Emergency Care’s Cape Warriors

They call it the ‘Cape Doctor’, the cooling south easter that arrived off Cape Town this month driving out a heat sizzler peaking at 35 degrees. There had been public health implications – a nurse had collapsed from heat exhaustion in a township clinic – and in an office at Bellville suburb in the city, another and yet more influential Cape Doctor surveys his brief.

Dr Cleeve Robertson is Director of Emergency Medical Services in the Western Cape, front line arm of the Provincial Department of Health providing quality emergency care to six million people in South Africa’s Western Cape Province. Its responsibilities include ambulance provision, medical rescue, patient transport, and air and mountain rescue medical services. The important Western Cape international tourist industry is another key participation.

With two divisions, Emergency Medical Services and Healthnet – Health non-emergency transport – Metro Ems deals with more than 40 000 calls a month. Currently it has a fleet of 516 emergency vehicles (250 ambulances), an operational staff of 1400, and stations throughout the Western Cape, with dedicated crew, management and communications centers. At any time 150 to 160 ambulances are on the ground, over half in Cape Town, the rest deployed across five rural districts.

A new computer system being introduced this year will improve response times and other operational efficiencies. And as well as improving ambulance co-ordination and dispatch, it will impact on all aspects of Metro EMS information and communications technology including radios, messaging systems and vehicle tracking. The potential gains are high and Dr Robertson is optimistic.

“The scale of efficiencies we can achieve was demonstrated in Cape Town when we re-organised communications in advance of this new system. Our performance target for priority one – emergency cases – is 90% within 15 minutes. In the city of Cape Town in April 2010 it was 27% within 15 minutes and this is now up to 70% following re-organisation – but without yet putting the new system in.

“We expect another 10-15% performance improvement on top of that. And then we shall use the business intelligence that comes out of the system to better place and dispatch ambulances throughout the Province. Obviously we need further resources in terms of manpower and vehicles to bring response times up to 90% of target. Coupled with the communications system that we shall be putting in we will probably achieve that.”

“Medivate provide innovative communications solutions and electronic products. Projects with Metro EMS regarding road and emergency gear to generate electronic rescue information for patients. As well as LOOXCIE, a product that enables a realtime image to be uploaded to a smart phone.  They are creating the future as the development of their products will decrease the time taken for information on patients to be found and recorded which makes it easier to save lives.” – Dr. Cleeve Robertson.

But in the current economic climate revenue receipts by Government have fallen and with it Governments’ capacity to finance services. “Budgets in the next two years are likely to be very tight with a huge pressure on finance.”

The realities of the city-rural divide are fundamental in the delivery of health emergency services in the Western Cape Province. “The dispatch model in our rural areas is very different from that in the city, where it is largely demand-driven,” says Dr. Robertson. “Distances can be a real issue. In the rural areas, where some of our towns are 100-150 km apart, it’s about having an ambulance close enough to dispatch someone to the nearest emergency. A rural station might get three calls in a day but those calls can take an entire day with very long mission times.

“Then there are major arterial roads running from Johannesburg to Cape Town through almost a desert area. High volumes of trucking traffic and commuters come down and there are a lot of traffic accidents. This means we have to place response services strategically along a route and terrain that is far from hospitable.”

In Cape Town sixty per cent of emergency cases are medical emergencies. There is another, and to an outsider, possibly startling factor. “Cape Town in particular has a very high injury rate, probably amongst the highest in the world, and this is related to two principal factors,” says Dr Robertson  – “inter personal violence  – there are a lot of gun shot and stabbing injuries – and secondly a very high rate of motor traffic injuries at high speeds with very severe injuries. And then there is HIV Aids, a significant health burden in South Africa, lower in the Western Cape but here closely rated to tuberculosis. This places a particular burden on our health services.” 

Another issue is wine industry related “There’s a huge alcohol consumption among the local population, among farm workers in particular, and this contributes to the high level of inter personal violence and traffic injuries where almost 50% of road traffic injuries are pedestrians”.

“Three Spears manage equipment, uniform items and stretcher strapping. They produce a wide range of products for the police, military and ambulances keeping patients safe and secure during transfer. “ – Dr. Cleeve Robertson.

Yet this diversity of issues and care experience says Dr. Robertson, makes paramedics in South Africa an exciting career and a focus of international medical study.

“We get a lot of medical tourism from doctors and paramedics from all over the world who come here to study and learn.  But we have a problem. While remuneration structures are very favourable to doctors and nurses, for some reason they are much less so to paramedics.  As a result we are losing personnel to the private sector and overseas.

“At the same time we have a problem with education and training. Paramedic training takes a long time – a university programme is now four years.  And then having trained, we have great difficulty with retention. South African paramedics are in demand all over the world because of their experience and exposure to illness and injury – we are in fact exporting paramedics. In the last two years I’ve lost fifty advance class paramedics to the rest of the world and private industry, while in this Province we produce only half that number every year. To lose that kind of human resource is simply huge.”

Meantime the profile of Metro EMS continues to increase, both for the local population and international visitors. “It’s important that people fully understand what the demands are and what services they are likely to get. 

I think we provide very good services, a very positive service with excellent personnel – among them the highest proportion of Advanced Life Support (ALS) paramedics in South Africa – and we have very good equipment and systems.  When you come to the Western Cape you can be assured of good service levels.”

Article by Ben Walker

Tags: Ben Walker, Cape Town, Emergency Medical Services, February Issue, Metro EMS

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