International EMS systems in South Africa: past, present, and future

MacFarlane, Campbell; Loggerenberg, Charl van; Kloeck, Walter

doi:10.1016/j.resuscitation.2004.11.003

Cited by 54 publications

(43 citation statements)

References 3 publications

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“…[4] Locally, there are three streams and different qualifications in order to become a paramedic. [14] Firstly, after completing a basic and intermediate course and gaining some practical experience, a 9 -12-month course (Critical Care Assistant Certificate) may be completed, allowing for registration with the Health Professions Council of South Africa (HPCSA) as a paramedic. Alternatively, paramedic registration may be obtained by completing a 3-year National Diploma course.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, a 4-year honours degree can be undertaken, allowing for the individual to register as an ECP (as opposed to paramedic) with the HPCSA. [14] Regardless of the stream chosen to obtain registration to practise, there is considerable variation between qualifications and even different educational institutions (offering the same qualification) in the exposure and training in critical care transport. This ranges from a 10-week module in critical care (including lectures and practical ICU ward rotations) to absolutely no teaching beyond the most basic elements of mechanical ventilation and the use of medication infusion devices.…”

Section: Discussionmentioning

confidence: 99%

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The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

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Background. Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics' training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. There is currently a critical shortage of intensive and specialist care in South Africa (SA). [1] In fact, 77% of state healthcare facilities and 16% of private healthcare facilities do not have intensive or high-care capacity.[1] Owing to this shortage, adequate district and provincial healthcare might not be available in many areas, [2] necessitating frequent transfer of patients to urban tertiary centres for specialist care.Internationally, paramedics undertaking critical care transfers (CCTs) have extended scope of practice when compared with standard emergency paramedics in order to be equipped for these high-acuity patients.[3] Locally, however, all paramedics registered as advanced life support (ALS) practitioners may undertake CCTs. [4] No extended training or additional scope of practice is given to these paramedics who might need to intervene to stabilise patients for transfer.[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.[7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%). [7] It was found that a number of technical AEs such as inadequate monitoring, absent venous access, and malpositioning of e...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

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“…4 However, there are several challenges to delivering high quality EMS care in sub-Saharan Africa, including patient overload, poor integration with other health services, limited and inefficient services, poor clinical documentation, and a shortage of physicians and necessary supplies. [5][6][7] The epidemiology of conditions presenting to the EMS needs to be studied to make efficient use of the scarce existing human, material and financial resources. 8 Ethiopia, a country with a low small vehicle/population ratio, is considered one of the countries worst affected by RTIs.…”

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confidence: 99%

The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia

Getachew

Ali

Tayler-Smith

et al. 2016

public health action

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T he global burden of road traffic injuries (RTIs) is growing constantly, with approximately 1.2 million people killed and 20-50 million people injured each year. 1 This major public health problem disproportionately affects low-and middle-income countries (LMICs), and is likely to become a greater problem, with RTI-related deaths and injuries forecast to increase by 80% in LMICs between 2000 and 2020. 2 RTIs place an immense burden on health care systems, diverting financial and human resources and bed occupancy from other priorities. 3 Emergency medical services (EMS), a system of ambulances and emergency departments (EDs) at hospitals, provide critical care for injured or ill patients before they are integrated into other health services. 4 However, there are several challenges to delivering high quality EMS care in sub-Saharan Africa, including patient overload, poor integration with other health services, limited and inefficient services, poor clinical documentation, and a shortage of physicians and necessary supplies. [5][6][7] The epidemiology of conditions presenting to the EMS needs to be studied to make efficient use of the scarce existing human, material and financial resources. 8 Ethiopia, a country with a low small vehicle/population ratio, is considered one of the countries worst affected by RTIs. 9 This is due mainly to poor road safety plans and the failure of drivers to abide by the traffic rules. 10 While some studies have highlighted the general burden of RTIs in Ethiopia, the burden of RTIs on hospital EDs is still an under-researched area. A study conducted in the ED of Black Lion Hospital, Addis Ababa, showed that RTI injuries constituted 48% of all ED casualities. 11 The study did not capture certain aspects of the RTI burden, however, such as the severity of cases, patient outcomes and the RTI-related workload in other hospital departments.To address these gaps, our study highlights the overall burden of RTIs in the ED of the Zewditu Memorial Hospital, Addis Ababa. We report on 1) the annual trend in the number and proportion of ED admissions resulting from an RTI, 2) the demographic and clinical characteristics of RTI cases, 3) the RTI outcomes at the end of the ED encounter, and 4) the specific characteristics and outcomes of RTI cases involving a head injury over a 1-year period. The results of this study are expected to guide efforts to improve the preparedness of EDs and the hospital referral departments that manage RTI cases. METHODS Study designThis was a descriptive cross-sectional study using retrospectively collected routine hospital data. Study settingEthiopia is one of the most populated countries in sub-Saharan Africa, with 82 million inhabitants. The country comprises nine regions and two city administrations; 16% of its population resides in urban areas. 12 Addis Ababa, the capital city, is the largest city in Ethiopia, with an estimated population of 3.5 million, constituting a quarter of the urban population in the country. 13 The country is poor, with a per capita gross ...

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“…('Anglo-American') (Pozner et al 2004, Symons & Schuster 2004, Black & Davies 2005, MacFarlane et al 2005) and physician-based ('FrancoGerman') models (Adnet & Lapostolle 2004, Gomes et al 2004, Langhelle et al 2004, Papaspyrou et al 2004, Roessler & Zuzan 2006. However, national and regional variation does occur and many EMS systems utilize elements from both models.…”

Section: Configuration Of Ems Systemsmentioning

confidence: 99%

Stroke and the emergency medical services – enhancing performance within the chain of survival

Puolakka

2017

Acta Anaesthesiol Scand

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International EMS systems in South Africa: past, present, and future

Cited by 54 publications

References 3 publications

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia

Stroke and the emergency medical services – enhancing performance within the chain of survival

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