The Protect America Act of 2007: A Framework for Improving Intelligence Collection in the War on Terror

The most important weapon in the War on Terror is intelligence. The Protect America Act of 2007, a modification of the Foreign Intelligence Surveillance Act (FISA), was favored by Congress for providing a positive framework for ensuring the proper rule of law kept pace with changes in technology. FISA closed the intelligence gaps that had arisen because of the application of the Act to foreign persons in foreign countries. FISA codifies in federal law the procedures associated with how electronic surveillance and searches of acquisition of foreign intelligence is conducted. In order to conduct electronic surveillance, a court order must be issued by a FISA judge. The judge must determine: (1) whether there is probable cause to believe that the target of the surveillance or search is a foreign power, or its agent; and (2) that the primary purpose is to collect foreign intelligence. The purpose of the Protect America Act was to provide an update to FISA in order to give the intelligence community the necessary tools to gather information about potential foreign enemies. One of the most relevant provisions is the requirement of the FISA court’s involvement in determining that reasonable procedures are used in ascertaining whether a target is outside the United States. These attempts to improve the U.S.’s national security policy have not been deprived of criticisms. The Act has been criticized for allowing massive, untargeted collection of international communications without court order or meaningful oversight. Despite this, the Protect America Act provides a framework for electronic intelligence gathering that keeps pace with heightened threats to national security due to advances in telecommunications technology

The Protect America Act of 2007: A Framework for Improving Intelligence Collection in the War on Terror

The purpose of this paper is to provide a brief overview of the efficacy of the Protect America Act in the context of the new ground it covers. If one couples the phenomenal technical advances in telecommunications technology) with an acknowledgement of the growing threats to national security posed by hostile nations, it is obvious that the nation's intelligence community must be properly equipped with the necessary tools to protect the nation. As Congress continues to revise and amend FISA, the Protect America Act of 2007 serves as a reminder of the many policy and legal tensions involved as the country grapples with balancing cherished civil liberties against the need for increased security and government accountability in this post-9/11 world

A Retrospective study of the pre-hospital trauma burden managed by the Western Cape Government Emergency Medical Services

Background: Trauma is one of the leading causes of premature death and disability in South Africa. There is a lack of data describing the pre-hospital trauma burden in sub-Saharan Africa. This study aimed to describe the epidemiology of common trauma emergencies managed by the Western Cape Government (WCG) emergency medical services (EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this Is the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these, 168 980 (34.3%), or 25.5 per 1000 population, were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were men between the socio-economically active ages of 21–40 years (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS caseload. The patient acuity was categorised as urgent in 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report on the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the World Health Organization (WHO) or any other low- and middle-income countries (LMICs). It also provides the foundation for further research on emergency care needs in South Africa and support for Afrocentric health care solutions to address this public health crisis

Antifibrinolytic drugs for acute traumatic injury

In South Africa, trauma is a major concern, with violence and road traffic accidents being the fifth and seventh leading causes of death, respectively. Antifibrinolytic agents have been used in trauma and major surgery to prevent fibrinolysis and reduce blood loss. We highlight an updated Cochrane review investigating the effect of antifibrinolytic drugs in patients with acute traumatic injury. The review authorsconducted comprehensive literature searches in January 2015 with regard to all randomised controlled trials comparing antifibrinolytic agents after acute traumatic injury. Three randomised controlled trials, of which two (n=20 451) assessed the effect of tranexamic acid (TXA), were included. The authors concluded that TXA safely reduces mortality in trauma with bleeding without increasing the risk ofadverse events. TXA should be administered as early as possible, and within 3 hours of injury. There is still uncertainty with regard to the effect of TXA on patients with traumatic brain injury; however, ongoing randomised controlled trials should shed more light on this

The Cochrane Corner in the SAMJ: Summaries of Cochrane systematic reviews for evidence-informed practice

This editorial introduces a regular contribution from Cochrane South Africa (http://www.mrc.ac.za/cochrane/cochrane.htm) to the South African Medical Journal, which will be called the ‘Cochrane Corner’. Our contribution takes the form of technical summaries of Cochrane systematic reviews handpicked for their relevance to South Africa and the African region. Our goal is to help ensure that the high-quality evidence in Cochrane reviews reaches a wider audience.

