Nigeria is a multiethnic and diverse country classified as a low-and middle-income-country. According to the United Nations, Nigeria is Africa’s most populous country, with an estimated population of 227.9 million in 2025. Nigeria has the highest number of poor people in the world, with 30.9 % of the population living on <2.15 USD daily. This, coupled with poor governance and weak healthcare regulations, a large proportion of young people (>90 % of the population are under 65 years of age with a median age of 18 years), and a high birth rate, present daunting challenges for the Nigerian healthcare system.Nigeria faces a high burden of trauma and infectious diseases, as well as a rising prevalence of non-communicable diseases. Historically, the emergency care system has been fragmented and poorly organized, and there was no pathway for specialist training in Emergency Medicine for physicians. Emergency Medicine is still in its nascence in Nigeria. In 2019, Emergency Medicine was formally established as a medical speciality by the National Postgraduate Medical College of Nigeria, and residency training programs were launched in 2022. This step by the national college recognized the need to train emergency care specialists to improve the management of critical patients and positively impact resuscitation outcomes. This is a review of developments in emergency medicine training and the various emergency care systems in Nigeria in recent times. The progress is palpable particularly with the introduction of Emergency Medicine Faculty by the National Postgraduate Medical College of Nigeria.

BackgroundTrauma accounts for over 60,000 deaths annually in South Africa and is also responsible for a high proportion of emergency centre (EC) visits. Up to 91% of trauma patients in the EC experience acute pain, underscoring a critical public health concern, particularly in low and middle-income countries (LMICS), where research indicates poor pain management and a paucity of data. This study aimed to describe trauma pain assessment and management practices in a busy Cape Town EC.MethodsThis single-centre retrospective chart review in a high trauma burden EC collected a convenience sample over two weeks in 2024. Data were extracted from the medical records of adult trauma patients presenting to the EC.ResultsA total of 234 patients were included, predominantly male (73.1%), with a median age of 33 (IQR 26–41). Only 32.9% (77) of the patients had their pain assessed and documented, largely only in the triage process, and no patient had their pain reassessed. Furthermore, only 42.3% (99) of patients received analgesia, including opioids administered to 48.5% (48), non-steroidal anti-inflammatories to 45.5% (45), paracetamol to 69.7% (69), and ketamine to 17.2% (17). The time from arrival to the administration of the first analgesia in the EC was documented in 83 patients, with a median time to analgesia of 375 min (IQR 152–611).ConclusionThis study demonstrates findings consistent with the global crisis of inadequate pain management. It reveals poor pain assessment and management, with prolonged waiting times for analgesia despite various indicators of potential pain severity, highlighting a crucial need for changes in pain management strategies. Training, awareness, and protocols to improve pain management are essential, along with considering nurse-led analgesia at triage.

IntroductionThe ongoing conflict between the Somali National Army and non-state armed actors has led to an increase in mass casualty incidents (MCIs) which burden the fragile Somali healthcare system. Hospitals often become overwhelmed during MCIs, which can lead to increased mortality. To address this gap in mass casualty management (MCM), the WHO developed the MCM course to help hospitals address MCIs through the creation of individualized MCM plans. This study evaluated the effect of the WHO MCM course on participants’ knowledge of MCM concepts and self-reported confidence in managing MCIs in trauma hospitals in Somalia.MethodsA prospective pre-post educational study was conducted with healthcare teams from trauma hospitals across Somalia in October 2023. The four-day MCM course utilized lectures and interactive tabletop exercises to introduce MCM concepts, simulate MCI scenarios, and help participants develop MCM plans. Participants’ knowledge was assessed using multiple choice pre- and post-tests. Confidence was evaluated using a 4-point Likert scale surveys, feedback forms were used to assess course acceptability. Paired t-tests and Cohen’s d were used to analyze pre-post changes.ResultsThe MCM course was completed by 23 participants from 3 regions across Somalia. They had an average of 8.5 years of clinical experience and 3 years of MCM experience. The mean post-course test scores (78.9%) showed a significant improvement (p<0.001; Cohen's d=1.82) compared to pre-course test scores 47.9% (28%-72%). There was also an improvement in self-reported confidence in the implementation and activation of MCM plans (d=0.49), understanding of MCM roles and responsibilities (d=0.55). The largest gains were in operational readiness (d=1.42), including clearing the emergency unit, documentation, and triage planning.ConclusionThe MCM course improved participant’s knowledge of key MCM concepts and self-reported confidence in managing MCIs. Although limited by small sample size and reliance on self-reported outcomes, findings suggest the course may support improved MCM readiness in conflict-affected settings.

