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.
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.
Emergency ambulance service is provided by each South African province. The government-operated ambulance system, also known in the Western Cape as METRO (Medical Emergency Transportation and Rescue Operations) provides emergency medical care as well as various rescue options (land, air and sea) to the public. [1] In addition to the paid responders, the government system is supplemented in many areas by 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, [2] 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 multiple private-for-profit ambulance companies, NetCare 911 [3] and ER24, [4] of which operate locally and nationally. The statutory services and private companies are further supplemented by voluntary ambulance services, including the South African Red Cross, [5] and St. John Ambulance. [6] 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.
Public and Private air ambulance service is provided by the multiple private aircraft charter companies throughout the country.
The system operates both helicopters and fixed wing turboprop aircraft.
These contracts(Tenders) is provided by each Province on a yearly basis to all respective service providers.
Technical Rescue services is for the most part provided by the local Fire Service of each municipality. However, due to the reduction in service, much of this has been taken over by volunteer organisations. Who work alongside the South African Air Force since the high altitude dictates the use of military specification helicopters. Carrying out the technical rescue needs in each province in conjunction with the South African Police Service Search and Rescue Division.
In South Africa there are currently 3 different levels of proficiency in Short course training:
This qualification has now been changed to:
The National Diploma (NDIP) is a three-year NQF 7, full-time study at a college or university. This qualification is no longer offered. Existing practitioners are allowed to continue to practise independently. And is now changed to a Diploma in Emergency Medical Care (DIPEMC) a two-year NQF 6 full-time study at a college or university.
CCA,DIPEMC and NDIP are all registered as a Paramedic - Ambulaans Nood Tegnikus(ANT) with the Health Professions Council South Africa and they can continue to do an additional 2 year Bachelours (B-Tech) now formally changed to Bachelours in Emergency Medical Care (BEMC) a four-year full-time degree. [7]
ECT and NDIP has been merged into the now known DIPEMC or Paramedic category
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. [8] A formal register is maintained for each type of EMS certification. All health practitioners in The Republic of South Africa are regulated by the Health Professions Council of South Africa (HPCSA) as set out in the Health Professions ACT. To confirm a practitioner's qualification and Valid license, one can check the i-Register [9]
Recently,[ when? ] the Health Professions Council of South Africa (HPCSA), has begun steps to change the system of education in the Emergency Services and they hope to change the EMS training system by 2010. These steps would involve limiting short course ( BAA ) and only having a 2-year nCert (Intermediate level qualification) and B-Tech (ALS level qualification). [10] 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 mid-level course is 2 years in duration, and exits on a level slightly above Ambulance Emergency Assistant (AEA), 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 five institutions in the country currently presenting the ECP qualification are the:
Under the old system, all levels of EMS personnel essentially functioned as an extension of their Medical Director's license to practice medicine. Under the new system, Emergency Medical Practitioners are permitted considerable latitude with respect to independent practice. Standing orders or protocols do exist, and consultation with a physician (particularly for all levels of qualifications) is an option, but for the most part the AEA ,ECP, CCA, ECT, DIP and NDIP functions as a fully independent practitioner, similar to the Paramedic Practitioners in the UK. Protocols are currently as of 2016, being referred to and replaced by: Clinical Practice Guidelines; and will thus phase out the terminology of "protocols"
Currently, ambulances are staffed by the BLS and ILS practitioners, usually working paired together (BAA & AEA). In many volunteer services however, a crew of two BAAs is not uncommon. The ALS providers normally work on rapid response vehicles to improve response times. ALS is 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 60,000. [11]
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 US standard, KKK-1822, but many meet neither standard. There are even examples of motorcycles with stretcher-carrying sidecars. [12] [13] [14]
In the past, EMS dispatch has occurred from a variety of sources, and in many cases, has involved self-dispatch, which the currently operating private companies still do. The evolution of EMS is a national priority, and the government has created a National Emergency Medical Service Strategic Framework, complete with goals and timelines. The current objective calls for centralised dispatch to be available from at least two call centres, located in major centres, in each South African province by 2010. [15] A national emergency telephone number for EMS has been established. This number is 10–177.
There are currently no official "response time" standards in the South African system. However, response times of fifteen minutes for high-acuity calls in urban areas are considered acceptable, By Private Emergency Medical Services. As for the State Owned Services response times vary between 1 Hour - 3 Hours for high-acuity calls and in rural areas, response times of 60 minutes by Private Emergency Medical Services for similar calls are not uncommon. For state owned Services never arriving is not uncommon. [16]
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to be EMT certified.
A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.
