[accordion] [acc_item title=”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%
Tabletop Mtn Rescue
[/acc_item] [acc_item title=”Prehospital Care 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
[/acc_item] [acc_item title=”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
[/acc_item] [acc_item title=”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”
[/acc_item] [acc_item title=”Level of Care”]
  • 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
[/acc_item] [acc_item title=”Medical Direction”]
  • Originally required on-line medical direction; now permitted to administer drugs according to designated protocols w/in scope of practice
[/acc_item] [acc_item title=”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
[/acc_item] [acc_item title=”Funding”]
  • Services funded by individual provinces from funds allocated by national gov’t; EMS Care free of charge to all earning below certain threshold
[/acc_item] [acc_item title=”Dispatch”]
  • 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
[/acc_item] [acc_item title=”Public Access Numbers”]
  • Available to anyone by calling toll-free emergency number (10177) or direct to regional call centers
  • 112 – toll-free cell number
[/acc_item] [acc_item title=”Emergency Medicine”]
  • 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”
[/acc_item] [acc_item title=”References”] [/acc_item] [acc_item title=”Links”]

  • Health Professions Council of South Africa – www.hpcsa.co.za
[/acc_item] [/accordion]
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