Evidence synthesis workshops: moving from face-to-face to online learning

Postgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa

Description de l’administration d’analgésiques pharmaceutiques par des auxiliaires médicaux spécialisés en réanimation du secteur public dans la ville du Cap

CITATION: Matthews, R., McCaul, M. & Smith, W. 2017. A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town. African Journal of Emergency Medicine, 7(1):24-29.The original publication is available at https://www.afjem.orgIntroduction: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. Methods: Aretrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5 mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). Discussion: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.Introduction: Les services d’aide médicale d’urgence sont dans une position idéale pour atténuer les douleurs aigues et la gêne. Les objectifs de cette étude étaient de décrire la gestion préhospitalière de la douleur par les services d’aide médicale d’urgence dans la province du Cap occidental, en Afrique du Sud. Méthodes: Une étude rétrospective et descriptive a été réalisée sur l’administration d’analgésiques par des auxiliaires médicaux spécialisés en réanimation. Les dossiers médicaux des patients générés dans la ville du Cap sur une période de 11 mois indiquant l’administration de morphine, de kétamine, de nitrates et d’un mélange de protoxyde d’azote/oxygène à 50 % ont été échantillonnés de manière aléatoire. Les variables étudiées étaient la dose de médicament, la fréquence d’administration des doses et la voix d’administration, l’âge du patient, son sexe, le trouble dont il souffre et le type d’appel, ainsi que les qualifications et le niveau d’expérience de l’administrateur. Résultats: Au total, 530 dossiers médicaux de patients ont été inclus (n = 530). De la morphine a été administrée dans 371 (70 %, IC 95% 66–74) cas, du protoxyde d’azote dans 197 (37 %, IC 95 % 33–41) cas et de la kétamine dans 9 (1,7 %, IC 95 % 1–3) cas. Un total de 5 mg de morphine ou moins a été administré dans 278 (75 %, IC 95 % 70–79) cas, la dose moyenne étant de 5 mg (IIQ 3–6). Des doses uniques ont été administrées pour 268 (72,2 %, IC 95 %, 67–77) administrations de morphine, cinq (56 %, IC 95 % 21–86) administrations de kétamine et 161 (82 %, IC 95 % 76–87) administrations de protoxyde d’azote. Les douleurs thoraciques étaient la raison de l’administration d’analgésiques dans 226 (43 %) cas. Les auxiliaires médicaux spécialisés en réanimation disposaient d’un niveau d’expérience moyen de deux ans (IIQ 2–4). Discussion: La gestion préhospitalière de la douleur aiguë dans la province du Cap occidental ne semble pas se conformer aux meilleures pratiques, car les auxiliaires médicaux spécialisés en réanimation utilisent de faibles doses de morphine. Les douleurs thoraciques constituent une raison importante de l’administration d’analgésiques pour le traitement préhospitalier de la douleur aiguë. L’analgésie multimodale n’est pas une caractéristique des soins dans ce service préhospitalier. Le développement de Directives pratiques cliniques pour la formation à la gestion préhospitalière de la douleur devrait être considéré comme un impératif.Publishers versio

Congress\u27s Consistent Intent to Utilize Military Commissions in the War against Al-Qaeda and Its Adoption of Commission Rules That Fully Comply with Due Process.

Congress responded to the terrorist attack of September 11, 2001 by passing the Authorization for the Use of Military Force (AUMF). In the following years Congress augmented that authority with the Military Commissions Act of 2006 (MCA of 2006) and the Military Commissions Act of 2009 (MCA of 2009). In passing these acts, Congress responded to the Supreme Court’s decision in Hamdan v. Rumsfeld, which found that President Bush’s attempt to establish military commissions required Congressional authorization. When drafting both MCAs, Congress recognized numerous evidentiary and trial procedures from federal civilian court were inappropriate for trying unlawful combatants. By these Acts, Congress provided a forum which could bring enemy combatants to justice. Despite this forum, President Obama reversed the policy when he announced the Department of Justice would prosecute an enemy combatant in federal civilian court. This reversal effectively recast the war on terror as a criminal matter. The Supreme Court recognized in Hamdi v. Rumsfeld and Hamdan v. Rumsfeld that detention and trial of enemy combatants are fundamental incidents of war encompassed in the AUMF. Legislators who drafted the AUMF concluded the belligerents in this new war should be tried for violations of the laws of war by military commissions. Congress set forth detailed rules for these trials which fully comply with traditional American notions of due process. While the traditions of justice demand fair trial, often seized evidence cannot meet all the evidentiary requirements imposed in civil trials. This includes Congress permitting reliable hearsay, not requiring the overly formal chain of custody requirements, permitting reliable but potentially damaging statements made by enemy soldiers, and limiting the jury pool to qualified officers. The trials of enemy combatants should proceed in the forum which Congress created