Emergency medical services in South Africa

Emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

in South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

are a public/private system aimed at the provision of emergency

Emergency

An emergency is a situation that poses an immediate risk to health, life, property or environment. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative...

ambulance

Ambulance

An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...

service, including emergency care and transportation to hospital

Hospital

A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

Land Ambulance

Emergency ambulance service is provided by each South African province

Province

A province is a territorial unit, almost always an administrative division, within a country or state.-Etymology:The English word "province" is attested since about 1330 and derives from the 13th-century Old French "province," which itself comes from the Latin word "provincia," which referred to...

. The system of government operated ambulances is generally referred to as 'Metro'. In addition to the paid responders, the government system is supplemented in many areas by unpaid volunteers. In cases where volunteers are used, the standards for operation are set by the provincial Health Department, which also provides vehicles, equipment, and operating expenses. Operations are normally administered at the local level through the Emergency Management Service
, which oversees police and fire protection, as well. The co-location of ambulances with fire apparatus is common in South Africa, although they are two independent services. The national emergency number for ambulances in South Africa is 10 177.

These publicly operated services are supplemented by two private-for-profit ambulance companies, NetCare 911 and ER24, both of which operate nationally, and by a variety of local private services, such as AmbuStat. The statutory services and private companies are further supplemented by voluntary ambulance services, including the South African Red Cross, and St. John Ambulance. All are required to meet the same standards as the public services with respect to staff qualifications. These services are self-dispatching, and do not participate in the national emergency number scheme.

Air Ambulance

Public air ambulance

Air ambulance

An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....

service is provided by the Red Cross Air Mercy Service from bases throughout the country. The system operates both helicopters and fixed wing aircraft, and both turboprop

Turboprop

A turboprop engine is a type of turbine engine which drives an aircraft propeller using a reduction gear.The gas turbine is designed specifically for this application, with almost all of its output being used to drive the propeller...

and jet aircraft

Jet aircraft

A jet aircraft is an aircraft propelled by jet engines. Jet aircraft generally fly much faster than propeller-powered aircraft and at higher altitudes – as high as . At these altitudes, jet engines achieve maximum efficiency over long distances. The engines in propeller-powered aircraft...

as well. Emergency air ambulance service is also provided by Netcare 911, operating nationally with both Fixed Wing (Jet aircraft) and Rotary Wing (Helicopters) Aircraft.
Private air ambulance charters are also available from a number of aircraft charter companies throughout the country.

Training

In South Africa

South Africa

The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

there are currently 3 different levels of proficiency in Short course training:

BAA or Basic Ambulance Assistant - This is a Basic Life Support
Basic life support
Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by...

(BLS) certification, and approximately the equivalent of the U.S. EMT-B. This is the minimum qualification to be a crew member of an ambulance in South Africa. Training includes a 160 hour course consisting of lectures and practical simulations. The lectures cover basic anatomy
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

and physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

, basic life support (including both CPR and first aid
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...

), emergency care, the use of ambulance equipment, including Automated External Defibrillators (AED
AED
AED may refer to:* Anhidrotic ectodermal dysplasia, a genetic disorder* Automated external defibrillator, a portable electronic device that diagnoses and can correct arrhythmia of the heart....

), and various medico-legal issues.

AEA or Ambulance Emergency Assistant - This is an Intermediate Life Support (ILS) certification, and generally the equivalent of the U.S. EMT-I, but with some added skills. To apply for this training, candidates must have a minimum of 1,000 hours of practical experience as a BAA and they must pass an entrance exam to be eligible for the course. As an alternative route to certification, those completing the more advanced tertiary qualifications may challenge the examination and be certified as an AEA after successfully completing their first or second year of training. Training at this level consists of a 470 hour course, consisting of 240 hours of lectures and practical simulations, and 230 hours of experiential learning. AEA's are qualified to practice various invasive techniques such as IV
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...

therapy, needle Cricothyroidotomy and needle Thoracocentesis, as well as Electrocardiogram
Electrocardiogram
Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...

interpretation, manual external defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...

, and are allowed to administer various drugs.

CCA or Critical Care Assistant - This is an Advanced Life Support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...

(ALS) certification which is not currently aligned to any National Qualification Framework (NQF) Diploma. Candidates must complete a 1,200 hour course to qualify as a CCA. They are qualified to practice a large array of invasive techniques, can perform cardio-version and are allowed to administer narcotics, sedatives and various other drugs.

There are currently 2 different University / Technikon qualifications:

ECT or Emergency Care Technician -This mid-level course is of two years duration, and exits on a level just above what many know as Intermediate Life Support (ILS), but below Advanced Life Support (ALS). This course is covered at 5 different training colleges in South Africa. Students who pass this course are eligible to apply to the HPCSA to be registered in the category of Emergency Care Technician (ECT). Lebone College of Emergency Care is situated in Pretoria.

BTech/BEMC or The Bachelor Degree Technology or Bachelor Degree in Emergency Medicical Care, is a four year professional degree and students who achieve this degree are eligible to be registered with the HPCSA in the register for Emergency Care Practitioner
Emergency Care Practitioner
An Emergency Care Practitioner may come from either a paramedic, nursing or allied health professional background and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard...

(ECP) which has an additional scope of practice. The most notable addition in stand-alone capabilities include Thrombolysis
Thrombolysis
Thrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...

and Rapid sequence induction
Rapid sequence induction
Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs...

. ECP's are also trained in the rescue disciplines offered by their University, normally up to the level of Advanced Rescue Practitioner. Example: High Angle II-, Motor Vehicle-, Fire Search and Rescue-, Aviation-, Confined Space-, Structural Collapse-, Industrial and Agricultural-, Trench-, Aquatic Rescue, etc. The advantage of the BEMC qualification, is that they can offer their patients a higher level of care as their protocol is higher than that of a CCA.

