WC EMS grapples with myriad of challenges in order to respond swiftly to patients

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.’’

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.’’

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.

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