||08 March 2009 07:00
|Show: ||Carte Blanche|
Emergency medical services are often in the news - not for saving lives, but for reasons like: a lack of equipment, poor salaries, and of course, staff shortages.
Bongani Bingwa (Carte Blanche presenter): "We are at the scene of a pedestrian accident. The victim was hit by a bus - the driver apparently couldn't see him. It happened too quickly [to react]."
It's no secret that, should you experience a medical emergency, getting a fully advanced paramedic to your side may be a matter of life or death...
Bongani: "Patient has been stabilised... the night is starting to get busy, it could be a long one. It's unimaginable what it would be like if these guys weren't available..."
There are three levels of life support practitioners:
Basic level, which provides extremely limited emergency care.
Intermediate level, where the practitioner can administer certain drugs and put up drips.
And then advanced level - the capacity to open airways and administer a multitude of drugs. The gap between intermediate skill and advanced skill is quite significant.
In 2007 Dr Cleeve Robertson, a senior staff member of the Western Cape Metro, filed an affidavit declaring that current paramedic training facilities were inadequate, and that graduates were often not fully prepared to provide emergency care. He also expressed doubt about the ability to produce sufficient personnel for future requirements, like the World Cup 2010.
Two years later the question must be asked: do we have enough life support practitioners in South Africa?
Lloyd Christopher (Chairperson: Emergency Care Practitioners): "There are over 45 000 registered practitioners - 39 000 of those are basic life support providers."
Bongani: "And then intermediate level?"
Lloyd: "Approximately 4 to 4 500."
Bongani: "And then advanced is just over 1 000?"
Lloyd: "That's right, about 1000... 1300."
Lloyd Christopher is the chairperson of the Health Professions Council emergency services board. He is also the HoD for emergency medical services at the Cape Peninsula University of Technology, which offers higher education training for paramedics. He does not agree with Dr Robertson's affidavit.
Bongani: "What do you make of the fact that Dr Robertson says that the universities of technology are providing the profession sub standard graduates?"
Lloyd: "That is incorrect and I would challenge that statement. There are various mechanisms we have put in place to ensure quality."
After this interview, Lloyd sent us an email in which he underlined the quality of training: "70 National Diploma paramedics and approximately 60 Critical Care Assistants have graduated from CPUT since 2003. He says the overwhelming consensus based on the feedback received by the department from both employers and alumni is that the quality of the programmes at CPUT is good."
David Stanton is the chairperson of Paramedic Association South Africa. He confirms that registered numbers quoted by the Health Professions Council do not reflect the actual number of paramedics working on the ground.
David Stanton (Chairperson: Paramedic Association SA): "In some of the first world countries we're seeing an advanced life support paramedic on every ambulance. I think we should be aiming for advanced life support paramedics at least covering every two or three ambulances."
Bongani: "What would that be in numbers?"
David: "I think we'd like to see around 2 000 advanced life support paramedics in the country."
Bongani: "But right now there are about 500 working?"
David: "Working, yes."
Max is an advanced paramedic who works for the State in Gauteng. He says there are shortages, but he preferred to remain anonymous in fear of reprisal.
Max' (Advanced paramedic): "The WHO depicts a certain number per capita. I wouldn't know the exact figures, but I know for a fact that currently, within the State, we are running at less than 50% of the total of people who should be there... and that's from ambulance operators right through to advanced paramedics."
Timm Irvine-Smith works as a volunteer on the streets of Cape Town. He firmly believes that paramedic shortages are dire.
Timm Irvine-Smith (Advanced Paramedic): "Until there is a paramedic on every ambulance in this country, we don't have enough. One on every ambulance... and the fact is there are not. You may have one or two in a city."
If this is true, the Health Professions Council's estimate of 1 300 registered advanced paramedics seems inaccurate.
David: "That's the number registered with Health Professions Council. In terms of the number that are actually working in our industry, I think you'll find it is significantly less."
Bongani: "What would that number be?"
David: "We're probably closer on 500 that are working within the country at the moment."
Peter Fuhri, the director for 2010 Preparations for the National Department of Health, says it is unrealistic to supply one paramedic per ambulance.
Peter Fuhri (Director: 2010 World Cup Preparations): "I think it's unachievable. The fact is that we are working towards an 80/20 percentage or ratio [of] advanced to intermediate life support and we feel the backbone of the service should be intermediate life support."
Timm: "We have a child with 20% burns..."
