Emergency services in the Western Cape are grappling with a
myriad of challenges that threaten their ability to respond swiftly and
effectively. From resource shortages and aging infrastructure to increasing
call volumes and rising levels of violence, frontline workers are under
mounting pressure and as communities grow and demands intensify, concerns are
rising over the long term sustainability of the province's emergency response
teams. The Western Cape's Department of Health and Wellness briefed the Provincial
Legislature’s Standing Committee on Wednesday, on the provision of emergency
medical services (EMS) in the province and the associated challenges.
COURTESY: WCPP
Director for EMS at Western Cape Government, Craig Wylie,
says it starts with bystander care, whereby the community keeps the patient
alive whilst waiting for the EMS. He says more than 10 000 emergency first aid
responders were trained in the Western Cape, and thus, he says, acts as a
pathway entry into the emergency medical services. Wiley added that there are
five emergency contact centers in the province and one mobile center for major
incidents.
‘’The clinical desk, which is a new addition to the emergency
contact center space, really looks at providing clinical care through
telephonic measures before the arrival of the ambulance to give advice to
bystanders or medical personnel that's on the scene that may want to assist.
This is driven by the computer aided dispatch system that we have deployed
within the province and really speaks to the effectiveness of the province's
responses to incidents. The provincial health operation center is a center that
deals with all of the major incidents within the space and makes sure that the
entire system comes together when a major incident occurs so that we can
adequately and effectively transport and treat patients towards the health
system as a whole.’’
‘’Our computer aided dispatch system solution allows the
contact center to assign appropriate vehicles to incidents. Emergency care
providers receive the call on a mobile data terminal in the front of the
vehicle that allows them to book towards the scene and also navigates them to
get there. And then there's a detailed electronic patient care report that gets
completed in the back of the vehicle, which allows us to understand the cases
better and allows us to understand the burden better within our system. In
terms of the PHOC [Provincial Health Operations Center], they really do look
after our major incidents, and they work on a principle called MIMS, which is
the Major Incident Medical Management and Support Principles. They're critical
to the function of a sober command and pull the whole system together when these
system wide coordination, when these major incidents does happen or the system
gets overload,’’ he added.
‘’In terms of the emergency response, primary response
within the province deals with incidences in the public space. We classify
incidences according to priority, so, ensuring that the most ill patients will
get a response the quickest. Medical rescue plays a vital role in the access
and extrication of patients, and the aeromedical service that we have in the
province allows us to retrieve critically ill patients from far away and bring
them to central places as well in time sensitive scenarios.’’
COURTESY: WCPP
Wylie says EMS team responded to more than 816 000
incidents in 2024.
‘’We do move many people within the inter facility transfer
space as well. Almost an 180 000 inter facility transfers last year. These
resources are shared, so it is not specific for inter facility transfers so
that the system can be agile to where the need is. Specifically, in 2024, we
saw more than 3 000 highly specialized ventilated transfers happening from
hospitals to specialized care. In addition, because of this, we have created a
critical care transport team within the Western Cape that is specialized
paramedics that is able to transport very small, very sick adults as well. Our
Health Net Services or Planned Patient Transport Services in 2024 transported
around a 150 000 patients. These staff and vehicles are across the entire
province ensuring that we can get our patients to where they need to be in the
appropriate time. Specifically, we focus on vulnerable patients within our
planned patient transport space, but this does differ when we speak about
patients coming from rural areas where vulnerability can be extended to your
ability to to be transported.’’
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SCREENSHOT: WCDoH&W
He also outlined the challenges faced by EMS staff and says
that about nine or 10 paramedics are needed to staff one ambulance.
‘’Just in terms of what it means to staff one ambulance, we
need between nine and ten emergency care paramedics or emergency care officers
to staff one ambulance. In the rural areas, our staff, it's actually very well
self organized, their ability to staff more than one ambulance at one time.’’
Wylie says what hampers operations is having to wait for
police escorts to attend to ‘red zone’ areas.
‘’So police escort results in compounded resource
constraint. We know the police is also resource constraint. EMS is resource
constraint. Together, if they rely on each other, there's obviously a compound.
Addressing these concerns are complex with certain initiatives underway such as
sub green corridors and several engagements with the SAPS. But solutions to
safety concerns should be co-created with local communities and emergency care
providers, and that's really where we focus is that we can create local
solutions. Of staff safety, a big concern for EMS, remains the mental health of
our providers. These providers have to go out to uncontrolled traumatic
incidences outside of four walls. They don't know the area that they're going
into. And then to be faced with a traumatic incident really does have a
significant impact on your mental health. The department and, Western Cape
government has employee assistant programs, which is really good and really engaging,
but mostly reactive and we have to have to start focusing on the physical and
mental health of our providers pre-employment and throughout the length of the
employment. Staff safety is directly linked with staff wellness and mental
health.’’
