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[accordion] [acc_item title=”General”]

Capital – Harare
Land Size – 390,757 sq km
Population – 11,651,818
Language(s) – English (official), Shona, Sindebele (the language of the Ndebele, sometimes called Ndebele), numerous but minor tribal dialects
[/acc_item] [acc_item title=”Prehospital Care Overview”]

  • UNAIDS (2002): Approx. 33% of adult population was HIV-positive.
  • “Healthcare … once considered to be very good, has been in a steady decline, with deteriorating facilities, increasing demand on resources and the high cost of disposable and capital equipment” (Thomson, 16)
  • “Arguable [that] one of the greatest problems at the moment is the high rate of staff attrition, with people leaving both the public and private sectors for other countries” (Thomson, 16)
  • Despite inadequate funding, resources and conditions, EMS care can be provided at very high level
    • Response areas – Exceptional distances with poor, unpredictable road conditions and driving practices:
      • “The low number of fatal ambulance accidents in the regulated services (two in the last 16 years known to the author, and neither the fault of the crew) speaks volumes for the crews’ capabilities” (Thomson, 18)
      • “Crews have to be trained and confident to manage patients for long periods” (Thomson, 18)
    • Nature of responses:
      • High rates of high-speed motor vehicle collisions
      • High rates of violent assaults
      • High suicide rates (OPP and Chloroquin tablet OD common)
      • Regular occurrence of MCIs
        • “Public transport accidents with 20 patients occur almost daily in Harare, with 50+ patient calls happening about once every 6 weeks” (Thomson, 19)
  • “The majority of people in the ambulance services – state, local authority and private are eager to see the profession develop, with a unified sense of purpose and a desire to meet acceptable international standards” (Thomson, 19).
  • July 2004 – 9 Ox-drawn ambulance given “as part of the struggle against climbing maternal mortality rates” (Klapp)
    • Pilot project by WHO, UNICEF and UN Population Fund
    • Donated to remote rural districts
    • Used to transport pregnant women to health facilities
    • Local community supplies OX, responsible for maintenance of ambulance
[/acc_item] [acc_item title=”History”]
  • Public perception used to be that ambulances were merely a means of getting to the hospital
    • A view “shared by many health care professionals and policy makers at all levels” (Thomson, 16)
  • In past 10-15 years, urban centers have begun to recognize that care begins in prehospital settings
    • As services develop they are beginning to become much more vocal in emphasizing the important role of prehospital care
  • 4 EMS Provider Types:
    • Local Authority Services
      • City, town or rural council runs ambulance services
    • Government, Hospital or Clinic based services
      • Mandate is to move PTs between hospitals/clinics
      • Required to attend to emergencies “out of the areas served by local authority ambulances”
      • Invariably “do not do this work, as they are not immediately available”
        • Reluctance by trained professionals to participate outside of supporting role in emergencies
    • Private services operated by mines, large estates, etc.
    • Private/For Profit services
      • “All private services are obliged to provider support for the local services in the event of a major incident and all have done so on numerous occasions” (Thomson, 17)
      • Medical Air Rescue Services (MARS)
        • Largest and oldest private provider
        • Ground fleet & access to fixed-wing
  • City of Harare Ambulance Service
    • 4 stations, approx. pop. 2 million
      • Calls outside city limits very common
      • “It is not unusual for ambulances to respond to calls with a 100 miles radius of the city, and incidents as far as 200 miles away have been attended” (Thomson, 18)
    • Response time goals – ambulance dispatch w/in 2min
    [/acc_item] [acc_item title=”Lead Agency”]
    • National registration system – “Health Professions Act” (2001)
      • Supervised by Allied Health Practitioners Council of Zimbabwe
      • Developed three-tier system to grade training and titles
        • Based primarily on South African system
      • Subsequent legislation includes registration of ambulance services and training facilities
    [/acc_item] [acc_item title=”Funding”]
    • Local authority services – Nonprofit
      • Funded by local ratepayers
    • Government, hospital or clinic based services
    • Private services operated by mines, large estates, etc.
    • Private/For Profit services
    [/acc_item] [acc_item title=”Levels of Care”]
    • Designations by Allied Health Practitioners Council of Zimbabwe (See Table 1)
      • “Ambulance Technician”
      • “Emergency Medical Technician”
      • “Paramedic”
    • Local Authority Services
      • Levels of care range from Basic to Advanced
        • “It is safe to say that the better a service is, the more of everyone else’s work it either has, or is ethically obliged, to undertake” (Thomson, 16)
    • Government, Hospital or Clinic based Services
      • “These are essentially a steel canopy on four wheels with a bed” (Thomson, 16)
      • Staffed by driver w/little or no training
      • PTs accompanied by Nurse, Nurse-aid or student nurse
        • Provider “invariably sits in the front of the vehicle on long trips” (Thomson, 16)
      • Many of staff received professional ambulance training
        • Often at own expense
      • Mandate is to move PTs between hospitals/clinics
      • Required to attend to emergencies “out of the areas served by local authority ambulances”
        • Regularly fail to respond as they are not available
      • Reluctance by trained professionals to participate outside of supporting role in emergencies
        • Aware of shortfalls of vehicle/equipment
        • Do not want to put self in compromising position
      • Mission hospitals may have better vehicles
        • Supplied through donation
        • Equipment, skill level and operating systems “are no better”
    • Private Services (operated by mines, large estates, etc.)
      • Run by company as part of “in-house” health care
      • “Generally sub-standard [ambulance] design and equipment” (Thomson, 16)
        • Drivers may be trained or un-trained, and accompanied by nurse or orderly
    • Private/For Profit Services
      • “Rapdily developing area at present, with many individuals or small consortiums trying to use this as a money-making service” (Thomson, 16)
      • General belief in Zimbabwe that all state-run services are inevitably substandard, and all private-run services are inherently better
        • “The reality is that this is not always the case” (Thomson, 16)

    Thomson N: “Emergency medical services in Zimbabwe” Resuscitation 2005;65: 15-19.

    [/acc_item] [acc_item title=”Dispatch”]
    • 999 – toll-free national number
      • Urban – answered by untrained operators and forwarded to appropriate public service
      • Rural – forwarded to nearest police station, who either forward to appropriate service or coordinate own response
    • 112 – cellular network access number
      • “generally works but where it is answered is network dependant” (Thomson, 17)
    • Dispatcher training is “variable”, and in some places there are either few resources or no dispatchers at all.
      • Many dispatchers are trained “in-house” (Thomson, 18)
      • “Services develop their own priorities and pre-arrival instructions (if any)” (Thomson, 18)
    [/acc_item] [acc_item title=”Emergency Medicine”]
    • Emergency Medicine not recognized as own specialty
    • “Larger provincial and central hospitals do have accident and emergency facilities, as do some of the private hospitals” (Thomson, 19)
      • “Departments are staffed  by people who are, by and large, not interested in emergency medicine, but are doing their locum work, or waiting for a training post in one of the other specialties of medicine” (Thomson, 19)
      • “Rural, district and small urban hospitals have no dedicated accident and emergency department” (Thomson, 19)
        • Rare to have more than one available doctor around the clock
        • “Seriously ill or injured patients will be discharged as soon as possible” (Thomson, 19)
    • “Zimbabwean nurses are generally well trained, and have a great deal of experience in managing ill patients and making decisions, which is why they are being recruited all over the world” (Thomson, 19)
    [/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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