a conceptual framework was constructed that identifies elements that significantly affect the preparedness of these centers. This framework may assist managers to take a comprehensive approach to assess these centers.