There have been major changes in pre-hospital emergency care training and education in South African over the past 30 years. This has culminated in the publication of a regulation that brings an end to an era of short courses in emergency care and paves the way for the implementation of the National Emergency Care Education and Training (NECET) policy. The policy envisions a 1-year higher certificate, a 2-year diploma and the 4-year professional degree in emergency medical care. This paper aims to describe the history of emergency care education and training in South Africa that culminated in the NECET policy. The lessons in the professional development of pre-hospital emergency care education and training may have application for emergency medical services in other countries.The migration of existing emergency medical services personnel to the new higher education qualification structure is a major challenge. The transition to the new framework will take time due to the many challenges that must be overcome before the vision of the policy is realised. Ongoing engagement with all stakeholders is necessary for the benefits envisioned in the NECET policy to be realised.  

Prehospital emergency medical care systems have traditionally focused on 'stopping the bleeding' and other forms of acute medical intervention. However, in 1996, the US National Highway Traffic Safety Administration recognised the role of emergency medical service (EMS) personnel in health promotion and injury prevention: 'Emergency medical services (EMSs) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. ' [1] Approaches to integrating emergency care and primary healthcare have subsequently been explored internationally. [2,3] In 2015, the Professional Board for Emergency Care, Health Professions Council of South Africa (HPCSA), adopted a position statement on social determinants of health. [4] This statement committed the Professional Board to review the EMS scope of practice and protocols to be explicitly inclusive of health promotion and preventive care. [4] The position statement also called on all providers of EMS education to educate students and practitioners on the importance of social determinants on health outcomes, and their role in identifying and responding to social determinants of health. This call is consistent with the 2008 report of the World Health Organization (WHO) Commission on Social Determinants of Health, which called on ministries of health and education, in collaboration with institutions offering health education, to make social determinants of health a standard and compulsory part of the curriculum of medical and health practitioners. [5] Social determinants of health are conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of wealth, power and resources at global, national and local levels. [5] However, little practical guidance is provided in these documents as to the most effective pedagogical methods by which to introduce social determinants of health into the emergency medical care curriculum. It is therefore imperative that EMS educators explore and share knowledge on experience of contextually relevant learning activities that serve to achieve this purpose. Service learning is one such activity that has been used in education of medical and other health science students. It combines the academic curriculum with service to a community in such a way that both Background. The inadequacy of training with regard to the social determinants of health in medical education has led to calls for a greater public health focus in medical and health education. This call is no less applicable to the education of emergency care students and other emergency care personnel than to any other category of healthcare practitioner. Emergency care personnel work within communities and are therefore uniquely positioned to identify social causes of poor health and to pl...

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Background Post-apartheid, South Africa adopted an inclusive education system that was intended to be free of unfair discrimination. This qualitative study examines the experiences and perceptions of racial discrimination between Emergency Medical Care (EMC) students, clinical mentors, and patients within an Emergency Medical Service (EMS) during clinical practice. Understanding the nature of such discrimination is critical for redress. Methods Within the conceptual framework of Critical Race Theory, critical ethnographic methodology explored how discriminatory social practice manifests during clinical practice. Semi-structured interviews enabled thematic analysis. We purposively sampled 13 undergraduate EMC students and 5 Emergency Care (EC) providers. Results EMC student participants reported experiences of racial and gender discrimination during work-integrated learning (WIL) as they were treated differently on the basis of race and gender. Language was used as an intentional barrier to isolate students from the patients during WIL because EC providers would intentionally speak in a language not understood by the student and failed to translate vital medical information about the case. This conduct prevented some students from engaging in clinical decision-making. Conclusions Unfair discrimination within the pre-hospital setting have an impact on the learning opportunities of EMC students. Such practice violates basic human rights and has the potential to negatively affect the clinical management of patients, thus it has the potential to violate patient’s rights. This study confirms the existence of discriminatory practices during WIL which is usually unreported. The lack of a structured approach to redress the discrimination causes a lack of inclusivity and unequal access to clinical education in a public clinical platform.