Further opportunities for educational advancement exist for the ECP, as they are able to articulate into various Masters (M.EMC)(Mphil.EM)(MSc.EM) and Doctorate (DEMC)(PhD) programmes.

All EMS personnel in South Africa are required to meet the standards of the governing body, the Health Professions Council of South Africa. A formal Register is maintained for each type of EMS certification. All health practitioners in The Republic of South Africa are regulated by the Health Professions Council of South Africa (HPCSA) in terms of legislation set out in the Health Professions ACT.

Future training

Recently, the Health Professions Council of South Africa (HPCSA), has begun steps to change the system of education in the Emergency Services and they hope to change the EMS training system by 2010. These steps would involve removing all the short course (BAA / AEA / CCA) and only having a 2 year nCert (Intermediatte level qualification) and nDip / B-Tech (ALS level qualification). Given the economics of the system and its current reliance on volunteers in some communities and locales, it remains unclear whether it will be either possible or practical to eliminate the BAA certification for anyone other than paid staff in the near future.

The mid-level course is 2 years in duration , and exits on a level slightly above Ambulance Emergency Assistant (AEA), but below Advanced Life Support (ALS). They are placed on the Emergency Care Technician (ECT) register. The clinician qualification is a four year professional degree in Emergency Medical Care (Bachelor Emergency Medical Care), and is placed on the Emergency Care Practitioner (ECP) register. The only four institutions in the country currently presenting the ECP qualification are the:

University of Johannesburg
University of Johannesburg
The University of Johannesburg came into existence on 1 January 2005 as the result of a merger between the Technikon Witwatersrand and the Rand Afrikaans University . Prior to the merger, the Daveyton and Soweto campuses of the former Vista University had been incorporated into RAU...
Central University of Technology
Central University of Technology
Central University of Technology, Free State or Central University of Technology is a University of Technology in Bloemfontein in the Free State province of South Africa. It was established in 1981 as "Technikon Free State". As part of the South African government's restructuring of tertiary...
Durban University of Technology
Durban University of Technology
The Durban University of Technology is a University of Technology in KwaZulu-Natal, South Africa. It was formed in 2002 by the merger of Technikon Natal and ML Sultan Technikon and was previously known as the Durban Institute of Technology. It has four campuses in Durban, and two in Pietermaritzburg...
Cape Peninsula University of Technology
Cape Peninsula University of Technology
Cape Peninsula University of Technology, a university in Cape Town, South Africa, is the only university of Technology in the Western Cape province, and is also the largest university in the province, with over 32,000 students.-History:...

Medical oversight

Under the old system, all levels of EMS personnel essentially functioned as an extension of their Medical Director

Medical director

As laboratory director,means that you are responsible for the overall operation and administration of the laboratory, including the employment of competentqualified personnel. Even though you have the option to delegate some...

's license to practice medicine. However, under the new system both Emergency Care Technicians and Emergency Care Practitioners are permitted considerable latitude with respect to independent practice. Standing orders or protocols do exist, and consultation with a physician

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

(particularly for the ECT) is an option, but for the most part the ECP and CCA functions as a fully independent practitioner, similar to the Paramedic Practitioners in the U.K..

Staffing

Currently, ambulances are staffed by the BLS and ILS practitioners, usually working paired together (BAA & AEA). In many volunteer services however, at least some of the time a crew of two BAAs is not uncommon. The ALS providers (CCA) normally work on rapid response vehicles in order to improve response times. CCAs are required to be dispatched in support of the ambulance crew to all Priority 1 (Code Red) patients (those with high-acuity conditions or injuries). The national objective is to have one staffed emergency ambulance for every 10,000 population by 2010, however, in some parts of the country this ratio is currently approximately 1 ambulance for every 30,000.

Vehicles

The vehicles used by EMS in South Africa can vary greatly across a broad range. They may be large or small, new or quite old, often driven by local economics. There is no specific current standard for ambulance design in South Africa. Some vehicles comply with either the European standard CEN 1789

CEN 1789

CEN 1789:2007 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients...

or the U.S. standard, KKK-1822, but many meet neither standard. There are even examples of motorcycles with stretcher-carrying sidecars. There is currently a major initiative underway by the government of South Africa to replace much of the aging existing fleet with brand new, high standard emergency ambulances. Current plans call for the replacement of approximately 450 ambulances by 2010.

Dispatch

In the past, EMS dispatch has occurred from a variety of sources, and in many cases, involved self-dispatch, as the currently operating private companies still do. The evolution of EMS is seen in South Africa as a national priority, and the government has created a National Emergency Medical Service Strategic Framework, complete with both goals and timelines. The current objective calls for centralized dispatch to be available from at least two call centres, located in major centres, in each South African province by 2010. A national emergency telephone number

Emergency telephone number

Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may...

for EMS has been established. This number is 10-177.

Response times

There are currently no official "response time" standards in the South African system. However, response times of fifteen minutes for high-acuity calls in urban area

Urban area

An urban area is characterized by higher population density and vast human features in comparison to areas surrounding it. Urban areas may be cities, towns or conurbations, but the term is not commonly extended to rural settlements such as villages and hamlets.Urban areas are created and further...

s are considered acceptable, and in rural areas, response times of up to forty minutes for similar calls are not uncommon.

Land Ambulance

Air Ambulance

Training

Future training

Medical oversight

Staffing

Vehicles

Dispatch

Response times

See also

Further reading

Land Ambulance

Air Ambulance

Training

Future training

Medical oversight

Staffing

Vehicles

Dispatch

Response times

See also

Further reading

Land Ambulance

Air Ambulance

Training

Future training

Medical oversight

Staffing

Vehicles

Dispatch

Response times

See also

Further reading