Climate change is a global public health emergency with implications for access to care and emergency care service disruptions. The African continent is particularly vulnerable to climate-related extreme weather events due to an already overburdened health system, lack of early warning signs, poverty, inadequate infrastructure, and variable adaptive capacity. Emergency care services are not only utilized during these events but also threatened by these hazards. Considering that the effects of climate change are expected to increase in intensity and prevalence, it is increasingly important for emergency care to prepare to respond to the changes in presentation and demand. The aim of this study was to perform a scoping review of the available literature on the relationship between climate change and emergency care on the African continent. A scoping review was completed using five databases: Pubmed, Web of Science, GreenFILE, Africa Wide Information, and Google Scholar. A ‘grey’ literature search was done to identify key reports and references from included articles. Two independent reviewers screened articles and a third reviewer decided conflicts. A total of 1,382 individual articles were initially screened with 17 meeting full text review. A total of six articles were included in the final analysis. Data from four countries were represented including Uganda, Ghana, Tanzania, and Nigeria. Analysis of the six articles yielded three key themes that were identified: climate-related health impacts that contribute to surges in demand and resource utilization, opportunities for health sector engagement, and solutions to improve emergency preparedness. Authors used the outcomes of the review to propose 10 recommendations for decision-makers and leaders. Incorporating these key recommendations at the local and national level could help improve preparedness and adaptation measures in highly vulnerable, populated areas on the African continent.

In March 2020, the World Health Organisation declared COVID-19 a global pandemic. Shortly after the first case of COVID-19 was reported in South Africa, the Western Cape province experienced a rapid growth in the number of cases, establishing it as the epicentre of the disease in South Africa. The aim of this study was to explore emergency care personnel's lived experiences and their perceptions thereof within the context of the COVID-19 pandemic in the Western Cape province. This study followed a longitudinal hermeneutic phenomenological approach. The convenience sample included prehospital and emergency centre medical personnel. Data were collected over a 4-month period using both one-on-one interviews and participant recorded voice recordings. Data were analysed following Ricoeur's theory of interpretation. Four themes were generated during the data analysis: 1) In the beginning, waiting for the unknown; 2) Next, change and adaptation in the workplace; 3) My COVID-19 feelings; 4) Support and connection. Participants discussed the uncertainty associated with responding to an unknown threat and a need to keep up with constant change in an overburdened work environment. Results showed high levels of uncertainty, restriction, fear, anxiety, and exhaustion. Despite these difficulties, participants demonstrated resilience and commitment to caring for patients. A need for support was also highlighted. Results indicated that change, over time, resulted in adaptation to a new way of practising and keeping safe. Healthcare workers experienced intersecting consequences as frontline healthcare workers and members of the public, all of which impacted their well-being. The importance of compassion and encouragement as forms of support was highlighted in the study. Robust and sustained support structures in a time of change, low mood, and exhaustion are essential.

Climate-related hazards are impacting community health and healthcare provision across the African continent, resulting in increased vulnerability and reduced capacity to withstand further impacts. While it is important to recognise that not all climate-related hazards result in disaster, this is often the case in populations that are already vulnerable, creating a vicious cycle that further increases risk. However, with appropriate multisectoral collaboration, planning and preparedness, community resilience can be strengthened, thereby reducing the likelihood and severity of disasters. Situated at the interface between health systems and communities, primary care providers are uniquely placed to identify climate-related vulnerabilities and emerging risks. Sharing these insights through disaster risk management platforms can inform planning processes and strengthen preparedness and resilience. With this purpose in mind, this article outlines key concepts and approaches in disaster risk management, supported by a real-life case study that illustrates lessons learned and their implications for primary health care, with the aim of better equipping providers to participate in and support resilience-building efforts.

Background: Owing to limited or centralised neonatal critical care resources, the interfacility transfer of neonates is inevitable. In many high-income settings, dedicated Critical Care Retrieval Services (CCRS) with additional education and training undertake neonatal critical care retrieval (CCR). In South Africa, however, these transfers are mostly conducted by advanced paramedics with limited education in neonatal care, and this may lead to high adverse event rates. In SA, a shortage of skilled neonatal interfacility transport services has been identified as one of the top ten avoidable causes of under-5 mortality. In order to address this gap in neonatal transfer education for paramedics in South Africa, the aim of this study is to develop a curriculum for neonatal critical care retrieval in South Africa. Methods: Using Kern’s approach to curriculum development, a general and targeted needs assessment was conducted through semi-structured interviews with experts in the field and a focus group discussion with a prospective student group. Interviews were preceded and informed by a literature review and retrospective chart review of neonates who underwent CCR in SA over a one-year period. Audio recordings of interviews were transcribed verbatim and subjected to inductive-dominant content analysis. Finally, qualitative codes were expanded into course outcome and a curriculum map was developed. Results: Six experts in neonatal critical care and retrieval participated in semi-structured interviews with a mean duration of 59 minutes. Following transcription and analysis, 372 codes were developed. Seven prehospital providers (prospective students) who are involved in neonatal transfers in South Africa participated in a focus group discussion with a duration of 91 minutes. The audio recording was transcribed and analysed with 97 codes extracted. The main categories were: Current status of neonatal CCR in South Africa; learning and education in neonatal CCR; and proposed curriculum structure. The proposed curriculum structure described 13 broad course outcomes to be delivered as a blended postgraduate programme. Participants noted that funding, employer buy-in and internet resources would be required. The targeted prospective student group should be all Advanced Life Support (ALS) providers with a change in their scope of practice on completion. Conclusion: This study described the need for additional education in neonatal critical care retrieval due to the limitations in the current and past education systems. This study provides a curriculum structure with course outcomes that can be used as a basis for the development of a complete curriculum for education in neonatal CCR, with the potential to greatly reduce adverse event rates.

Background: Climate change exacerbates existing social inequalities, placing a disproportionate burden on already vulnerable populations. As emergency care often functions as the initial point of contact for affected patients, it is crucial that these specialists understand the impacts and are appropriately trained to respond. However, it is unclear whether specialists in South Africa are equipped with the knowledge and preparedness to do so in clinical practice.Methods: This study followed a quantitative survey design to describe emergency medicine registrars’ and physicians’ perceptions about climate change and health, climate-related health education, and self-perceived preparedness to respond to these impacts.Results: The majority (80%, n = 16) of 20 participants (combining ‘probably’ and ‘definitely’) recognised climate-related health impacts; 70% (n = 14) believed that it would impact their own health, and 95% (n = 19) felt that it would impact their patients’ health (combining ‘agree’ and ‘strongly agree’). However, none of the participants had received any formal training on the topic, and only 3 participants (15%) indicated that they ‘probably’ have enough information to prepare and respond to the health impacts of climate change. When asked about key priorities to improve preparedness, 65% (n = 13) highlighted the importance of education and information.Conclusion: The findings suggest a gap in preparedness and underscore the need for a climate-responsive emergency care education.Contribution: This is the first study in South Africa to describe emergency medicine specialists’ perceptions and preparedness in relation to climate change and health, establishing a foundation for future curriculum development.