Interview with the Author: AfJEM: Michael McCaul on South African pre-hospital guidelines


Series: “Interview with the Author…”


The badEM crew interviewed Michael McCaul regarding his newly released article in AfJEM Volume 6 Issue 3 entitled: “South African Pre-hospital  practice guidelines: Report on progress & way forward” by Michael McCaul, Ben de Waal, Peter Hodkinson & Karen Grimmer

Link to open access article: Click here

Corresponding author email:

Author’s twitter handle: @MikeMcCaul3


1. Tell us about yourself. How did you get involved in this field/this research?

About myself

This is often a difficult question to answer. The answer requires a story, otherwise you only get to know about half my life! Currently, I am a researcher and biostatistics consultant at the Biostatistics Unit within the Centre for Evidence-based Health Care (CEBHC) at Stellenbosch University (Life 1). However, my roots stem as an operational paramedic (emergency care practitioner) working mostly in private emergency medical services (EMS) (Life 2). I know, how on earth do you transition from clinical practice to research and statistics? The answer in my case was pretty simple – I was not content with the status quo: using outdated protocols, feeling ill-equipped to challenge practice & lack of professional development. This made my next step really easy & I equipped myself to be able to change by doing my masters in clinical epidemiology. I am now in the process of studying towards a PhD in public health & currently further specialising in biostatistics, research synthesis & guideline development.

About the research

Under the leadership of the African Federation of Emergency Medicine (AFEM) & various other collaborators mentioned in the editorials, the AFEM team responded to an open call from the Professional Board of Emergency Care (PBEC) to review the current national Emergency Medical Services (EMS) protocols. The CEBHC was a specialised collaborator within this call focusing on methods & synthesis. In our editorial series we reported on the current state of EMS guidance in South Africa & in the latest issue provided an update on the guideline development project (which has been released by the PBEC) & the next steps that needs to be taken.


2. What is the key message of the editorial?

The key message is really threefold. Firstly, for the first time in Africa’s history a truly evidence-informed clinical practice guideline has been developed. Not a protocol, not a list of pharmacopeia but a document that reflects current best evidence recommendations to guide emergency care decision makers, educators & most importantly the emergency care providers.

This leads me to the second key message – guidance implementation. A clinical practice guideline can only impact practice at the coal-face (the bedside) if the implementation strategy takes in consideration the local context & rolls out best-practice recommendations using multi-faceted interventions that includes paramedics as shared-decision makers. In South Africa, the onus & responsibility now lies with the emergency care profession as a whole to engage with the guideline implementers (the PBEC), focusing on constructively highlighting implementation concerns, existing system gaps & providing sound solutions to problems.

The AFEM CPG development project team has synthesised & reported on the best available evidence for emergency care practice relevant to South Africa. We have an unprecedented opportunity to align our profession to international clinical practice standards. This includes the opportunity to challenge the system, identifying where evidence is uncertain or lacking (ie. scope & practice limitations) & driving change to the benefit of our patients and the needs of all paramedics.

Lastly, best evidence is often a hard pill to swallow, especially if it challenges the status quo, even if it is to our patients benefit. The problem the profession faces today, is not about the evidence – the evidence is clear enough. The problem we face today is about the status quo, it’s about the lack of inclusive educational reform, it’s about paramedics leaving our country, it’s about not wanting to change & it’s about lack of leadership to ensure change.

What was our key message? It is about change, change for the better & getting all of us to be part of making it happen.

Check out the full-text open access article:  Click here

More about AfJEM (excerpt from their newsletter)

AFEMAfJEM is an open access publication in the spirit of bringing #FOAMed to Africa. This is an important consideration, especially in a low to middle income setting where prospective readers, that may benefit from published information, will most likely not be able to access subscription based journal content.  The AfJEM has no front end (author) or back end (reader) fees, & on top of that it offers a free Author Assist service that has been shown to reverse one in every four reject decisions (of manuscripts that fall within the journal’s scope) over the last five years.

More from AFEM:

Supadel (clear)
Support a delegate (Supadel) is a conference sponsorship program with a difference. Supadel is a peer-to-peer sponsorship scheme that enables prospective AfCEM2016 delegates from developed regions to financially support their peers from low & middle income countries.
For more information, to donate or to apply visit the: Sponsorship application page

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Podcast 15 – Fabian Berger, tornado jets and human factors training

Fabian Berger is a tornado pilot with the German air force and amateur race car driver. He is also an aircraft accident investigator.

He was inspired to take his aviation experience of simulator based training, crew resource management (Fabian calls it Race Resource Management to better contextualise it) and human factors education to race officials and motorsport medics, so that's what he did through the DMSB in Germany.

I caught up with him after his talk at the FIA Institute's chief medical officers seminar last week in Vienna. This stuff has been evolving rapidly over the last few years in critical care medicine (ED, ICU, anaesthetics and prehospital medicine) and there is every reason to put it to use in motorsport medicine as well.

Keep an eye on this site as I should have a summary of the two day CMO seminar ready to publish very soon. It's quite lengthy (You'll find out why) so I will probably split it up over a couple of posts.

Here is the podcast:

Here are some additional resources for simulation training, human factors training and crisis resource management:

The EM Mindset by Chris Hicks (@HumanFact0rz) on emDocs

The Fog of War: Training the Resuscitationist Mind also by Chris Hicks on the EM Crit podcast

The Flow Model: Balancing challenge and skills on

Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. Jesse Spurr, Jonathan Gatward, Nikita Joshi, Simon D Carley. Emerg Med J. 11 March 2016.

MobileSim - An excellent in-situ sim resource blog by critical care physician Jon Gatward (@jgatward)

Simulcast - An evolving simulation-based educational blog and podcast resource by Jesse Spur (@Inject_Orange) and Victoria Brazil (@SocraticEM)