IntroductionEffective emergency care (EC) in low- and middle-income countries (LMICs) depends on evidence that is relevant, implementable, and locally informed. Engaged research offers a means to achieve this, yet practical understanding of how to identify and involve communities remains limited. Defining the “community” is a critical but underexplored step, and little is known about how engagement operates within LMIC EC systems. This study explored stakeholder perspectives on the composition and relationships of the EC community.MethodThis was a qualitative study using semi-structured interviews and descriptive content analysis exploring stakeholder perspectives on the EC community. Purposive and snowball sampling ensured diverse representation. Transcripts were analysed inductively drawing on Braun and Clarke’s thematic framework and reported in accordance with COREQ guidelines.ResultsThirty stakeholders participated, including emergency physicians, nurses, prehospital providers, academics, policymakers, and community representatives, many holding overlapping roles. Analysis identified three overarching categories:(1) breadth, variability, and ambiguity within the community;(2) fragmentation and exclusion; and (3) engagement potential and the role of frontline clinicians.ConclusionsThis study highlights the complexity of defining the EC community, with boundaries that are broad, variable, and often contested. Participants identified the absence or unclear roles of key stakeholders, including patients, decision-makers, and frontline clinicians, within research processes. Fragmentation and limited trust were viewed as major barriers to meaningful engagement, reinforcing the need for stronger, more transparent relationships within the community. Frontline clinicians were consistently recognised as underutilised yet uniquely positioned to connect clinical realities with academic research and community priorities. Strengthening engaged research in this context will require clearer guidance on how and when to involve stakeholders, structured mechanisms to build and sustain trust, and practical support for clinician participation. Together, these steps could help embed engagement more deeply into research culture and enhance the relevance and impact of EC scholarship.

The Accident and Emergency (A&E) unit is a key entry point for healthcare in Nigeria, yet data on its functionality and capacity for emergency care remain limited. This study evaluates the functional capacity of A&E units in Nigeria using a modified Emergency Care Assessment Tool (ECAT). A cross-sectional study was conducted from September to October 2020 in seven tertiary hospitals across Nigeria. Six hospitals, one from each of the country's six geopolitical zones, were randomly selected, while the seventh-Nigeria's main trauma center located in the capital-was purposively included. Doctors and nurses routinely working in A&E units were interviewed using a modified Emergency Care Assessment Tool (ECAT), which evaluates the availability of essential medical interventions (signal functions) for managing six common, life-threatening sentinel conditions: Maternal and Child emergencies, Respiratory failure, Trauma, Shock, Altered mental status, and Severe pain. Among 503 healthcare providers surveyed (393 doctors and 110 nurses), significant differences were observed in the performance of signal functions across all six sentinel conditions (p < 0·001) and across the seven study sites (p < 0·001). The overall average capacity score was 2·69 out of 3. Federal Medical Center Katsina (North-West zone) recorded the highest mean score of 2·92 (95% CI: 2·77 - 3·07), while UCTH (South-South zone) had the lowest at 2.44 (95% CI: 2·27 - 2·60). Among the conditions assessed, respiratory failure had the lowest mean score at 2·55 (1·88-3·21). This study reveals a higher-than-expected national average A&E capacity score (2·69 out of 3) in Nigerian tertiary hospitals but highlights ongoing challenges, particularly in managing respiratory emergencies. Notable regional disparities were observed, with the Northern region outperforming others. Findings emphasize the need for objective, on-site evaluations and broader inclusion of facilities, along with targeted, region-specific investments to improve equitable emergency care nationwide.

IntroductionCardiopulmonary Resuscitation (CPR) is an important emergency care skill for all healthcare professionals. The success of CPR is determined by multiple patient and healthcare professional factors, such as CPR training and adhering to the guidelines for managing sudden cardiac arrest. Nurses have a high chance of identifying a patient in sudden cardiac arrest and initiating CPR for a better health outcome. This study assessed the knowledge and practice of adult CPR among nurses at the Emergency Department (ED) of a tertiary Hospital in Ghana.MethodsA quantitative cross-sectional study was employed, where 132 nurses were randomly selected and interviewed from June 2020 to November 2020. Data was collected by trained research assistants with a structured questionnaire and analysed with STATA Version 16.0ResultsMajority (n = 117, 86.64%) of the respondents could identify a patient in sudden cardiac arrest, and 94.70% (n = 125) had performed CPR at least once within the last two years. Availability of guidelines and protocol based on the AHA guidelines for managing sudden cardiac arrest (p = 0.020) and good CPR practice (p = 0.044) were associated with good knowledge of CPR in this study.ConclusionOur study found respondents generally had good knowledge and good practice of CPR. Making AHA guidelines available to ED nurses for managing sudden cardiac arrest was significantly associated with good knowledge of CPR. Therefore, regular CPR training and providing AHA guidelines for managing sudden cardiac arrest are recommended to increase the level of knowledge of adult CPR.

