An Assessment Of Community Knowledge And Altitude Towards Emergency Health Situation

INTRODUCTION
The Emergency Department, which is also referred to as the Emergency Room (ER), Emergency Ward (EW), or Casualty Department is a medical treatment facility that specializes in the acute care of patients who present without prior appointment.[1] Emergency care is one delivered in the first few hours after the onset of an acute medical condition, e.g., a childbirth complication, heart attack, injury, or any health problem that reaches an acute stage and poses a threat to life.
The Emergency ward responds to and manages a variety of cases in all the clinical areas and it provides insight into the quality of care available in the institution. The quality of care in the ER is an indirect indicator of the standard of health-care delivery that is provided in a health institution; therefore, the ability of a hospital to respond to an emergency depends on having staff who know what to do and have the skills needed to do so.
In Nigeria, reports from various centers and studies show a high mortality rate for cases that present to the Emergency Department. Therefore, the need for a realistic hospital and emergency service response program designed on the principle of equitable distribution of appropriate equipment and supplies and well-trained emergency medical personnel, cannot be overemphasized. In 2010, a study carried out at Imo State University Teaching Hospital located in the suburban town of Orlu in Imo State, Nigeria recorded that there was a total of 281 deaths out of 5754 cases treated at the A and E, showing a crude mortality rate of 4.88%. A similar study done in Port Harcourt, Nigeria in an urban teaching hospital over a 3-year period reported a crude mortality of 2%. About 23.13% of all these deaths were caused by injuries and trauma sustained from road traffic accidents.

The outcome of a patient and the speed of recovery of emergencies presenting to a hospital are largely dependent on the initial response by emergency health workers and the quality of care delivered at presentation. This means that the knowledge and attitude of these emergency workers toward the management of the emergency cases presenting to their hospitals, and their preparedness, add up to a major factor that determines the outcome and recovery of such patients. In addition to working toward the patients’ survival, preparedness encompasses planning, training, equipment, and exercises.
The high mortality rates at the emergency centers in tertiary hospitals (government-owned) in the country have been of major concern. A study at the University of Benin Teaching Hospital showed that 288 patients died over a 3-year period. At the University College Hospital, Ibadan, a study showed that 168 patients died within 1 year. These high mortality rates are a result of the imbalance between emergency physicians available and patients who present to the emergency centers as suggested by recent studies, which is currently considered a threat to health-care delivery and outcome for patients worldwide. Judging by these reports, the available staff in our emergency centers need to be trained so that medical and emergency professionals who understand emergency preparedness are better equipped to respond adequately to hospital emergencies. This study aimed to assess the knowledge and attitude of emergency personnel at the central hospital ughelli delta state Nigeria.

1.1 BACKGROUND OF THE STUDY
In recent years, the world’s public health emergencies continue to occur and seriously affect people’s health physically and mentally. Among all public health emergency response agencies, hospital is the key place to provide medical and psychological services, and medical staffs are the main force involved in response to public health emergencies. The knowledge, skills, attitudes and behavior of the medical staffs have a direct impact on regional or national public health emergency management. Studies have shown that 80% of the world public health emergencies occurred in the community, in turn, primary health care institutions plays an important role in the emergency management system and they are the first hurdle to effectively reduce devastation from disasters. Implementing the national policy of “community public health service package” which requires primary health services to handle community public health emergencies collaboratively. However, there were few reports concerning on community health emergencies response in Nigeria. Moreover, there were no reports that comprehensive analyzed the knowledge, attitude and behavior, and the response capacity of primary care medical staffs of Nigeria. Some published reports were only concerning on the portion of knowledge, attitude and behavior, or response capacity. Studies have indicated that the knowledge, attitude and behavior of primary care medical staffs for public health emergency were not satisfactory, the response capacity of primary care medical staffs are relatively low. Their knowledge and attitude on emergency reflect their level of theoretical knowledge and belief. Their behavior reflects their practice and experience of public health emergencies. The knowledge, attitude and behavior are the parts of the health emergency response capacity, and directly affect the capability of their response capacity. Therefore, improvement of the emergency response capacity of primary care medical staffs is the key element for handling public health emergencies effectively. It is of great significance to explore knowledge, attitude and behavior, and the response capacity of primary care medical staffs, and analyze the main factors. Here, we investigated the knowledge and attitude capacity of medical staffs from central hospital Ughelli.