A medical director is a physician who provides guidance and leadership on the use of medicine in a healthcare organization. These include the emergency medical services, hospital departments, blood banks, clinical teaching services, and others. A medical director devises the protocols and guidelines for the clinical staff and evaluates them while they are in use.
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
Paramedics in Germany are the main providers of emergency care in emergency medical services in Germany. There exist two professional levels regulated by federal law, the Rettungsassistent and the Notfallsanitäter.
The British Columbia Ambulance Service (BCAS) is an ambulance service that provides emergency medical response for the province of British Columbia, Canada. BCAS is one of the largest providers of emergency medical services in North America. The fleet consists of more than 500 ground ambulances operating from 183 stations across the province along with 80 support vehicles. Additionally, BCAS provides inter-facility patient transfer services in circumstances where a patient needs to be moved between health care facilities for treatment. BCAS also operates a medical evacuation program that utilizes both fixed-wing and rotary aircraft.
A Paramedic in Australia is a health care professional who holds a minimum of a Bachelor's Degree in Paramedicine and is registered with the Paramedicine Board of Australia via the Australian Health Practitioners Regulation Agency (AHPRA) As of December 2021, there are over 22,500 registered paramedics in Australia, of which approximately 70% (15,750) work for a jurisdictional service, and of which 47% of which are female. Paramedics in Australia may undergo further training and complete a Master's Degree to specialise in either Intensive Care or Primary Care medicine.
The Welsh Ambulance Services NHS Trust is the national ambulance service for Wales. It was established on 1 April 1998 and as of December 2018 has 3,400 staff providing ambulance and related services to the 3 million residents of Wales.
Emergency Health Services (EHS) is a branch of the Nova Scotia Department of Health tasked with providing emergency medical services. It is also responsible for transportation of patients between hospitals and medical facilities. At present, all ground ambulance and air ambulance service in Nova Scotia is contracted by EHS to Emergency Medical Care (EMC), a subsidiary of Medavie Health Services.
In the United States, emergency medical services (EMS) provide out-of-hospital acute medical care and/or transport to definitive care for those in need. They are regulated at the most basic level by the National Highway Traffic Safety Administration, which sets the minimum standards that all states' EMS providers must meet, and regulated more strictly by individual state governments, which often require higher standards from the services they oversee.
Emergency medical services in France are provided by a mix of organizations under public health control. The central organizations that provide these services are known as a SAMU, which stands for Service d’aide médicale urgente. Local SAMU organisations operate the control rooms that answer emergency calls and dispatch medical responders. They also operate the SMUR, which refers to the ambulances and response vehicles that provide advanced medical care. Other ambulances and response vehicles are provided by the fire services and private ambulance services.
Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.
An Emergency Care Practitioner (ECP) generally come from a background in paramedicine and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard paramedic or qualified nurse. It has been recommended by the College of Paramedics that ECPs be trained to PgDip or MSc level, although not all are. Evidence of the best way to target Emergency Care Practitioners is limited with utilisation of traditional Ambulance dispatch codes not always being shown to be most effective and referrals from GPs also potentially failing to deliver management of demand that would be appropriate for this different level of practitioner. Evidence however clearly demonstrates that in discreet groups of patients the use of these extended role staff responding to emergency calls can reduce admissions and thus improve patient outcomes as well as delivering a clear cost saving to the NHS.
Emergency medical services in Italy currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support (ALS) procedures. The emergency telephone number for emergency medical service in Italy is 118. Since 2017 it has also been possible to call by the European emergency number 112, although this is a general police/fire/medical number.
Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.
Emergency medical services in New Zealand are provided by the Order of St John, except in the Greater Wellington region where Wellington Free Ambulance provides these services. Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics. Strategic leadership of the sector is provided by NASO which is a unit within the Ministry of Health responsible for coordinating the purchasing and funding of services on behalf of the Ministry and the Accident Compensation Corporation.
The Operational Medical Orderly, better known as the Ops Medic is the collective name for the South African Defence Forces Operationally trained Medics. The Ops refers to the Operational area and was used to indicate that the medical orderlies deployed to the Operational area or theatre of operations of the then South African Defence Force (SADF). The Operational area referred to the border or cutline between Namibia and Angola where the Angolan Bush War conflict or border war was taking place from the 1970s to 1989.
The New York City Fire Department Bureau of Emergency Medical Services is a division of the New York City Fire Department (FDNY) in charge of emergency medical services for New York City. It was established on March 17, 1996, following the merger of the FDNY and New York City Health and Hospitals Corporation's emergency medical services division. FDNY EMS provides coverage of all five boroughs of New York City with ambulances and a variety of specialized response vehicles.