South Africa

DIEMS Home Page





General

Capital – Pretoria

Land Size – 1,219,090 sq km

Population – 49,109,107

Language(s) – IsiZulu 23.8%; IsiXhosa 17.6%; Afrikaans 13.3%; Sepedi 9.4%; English 8.2%; Other 27.7%


Prehospital Care


Table Mountain, Cape Town – Unresponsive, multi-trauma patient w/severe head injuries; © Thomas Sly – Flickr, with permission

Tabletop Mtn Rescue


Overview

  • In past 15yrs (10yrs since transition to democracy), prehospital care has moved from isolated FDs (BLS) to complex, sophisticated system of ground/air response covering whole country to varying degrees
    • Sophisticated ALS response in urban areas
    • Scarce response in rural areas
      • Result of previous political climate
    • EMS personnel in South Africa experience remarkable spectrum of clinical exposure
    • Training is of the highest standard worldwide
    • Problems:
      • Pt overload
      • Under-financing
      • Lack of equality in distribution of resources
    • Recently established specialty in emergency medicine will lead to:
      • Higher standards of ED Pt care
      • Improved Leadership
      • Improved Organization
      • Improved Data Capture and QA


History

  • 1977- law passed making provision of ambulance services responsibility of the then four provincial administrations
    • Basic ambulance services serving communities w/in local gov’t boundaries
      • No services in many parts of country
  • 1994 – regulations making it compulsory for all practitioners to register
    • National curricula for emergency care established
  • Great disparity of services available between provinces
    • All have problems with use of services for mild injuries and illnesses
      • Resulting drain on resources
      • Public education, better public transport and availability of more basic patient transport vehicles required


EMS System Model

  • Varies along population and socio-economic levels:
  • Public Sector:
    • Insufficient personnel and poorly maintained vehicles and equipment due to financial restraints
  • Private Sector:
    • Growing competence to provide sophisticated pre-hospital care and exceptional clinical expertise
  • Response Time Goals
    • Urban – 15mins
    • Rural – 40 mins
      • Greater Johannesburg only reported district to achieve these goals “semi-regularly”


Lead Agency


Levels of Care & Education/Training

  • Basic Ambulance Assistant (BAA):
    • Min 1mo trainingCPR/AED
    • First Aid
    • Basic Vehicle Extrication
    • Packaging Techniques
    • Simple Trauma Mgmt
    • O2, Entonox, Oral Glucose and Activated Charcoal
      • Recommended industry standards: minimum BAA personnel on every EMS vehicle
  • Ambulance Emergency Assistant (AEA):
    • Experience + 3-4mos. Training
    • Neb Rx for Asthma
    • IV and Fluids
    • IV glucose
    • Aspirin
    • Man. Defib
  • Critical Care Assistant (CAA):
    • Similar to US Paramedic
    • Experience + 9-12mos. full-time training
    • Extensive emergency medical protocols designed along lines of:
      • PALS
      • ACLS
      • ATLS
    • Advanced Airway Mgmt
    • Synchronized Cardioversion
    • 27 different meds
      • Benzodiazepines
      • IV analgesics
      • Emergency Cardiac meds
  • National Diploma in Emergency Medical Care:
    • Post-Graduate study
    • Top level of prehospital Emergency care practitioner
    • Dedicated 3yr full-time training programs at specificpost-graduate technical colleges
      • In-depth Anatomy/Physiology
      • Wide range of related disciplines
        • Rescue
        • Communications
    • “They may, in fact, be amongst the best trained paramedics in the world” (Macfarlane, 147)
      • Thoroughness and Extent of Training
      • Significant on-road experience
      • High quality of advanced medical instruction
      • May extend academic training by completing 4thyr and graduating with a Bachelor of Technology degree


Medical Direction

  • Originally required on-line medical direction; now permitted to administer drugs according to designated protocols w/in scope of practice


Specialty Care

  • HEMS
    • Single national coordinating service
    • Run under auspices of Air Mercy Service of the Red Cross
    • 5 dedicated helicopters in the major metropolitan areasJohannesburg 24h twin-engine service was once busiest in world
    • Private-operated fixed-wing air evacuation, both nationally and into sub-saharan Africa
      • Hospitals frequently receive poly-trauma/complicated medical cases from entire Southern African region


Funding

  • Services funded by individual provinces from funds allocated by national gov’t; EMS Care free of charge to all earning below certain threshold


Dispatch/strong>

  • Call centers have varied capabilities with more sophisticated using software programs for triage and appropriate vehicle dispatch
  • No formal EMD training courses yet implemented for most call center personnel


National Emergency Telephone #

  • Available to anyone by calling toll-free emergency number (10177) or direct to regional call centers
  • 112 – toll-free cell number

Emergency Medicine & Emergency Care

  • March 2004 – Emergency Medicine officially established/recognizes as separate medical specialty
  • Gov’t Hospitals
    • Modelled on former UK “Casualty Departments”
    • Significant Pt overload
    • Large number of ambulatory, non-emergent Pt’s
    • Many are primary health care Pt’s that have bypassed local clinics
    • Pt’s can be impatient, aggressive and can resent more serious cases being attended before them
  • Private Hospitals
    • Well-developed and extensive private sector, many of which have EDs
      • Many EDs are essentially general practices
      • Non-regular presentation of “true emergencies”


References


Links

DIEMS Home Page