South Africa's emergency medical services (EMS) finds itself in a globally unique situation as far as the opportunities are concerned to develop and deliver EMS services to its people living in the rural and sparsely populated areas of the Republic. South Africa has a uniquely developed EMS. It is difficult to pin point exactly when our various ambulance services reached the historical developmental point where they could be called EMS but I personally would like mark that point in time as 2 January 1988.
By this time, two important things had happened. First, in-service paramedic students had completed their nine month training course and we had ‘critical care assistants’ working in various services in South Africa. Second, the first graduate paramedics had completed their three years training programme and were all employed in various services. The employment, in the January of 1988, of these men and women represented the product of about ten years worth of work by many motivated and gifted people and millions of Rands of investments by the state.
Since then, EMS training systems in South Africa have continued to develop until this current point in time. Now there are four well-established universities offering the Bachelors Degree (BA) in health care Sciences: Emergency medical care, which has recently evolution out of the older Btech degree in Emergency medical care and rescue.
Additionally the traditional short paramedic courses are being replaced by a longer two year, emergency care technician programme focused on the staff in-service. The universities of technology and the more traditional universities are now offering Masters and PhD-level programmes in emergency medical care and emergency medicine which are open to post-graduate EMS staff.
So the infrastructure to supply the most vital component of any EMS service i.e. trained people, is for all meaningful purposes, well up and running. However, the current situation represents a dichotomy, as South African people living in and working remote areas suffer from a chronic lack of EMS services.
Many academic attempts have been made to try and understand this issue, all of which highlight a massive migration of paramedics to other African countries and more developed nations as a large part of the problem. Many theories have been promulgated as to why this may be happening. Complaints about salary and working conditions lead as the main course of job dissatisfaction.
Currently, rural response times are often measured in periods of more than twelve hours. Self-rescue and community or family self-help informal networks exist where formal EMS programmes should operate. Rural hospitals frequently wait for several days at a time for intensive care unit (ICU) level transportation better equipped facilities.
Concurrently over the last few years many local authorities and provincial government departments have been declared bankrupt and have been placed under administration by central government. This sad administrative scenario is often reflected on the ‘street’ level in various government departments including EMS i.e. service delivery is often poor. Typically the departments effected are in the remote areas. Central government programmes such as the National Aeromedical Tender and the previously mentioned EMS training programmes, greatly assist in EMS service delivery, however the author fears that until the general government administrative issues are dealt with, EMS service delivery will continue to suffer.
Our politicians and senior government officials need to pay careful attention to good government. When this occurs, issues around EMS service delivery and indeed all service delivery, in government departments should greatly improve.