1.2 AIMS AND OBJECTIVE
With the high rate of deaths recorded in our emergency centers in Nigeria and worldwide, there is a need for us to assess the responsiveness of emergency health workers to emergency cases, which is a function of their knowledge and their preparedness. The World Health Organization (WHO) recommends periodic assessment of the capabiliity of health facilities to respond to emergencies. Hospital preparedness assessment is a means for a hospital to test and evaluate its capabilities and/or recovering from an event that placed a significant strain on its patient care and operating systems.

1.3 OBJECTIVES OF THE STUDY
The objectives of the study are to determine the following:
i. The level of knowledge of emergency workers in emergency preparedness;
ii. the attitudes of emergency workers toward emergency cases presenting to these hospitals;
iii. the current practices of emergency workers regarding emergency preparedness;
iv. and whether there are hospital-specific plans regarding emergency preparedness and management.

1.4 SIGNIFICANCE OF THE STUDY
The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at the central hospital ughelli as regards emergency management and preparedness.

1.5 SCOPE OF THE STUDY
The Accident and Emergency Department, which is also referred to as the Emergency Room (ER), Emergency Ward (EW), or Casualty Department is a medical treatment facility that specializes in the acute care of patients who present without prior appointment. Emergency care is one delivered in the first few hours after the onset of an acute medical condition, e.g., a childbirth complication, heart attack, injury, or any health problem that reaches an acute stage and poses a threat to life. The Emergency ward responds to and manages a variety of cases in all the clinical areas and it provides insight into the quality of care available in the institution. The quality of care in the ER is an indirect indicator of the standard of health-care delivery that is provided in a health institution; therefore, the ability of a hospital to respond to an emergency depends on having staff who know what to do and have the skills needed to do so.

1.6 OBJECTIVE OF THE STUDY
The main objective of this study was to: ascertain the of the community knowledge and altitude towards emergency health situation in central hospital ughelli. At the end of the study the students involve shall be able to:-
1. Ascertain the level of knowledge possessed by the health workers towards emergency health situation in central hospital ughelli
2. Determine the level of altitude or reaction towards emergency health situation in central hospital ughelli, of those expectant mothers of study.
3. Ascertain the relationship between the emergency of their patients and those with prior appointment.

1.7 LIMITATION OF THE STUDY
Every research work require a thorough examination of the large pool of people and reading materials as it is a research that requires lots of one on one discussion from people different department of the hospital. This means that lots of questionnaires would be distributed the health worker of the hospital with questions designed to assess the community knowledge and altitude towards emergency health situation. The above are the limitations of this research work namely the time constraints and financial inadequacies to cover wider grounds.

1.8 RESEARCH QUESTION
This study is on an assessment of community knowledge and altitude towards health situation in central hospital, Delta State. To achieve this, the following specific research questions were asked.
1) What are the levels of community knowledge of the emergency situation possessed by the health personnel in the central hospital of Ughelli, Delta State.
2) What are the levels of emergency practice of those health workers of the study?
3) What is the strength of relationship between the knowledge and altitude of the health workers of the study?
4) What is the level of knowledge of the health workers of the study based on their levels of education, age and position in the hospital?

1.9 DEFINITION OF TERMS
Acute care: hospital-based medical and surgical treatment Or the administrative process by which a hospital records the commencement of a new episode of care.
Admitted patient: A patient who undergoes a hospital’s admission process to receive treatment and/or care. This treatment and/or care is provided over a period of time and can occur in hospital and/or in the person’s home (for hospital-in-the-home patients)
Admission: when a patient is taken into hospital.
Ambulance service: a service that responds to 999 calls and major incidents, urgent admission requests from doctors, and high-dependency and urgent transfers between hospitals.
Clinical audit: a measurement and evaluation by health professionals of the clinical standards they are achieving.
Clinician: a general term used to refer to any professional who provides clinical care to a patient.
Clinical negligence: breach of duty by a healthcare professional.
Community care: social care or treatment given to patients outside hospital.
Community health services: NHS services provided outside a hospital, eg by district nurses, health visitors and community midwives.
Continuing care: a person’s care needs after hospital treatment has finished.
Elective admission: patient admitted to hospital from the waiting list for treatment.
Emergency admission: patient admitted to hospital at short notice because of clinical need.
Elective operation: operation booked in advance.