‘’Then around retention of emergency care providers, and
you'll see largely my focus on the challenges is our providers because we need
providers to be in ambulances to be able to service incidents. So the brain
drain continues to reduce our workforce and specifically in The Middle East.
Similarly, staff appointment in rural aim to staff appointed in the rural space
often aim to move towards the urban space. We cannot compete with salaries or
workplace safety and workload of the international markets. But what we can do
is we can ensure that there's career advancement, there's a work life
balance.’’
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SCREENSHOT: WCDoH&W
Health and Wellness MEC, Mirelle Wenger, says the
department continues to have a fiscal constraint with 34% of the budget
allocated to the health sector, as it feels the pinch from 2023.
‘’Despite that, even in this year, in terms of our staff, we
are not in a position to grow yet. We are building back, but we are not yet at
the place where we can say we are growing in terms of our number of employees.
It means that we have high service pressures and we have to do more with what
we have. Therefore, we're working very hard at making sure we can be as
efficient as possible. In particular, for example, in the EMS space, we have
just recently launched a think tank with the private sector, which is working
on specific things that will help, for example, in the EMS space. Let me give
you a practical example and that lies in imaging. If a patient presents in a
rural area and they are then taken to the district hospital, if that hospital
does not have sophisticated imaging capability, for example, a CT scanner, the
ambulance will then take that patient to the nearest facility that does, and
sometimes that could be as far as two hours away. That means that ambulance is
now taken out of circulation to help that that patient to get their scanner and
then return based depending on what the results of the imaging shows. That then
puts pressure on the remaining ambulances in that area. It also depends on the
day, is it a weekend or high pressure times, then it means that the waiting
times will go up.’’
In emergencies, every second counts—but in some areas,
those vital minutes are stretching longer than ever.
‘’The day in a life of a paramedic is very hard to explain
if you have not lived it yourself. We make considerable effort to ensure that
we get out there and actually spend time, firstly, serving the population, but
secondly, understanding the day in the life of a paramedic and what the
challenges are that they actually get to. So just in terms of a general day,
and I think it is very different between urban and rural. In the urban areas,
our crews will come on duty in the mega station. They will need to quickly do
their handover and take over, deal with all of their PM issues, deal with all
of their queries to people management or to finance that they need to make
around uniforms, etc. They have about fifteen minutes to do that, and then they
need to go out,’’ said Craig Wylie, Western Cape's director for EMS.
‘’In the urban area, our ambulance crews will do between
ten and twelve incidents a day. In the past, that meant that you could get 60
minutes per incident. At the moment, we get around 2 000 escorts per month from
the SAPS in the urban area. Waiting times for SAPS escorts can sometimes take
more than sixty minutes, but you are still required to still do your 10 to 12
calls a day. You now need to do more than one person per call. We then have to
have interpersonal relationships. As you know, the community, rightfully so,
will get quite angry at our ambulance staff,, because it is taking them so long
to get there in the first place. So we see this negative feedback loop
occurring where it takes longer, people get angrier, the mental health of our
staff takes a significant decline,’’ he added.
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SCREENSHOT: WCDoH&W
Juanita Arendse Chief Director: Emergency & Clinical
Services Support at Western Cape says the target is 30minutes for
life-threatening cases, however patients have to wait more than an hour to be
assisted and explained that staff prioritises cases.
‘’The target is 30 minutes for a priority 1 client in the
metro and 40 minutes for priority one client in rural areas, because of the
distance. We have achieved 48% of that target in metro and because of the other
things that is outside of our control, and we've achieved 82% out in rural. A
lot of the reduced achievement of that target in the metro is because of the
red zones, and we have to wait for escorts. We experienced it ourselves when we
rock up at a police station, and there was only one SAPS vehicle for the night
and you have to wait until that SAPS vehicle comes back in after they have
attended to something, and then they escort you to the client, which is out of
our control.
‘’We also found that a lot of the clients exaggerate the
symptoms or they paint a different picture and when they [paramedics] arrive on
scene, it is a completely different to what the call has received, but that
means that another client who really is in that situation now waits. That is
also something we have been trying to address through communications and all of
those things.
MEC Mirelle Wenger reminded the public of various
communication channels to ensure complaints, compliments, or suggestions are
attended to. You can contact the provincial client support center by sending a
‘please call me’ or calling them to lodge a complaint on 086 142 142, or simply
send an email to service@westerncape.gov.za. You can also SMS the word help
followed by your name, the nature of your complaint, facility, and if
applicable, the name of a staff member to 31022.
Done By: Mitchum George
SUPPLIED
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