EMS system in South Africa
Here it finally is: My post on EMS in South Africa.
It is partly taken from http://en.wikipedia.org…
In South Africa there are 3 different levels of short course training for paramedics:
- BAA (Basic Ambulance Assistant) – This is a Basic Life Support (BLS) certification, and is 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 and physiology, basic life support (including both CPR and first aid), emergency care, the use of ambulance equipment, including Automated External Defibrillator’s (AED) and Oxygen, and various medico-legal issues.
- AEA or Ambulance Emergency Assistant – This is an Intermediate Life Support (ILS) certification, and is the equivalent of the U.S. EMT-I, but with some added skills. To apply for AEA/ILS training, candidates must have at least 1,000 hours of practical experience as a BAA/BLS 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 therapy, needle Cricothyroidotomy, needle Thoracocentesis, ECG interpretation, manual external defibrillation, and are allowed to administer various drugs.
- CCA or Critical Care Assistant – This is an Advanced Life Support (ALS) certification. It may be compared to the U.S.AEMT-CC. To apply for ALS/CCA training, candidates must have at least 1,000 hours of practical experience as a ILS?AEA and they must pass an entrance exam to be eligible for the course. Candidates must complete a 1,200 hour course to qualify as a CCA/ALS. 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.
Then there are also 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).
- BTech/BEMC or The Bachelor Degree Technology or Bachelor Degree in Emergency Medical 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 (ECP) which has an additional scope of practice. The most notable addition in stand-alone capabilities include Thrombolysis and Rapid sequence induction (RSI). 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, 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 (HPCSA). All health practitioners in The Republic of South Africa are regulated by the HPCSA in terms of legislation set out in the Health Professions ACT.
The national objective is to have one staffed emergency ambulance for every 10,000 population, however, in some parts of the country this ratio is approximately 1 ambulance for every 30,000.
There are currently no official “response time” standards in the South African system. However, response times of fifteen-to-twenty minutes for P1 (Red/Critical) calls in urban areas are considered acceptable, and in rural areas, response times of up to forty minutes to an hour, for similar calls are not uncommon.
Emergency Medical Services in South Africa fall under two categories, private sector and government sector. The government ambulance services are generally referred to as ‘Metro’ – or an acronym name depending on the area (ie. JEMS – for Johannesburg Emergency Management Services, EMRS for Eastern Cape Emergency Medical Services, etc). In addition to paid paramedics, the government sector has many unpaid volunteers. The co-location of ambulances with fire apparatus is common in South Africa, although they are two independent services. The national emergency number for the Emergency Services (EMS and Fire) is 10 177.
These government operated services are ‘helped’ by two main private-for-profit ambulance companies, namely:
- Netcare 911 – Who was the first nationwide private EMS company, and are now one of the largest EMS companies in SA. They operate from +-60 base’s around the country, with an emergency vehicle fleet of: a number of Medical Helicopters (HEMS) staffing doctors – trained in Emergency medicine, and an ALS/CCA paramedic;
+-100 ambulances crewed as either: A Dedicated Intensive Care Units (equipped with specialized equipment) capable of facilitating Inter-hospital Transfers – ranging from adults through to neonatal ICU patients staffed by any health care professional required, a Basic unit staffing 2 BAA’s/BLS’s, a Intermediate unit staffing a AEA/ILS and a BAA/BLS, or advanced staffing a ALS/CCA and ILS/AEA or just 2 ILS/AEA’s;
+- 60 RRV’s (Rapid Response Vehicles – vehicles used to get to a “call” as fast as possible) staffed by a ILS/AEA or ALS/CCA paramedic and +-5 Doctor RRV’s which are staffed by doctors specializing in Emergency medicine and only respond to the most critical of calls.
- ER24, who operate out of (x) bases that are strategically placed in all major metropolitan areas and towns around the country as well as contracts with well-established ambulance service providers in the outlying areas. The National ER24 Emergency Call Centre based in Johannesburg handles in excess of 40 000 emergency calls per day.
In August 2000 a second major private emergency medical care company was registered in South Africa, ER24. ER24 is 100 percent privately owned by Medi-Clinic (A group of private hospitals in South Africa). Soon to become one of the largest privately owned Emergency Medical Care providers, ER24’s name was changed to ER24 EMS (Pty) Ltd. and now known in the industry as ER24.
The ER24 fleet consists of a 225 ground vehicles:
- Ambulances which are staffed similarly to the Netcare Ambulances, but don’t have Dedicated Intensive Care Units.
- To cater for a much lacking need in South Africa, ER24 and Discovery Health partnered in June 2009 to launch the Medicopter. The first Medicopter was launched in June 2009 in Johannesburg. A few months later the Medicopter was launched in Cape Town. Today, ER24 operates three Medicopters across South Africa with the third in KwaZulu Natal.
- RRV’s staffed the same as Netcare’s RRV’s, but they also have Medicopter Ground Support Units (MGSU) which are fully medically equipped BMW X5’s. After the partnership between ER24 and (a medical aid company), and the subsequent launch of the ER24 Medicopters, three ground units were set in operation in Johannesburg, Cape Town and Durban. The unit comprises of three crew members who are qualified as Intermediate Life Support practitioners. The MGSU acts as a normal RRV, but is also called out to calls that require the Medicopter. The crew staffing the MGSU have been trained in the ways of HEMS, and have the knowledge to allow for the Medicopter to land, take-off, and be 100% safe throughout this process.
- Rescue Vehicles which carry paramedics trained in the various rescue disciplines, and carry specialized rescue equipment.
- Fire & Rescue vehicles, of which there is only 1 at this time, and is based at a mine.
- And Trauma Support vehicles, staffing trauma counselors, which are called in to traumatic scenes to help grieving relatives, traumatized victims, etc.
both of which operate nationally, and by a variety of smaller private services, such as Emer-g-med.
Or Hatzolah, which provide EMS exclusively to the Jewish communities.
All private, and volunteer organisations are required to meet the same standards as the government services with respect to staff qualifications. These private and volunteer services are self-dispatching, and do not participate in the national emergency number scheme.
Public air ambulancee service is provided by the Red Cross Air Mercy Service from bases throughout the country. They also operate fixed wing aircrafts.
Emergency air ambulance service is also provided by Specialized Trauma Air Rescue (STAR), 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.
And there is Helivac who run also operate a HEMS service.
And there you have it! The EMS system in South Africa!
P.S. I don’t work in the industry (YET!), so some things may be wrong, if they are feel free to leave a comment and correct me!
With many thanks to Marcel From http://marcelnlsn.wordpress.com/ and Vanessa Jackson from ER24! :)