Emergency medical services in South Africa

Infobox Country
common_name = South Africa

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capital = Pretoria [cite web|url=https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html|title=All facts unless otherwise cited are from: The CIA World Fact Book|accessdate=2008-10-06]
area_km2 = 1219912
area_sq_mi =
population_estimate = 48,782,756
population_estimate_year = July 2008
population_density_km2 = 39.98
population_density_sq_mi =
healthcare = Public/private mix

Emergency medical services in South Africa are a public/private system aimed at the provision of emergency ambulance service, including emergency care and transportation to hospital.

Organisation

Land Ambulance

Emergency ambulance service is provided by each South African province. The system of government operated ambulances is generally referred to as 'Metro' [cite web|url=http://www.metroems.org.za/|title=Metro EMS website|accessdate=2008-09-17] . 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 [cite web|url=http://www.joburg.org.za/content/view/697/78/|title=Emergency Management Service|accessdate= 2008-09-16}] , 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 [cite web |url=http://www.netcare911.co.za/live/content.php?Item_ID=4091 |title=NetCare 911 website |accessdate= 2008-09-16] and ER24 [cite web |url=http://www.er24.co.za/|title=ER24 website |accessdate= 2008-09-16] , 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 [cite web|url=http://www.redcross.org.za/|title=South African Red Cross|accessdate=2008-09-17] , and St. John Ambulance [cite web|url=http://www.stjohn.org.za/|title=St. John Ambulance|accessdate=2008-09-17] . 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 service is provided by the Red Cross Air Mercy Service [cite web|url=http://www.ams.org.za/ |title=Red Cross Air Mercy Service |accessdate= 2008-09-16] from bases throughout the country. The system operates both helicopters and fixed wing aircraft, and both turboprop and jet aircraft as well. Emergency air ambulance service is also provided by Specialized Trauma Air Rescue (STAR), [cite web|url=http://www.star.org.za/|title=STARS website|accessdate=2008-09-17] a not-for-profit group, operating nationally, and formerly known as 'Flight for Life'. Private air ambulance charters are also available from a number of aircraft charter companies throughout the country.

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Capetown_Air_AmbulanceImage:HeloTraining.jpg|Capetown_Air_Ambulance_Orientation

tandards

Training

In South Africa there are 3 different levels of proficiency of emergency medical technician:

*BAA or Basic Ambulance Assistant - This is a Basic Life Support (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 comprising of lectures and practical simulations. The lectures cover basic anatomy and physiology, basic life support (including both CPR and first aid, emergency care, the use of ambulance equipment, including Automatic External Defibrillators (AED), 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 levels of certification may challenge the examination and be certified as an AEA after successfully completing their first year of training. Training at this level consists of a 470 hour course, comprising of 240 hours of lectures and practical simulations, and 230 hours of on-the-job training. AEA's are qualified to practice various invasive techniques such as IV therapy, needle Cricothyroidotomy, needle Thoracocentesis, Electrocardiogram interpretation, manual external defibrillation, and are allowed to administer various drugs.

*CCA or Critical Care Assistant - This is an Advanced Life Support (ALS) certification. Candidates must complete a 1,200 hour course to qualify as a CCA, or they must complete a 3-year (5-year part-time) National Diploma in Emergency Medical Care at the Wits or Durban Technical University. As an alternative, they may complete a four year Bachelor's degree in pre-hospital care (B.Tech), at one of four universities. CCAs are qualified to practice a large array of invasive techniques, can perform cardio-version and are allowed to administer analgesics, sedatives and various other drugs.

All EMS personnel in South Africa are required to meet the standards of the governing body, the Health Professions Council of South Africa [cite web|url=http://www.hpcsa.co.za/hpcsa/default.aspx|title=Health Professions Council of South Africa|accessdate=2008-09-17] . A formal Register is maintained for each type of EMS certification. All health practitioners in The Republic of South Africa are regulated by a standards generating body (SGB), the Health Professions Council of South Africa (HPCSA).

Future training

Recently South Africa's emergency medical services (EMS) governing body, the Health Professions Council of South Africa (HPCSA), has implemented steps to improve the quality of education and they hope to change the EMS curriculum by 2010. These steps would involve removing all the short course (BAA / AEA / CCA) and only having a 1 year nCert (ILS level qualification) and nDip / B-Tech (ALS level qualification). [cite web |url=http://www.resuscitationjournal.com/article/S0300-9572(04)00458-7/abstract|title= Resuscitation Journal|accessdate= 2008-09-16] 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 Department of Education has initiated the phasing out of short course training. This is to be replaced with a mid-level technician, and a pre-hospital clinician. The mid-level course is 2 years in duration , and exits on a level just above what many know as Intermediate Life Support (ILS), 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 to currently permitted to train to the ECP qualification are the:

*University of Johannesburg
*Central University of Technology
*Durban University of Technology
*Cape Peninsula University of Technology

Medical oversight

Under the old system, all levels of EMS personnel essentially functioned as an extension of their Medical Director'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 (particularly for the ECT) is an option, but for the most part the ECP functions as a fully independent practitioner, similar to the Paramedic Practitioners in the U.K..

taffing

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 [cite web|url=http://www.ecdoh.gov.za/press_releases/119/PE_ambulance_shortage_exaggerated/10_May_2007
title=Govt Media Release|accessdate=2008-09-17] .

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 or the U.S. standard, KKK-1822, but many meet neither standard. There are even examples of motorcycles with stretcher-carrying sidecars [cite web|url=http://www.int.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20050519071611743C757718|title=Motorcycle Ambulance|accessdate=2008-09-17] . 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 [cite web|url=http://www.sa2010.gov.za/government/health.php|title=National EMS Strategic Framework|accessdate=2008-09-17] .

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 [cite web|url=http://www.sa2010.gov.za/government/health.php|title=National EMS Strategic Framework|accessdate=2008-09-17] . A national emergency telephone number 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. The inequities of the past continue to manifest themselves in terms of areas which are severely under-resourced, and of a system which struggles to address such inequities. As a result, response times of fifteen minutes for high-acuity calls in urban areas are considered acceptable, and in rural areas, response times of up to forty minutes for similar calls are not uncommon [cite web|url=http://www.ncbi.nlm.nih.gov/pubmed/15680521|title=EMS Systems in South Africa|accessdate=2008-09-17] .

References

ee also

*Emergency Medical Services (Home Page)
*Emergency Medical Services in the United States
*Emergency Medical Services in France
*Emergency Medical Services in the United Kingdom
*Emergency Medical Services in Italy
*Emergency Medical Services in Germany
*Emergency medical services in Australia
*Emergency medical services in Norway
*Emergency medical services in Canada
*Emergency medical services in Israel

Further reading

*"International EMS systems in South Africa: past, present, and future", C . MacFarlane et al., "Resuscitation", Volume 64, Issue 2, Pages 145-148.