Introduction: An effective Emergency Medical Service (EMS) depends on a well-functioning Emergency Medical Dispatch (EMD), which influences response times, resource allocation, and patient outcomes. Competent EMD staff are essential for gathering information, making rapid decisions, dispatching resources, and providing life-saving pre-arrival instructions. While high-income countries use standardized computer-aided dispatch systems, many low- and middle-income countries (LMICs), including South Africa, lack such systems and rely on staff competencies. This scoping review sought to identify the competencies for EMD staff.Methods: We searched the international literature using the keywords “Emergency Medical Service”; “EMS call centre”; “competencies” and their synonyms. Two reviewers independently reviewed the identified articles. The articles were tabled highlighting findings focused on EMD system requirements; EMD staff competency requirements; education and training for EMD staff.Results: Among the 35 articles identified, five (14%) originated from LMICs with no articles specifically addressing the competency requirements for staff working in an EMD. A total of 16 (46%) studies highlighted the need for qualified staff (nurses, physicians and paramedics). The use of computer aided dispatch and Medical Priority Dispatch System in an EMD was identified in 13 (37%). The review of existing programs identified eight EMD programs emphasizing effective interview and communication skills, use of technology, medical terminology, first aid, stress management, resource allocation, effective reporting and feedback. Literature showed a renewed interest in EMD research within the last 5 years, particularly in LMICs where EMS are poorly developed.Discussion: The scoping review highlighted a lack of evidence on the competencies and performance needs of EMD staff. While key skills such as information gathering, decision-making, and resource allocation are recognized, further research is needed to define core competencies and develop context-appropriate training, especially in LMICs where such evidence is scarce.

IntroductionEssential medications, supplies, and equipment are crucial for emergency care; however, significant resource shortages in low- and middle-income countries, including Ethiopia, hinder the delivery of safe services. Although research on emergency capacity analysis has been conducted at the hospital level, data from lower levels, such as health centers, are lacking, despite numerous studies recommending the development of emergency services at the primary healthcare level to reduce the burden on hospital emergency departments. Therefore, this study primarily aims to assess the availability of emergency equipment and drugs and barriers to availability in health centers in Addis Ababa, Ethiopia.MethodsAn explanatory sequential mixed method design study was conducted in Addis Ababa, in September 2025. Quantitative data were collected from the six health centers selected through convenience and random sampling. Non-probability purposive sampling was used to select key informants for the qualitative interviews, and thematic content analysis was conducted to develop items that emerged from the transcribed information.ResultsThe survey revealed a significant gap in availability of emergency equipment and drugs. While oxygen delivery devices and infection control materials were widely available, critical equipment and essential medications like crash carts, defibrillators, digoxin, and sodium bicarbonate were largely absent. Qualitative analysis identified the barriers to be ineffective management, disjointed logistics and health system, shortage of human resource and patients’ financial constraint.DiscussionThe readiness of health centers to provide emergency care in Addis Ababa is inadequate, largely due to resource shortages and systemic barriers. Urgent interventions are needed to improve emergency preparedness at the primary care level, including provision of crash carts, investment in staff training, and revision of procurement and policy frameworks.

The 2024 Marburg Virus Disease outbreak in Rwanda underscored the indispensable role of Emergency Departments in the early detection, containment, and management of novel infectious diseases. As public health crises continue to grow in complexity, the Emergency Department becomes uniquely positioned to bridge the gap between clinical care and public health responses. Using lessons learned from King Faisal Hospital, Rwanda during the outbreak, this report outlines how Emergency Departments serve as frontline defenses during crisis management and identifies strategies to strengthen and enhance their preparedness.

IntroductionEmergency Medicine (EM) is a nascent, but rapidly growing speciality within South Africa, encompassed by worldwide recognition of the need for improved emergency care. Although EM physicians increasing lead many larger South African Emergency Departments, the initial provision of emergent care often occurs at facilities manned by junior, non-specialist doctors, early in their career. Newly qualified doctors complete a 2-year internship phase, during which their exposure and training in EM is not standardised. Limited data regarding the impact of EM on foundation year training exists in South Africa. Therefore, a need exists to identify EM knowledge gaps at the end of internship, to direct future EM training.MethodsA cross-sectional study utilising an EM assessment tool previously developed via a modified Delphi study by the authors was performed. During 2022-2023, final-year interns in two cities in the Eastern Cape of South Africa were invited to participate in the assessment tool and complete a short survey on self-perceived knowledge and readiness to manage emergent conditions in their community service year.ResultsA total of 146 interns from two sites participated in the study (representing undergraduate training from all South African medical schools). Participants scored poorly on questions regarding the assessment of acute cardiac events and resuscitation of acutely ill patients and scored highest in questions on obstetric emergencies and management of urgent, rather than emergent conditions. Interns emphasised the need for longer exposure time in EM, and the need for structured and standardised training, including the use of simulations, case-based discussions and practical skills training.ConclusionTo improve the quality of emergency care in the South African public healthcare system, EM training and exposure at the internship level should be prioritised. Recommendations include instituting structured and standardised EM training within a supervised environment and further research on intern readiness to manage emergent medical conditions.