Bongani: "We have been called to the scene - there is a two-year-old who has suffered 20% burns and he's being transported from one hospital to another. But the problem is it's intermediate level practitioners who can't administer what will need to be [administered] if anything goes wrong... so Timm and his team are here to assist if anything goes wrong."
Timm: "Ok - one happy crew - they've got advanced backup. Let's go to Somerset."
In most cases intermediate practitioners can cope with an emergency, but for high care the role and presence of an advanced paramedic is what gives patients optimum medical care.
In answering your emergency, often an ambulance will be dispatched with basic and intermediate life support practitioners on board. Only once on site - and if your emergency requires it - an advanced paramedic will be called to the scene, taking critical time from your window of survival.
Max': "Already our standard is low... 40 minute response times when somebody is in a critical condition is pointless... you arrive there [and] do declaration of death and that's it."
South African law states that practitioners cannot practice protocols for which you are not registered. It was in a desperate emergency call that Ursula Beatty witnessed the tragedy of what can happen when there are not enough paramedics in this country.
Ursula Beatty (Life support practitioner): "We were called to a man in a coma - that's what we were told by the call centre. We arrived and the family are giving CPR on the patient... and I look at this and immediately call for advanced life support backup, because this patient needs to be incubated. They need to get a tube down the throat so that he can breathe. It's not an intermediate support protocol... and he needs drugs..."
Ursula was trained as a UK advanced paramedic but was only registered as an intermediate in South Africa. She therefore was not allowed to intervene and had to wait for the advanced paramedic to arrive.
Ursula: "40 minutes later the paramedic arrives because they are so short."
Sadly the patient did not survive.
Ursula has subsequently decided to emigrate to Britain as she felt there were obstacles preventing her from reaching her full potential here.
Ursula: "I have to leave my family and friends and a country that I love to go and work in the UK. And yes, it is a good opportunity to work there and I'm lucky I've got a job... I'm walking into a job as a paramedic tutor to a life support paramedic in the UK. I don't want to work there, I want to work here. I want to work for government; I want to work for Metro as a paramedic in South Africa."
Bongani: "What will Ursula's loss mean to South Africa?"
Timm: "The question you have to ask is: this is a committed individual with SA interest at heart - how could we lose a person like that? Now anyone with less commitment to this country is gone in a heartbeat, chasing the big bucks in Saudi, Doha, any other place that automatically accepts our qualifications."
In the last year an exodus of advanced life support providers has left the country with a shortage that may have dire consequences."
David: "In terms of emigration and working contracts, we have probably seen... in my personal circle of friends... probably 20 to 30 in the last year..."
Lloyd: "There has been a significant drain of paramedics from South Africa. South African paramedics are highly regarded and highly qualified - they can walk into employment in any country in the world."
With the World Cup looming, the question must be asked: how will we cope?
Peter: "If we look at our peak - including the fan parks, public viewing areas and so forth '' paramedics, in terms of advanced life support practitioners in the true sense, we would field 350 around the country. We believe we have sufficient personnel."
According to estimates made by MMC, a medical management events company, flagship stadia in Cape Town and Johannesburg - which have been designed to host crowds of up to 80 000 - will need one advanced paramedic for every 5 000 people.
In addition, it's recommended that for every 1 000 fans at least one basic or intermediate practitioner will be necessary.
Close on a hundred life support practitioners are needed at every event. That's nearly 900 medics for the World Cup.
This figure does not include the 110 advanced paramedics stipulated for personal use of the FIFA delegates.
And it also excludes the rest of the public who won't be attending any of the football matches.
Peter: "If we look at the FIFA requirements, they are fairly vague in terms of what is required. If anything, we are providing more than what they require."
Max': "We are not in a position to look after our own community, never mind 500 000 people more. I don't think we are coping now... never mind for 2010."
It has been suggested that the shortage of paramedics can be remedied by importing foreign medics into South Africa for the World Cup.
Lloyd: "The HPC has made allowances for foreign qualified health practitioners to come into the country and be able to practice for the period of the World Cup."
Peter: "There is absolutely no preparation to introduce paramedics from overseas."
Someone like Ursula, who has taken her medical skills abroad and, being registered with the Health Professions Council here, would now qualify as a foreigner who could help during 2010.
Ursula: "And the irony is they will import UK paramedics - so ironically maybe I will come back here in 2010 for that interim six weeks to work as a paramedic... but as a foreigner."
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