College of Emergency Care- KwaZulu Natal

Emergency Operations :

Emergency Operations is the largest section of EMS where Medical emergencies are responded to and patients are treated in the pre-hospital field before being transported to hospital for further care through the utilisation of specialised vehicles, equipment and skilled paramedics.

KZN EMS provides a rescue service which includes rescuing people who are entrapped in a motor vehicle after an accident to falling down a cliff.  4×4 rescue vehicles have been converted to carry specialised equipment, including the “jaws of life” and emergency lighting which is required to perform medical rescues. The weight and bulk of this equipment is taken into consideration when converting these vehicles.

These vehicles are not designed to transport patients but have medical equipment on board and are staffed by medical personal that have a medical and rescue qualification.

Basic Life Support (BLS)

• These practitioners provide Basic Medical Care interventions to patients in Emergencies. This includes CPR, stopping of bleeding, helping women in labour and other non-invasive procedures. To be Basic Life Support you need Matric, Code 10 Drivers License and PrDp. To be qualified as a Basic Ambulance Attendant (a one month course) and be registered with the Health Professional Council of South Africa.
  Total number of BLS in KZN- EMS :1877

Intermediate Life Support (ILS)

• These practitioners provide Intermediate Medical Intervention including IV therapy (drips) Bronchodilators, Defibrillation (shock) chest decompression etc.
  To be an Intermediate Life Support you, need 1000 operational hours as BLS, pass the pre-course examination for entry into ILS course, then complete the four month training course and register as ILS at the HPCSA. Plus all other requirements as for BAA.
  Total of AEA’s in KZN- EMS: 887

Emergency care technician (ECT)

• Part of the selection criteria for KZN EMS staff to attend the ECT course the staff must be an AEA and pass several other entrance exams, including a test paper and fitness test.  There is then followed with two years for formal training. The scope of practice of an ECT is only slightly less that of the advanced life support paramedics. The vision for is that ECT’s replace the ILS as the mid-level worker in the EMS field.
  Total of ECT’s in KZN- EMS:1

Advanced Life Support Paramedic

• This category of staff are pre-hospital Advanced Skills providers. This includes: Advanced Airway Management, IV Drug Therapy upto schedule 7 drugs, Advanced midwifery , Advanced Resuscitation, Aviation Medicine, Marine Medicine.

South African advanced life support paramedics are in high demand throughout the world due to the nature of training and skills. Training can be done either by being an ILS (with a 1000 hours of experience) and then attending a one year training course to be a Critical care Assist or attend certain Universities of Technology who offer the  four year long Bachelor of health sciences.
Total of ALS in KZN- EMS:92The public can access these courses directly through the private colleges, however EMS training must be provided by colleges accredited by the HPCSA.(HPCSA Accredited Emergency Care Education and Training Providers)

Emergency Management Centres

Each district has an Emergency Management Centre where emergency calls are received, triaged (the calls are placed on order of medical priority, not first come, first serve) and then an ambulance is dispatched to the case.

The control rooms play a vital function as this is where the emergencies are coordinated.

KZN EMS can be contacted by dialling 10177

Advice to people when phoning any emergency number:

• Give full details of the reason for calling the emergency number (there has been a car accident etc.)
• Answer all the questions you are asked
• Do not exaggerate the extent of the emergency
• Do not hesitate to give a phone number that you can be contacted back on
• Provide clear and exact directions to where the emergency is

Patient Transport Services

This is a large component of EMS. Its main function is to transport patients, normally with chronic illnesses, who are not ill enough to require to be transported in an ambulance but who require transport for non-emergency referrals between Hospitals and from PHC Clinics to Community Health Centres and Hospitals.

These trips are planned and the patients attend prearranged appointments, after being referred to a particular clinic. The appointment letters are normally used to book places on the busses. The patients are seen as out patients at these hospitals and are transported back after their appointments.

Vehicles ranging from mini busses to large 60 seat buses are used to transport these clients. Some of the buses have had conversions done to allow for stretchers to be lifted into the bus by an hydraulic ramp. These buses are able to carry seated, wheelchair and stretcher patients.

There is basic medical equipment on board and there is medical staff other than the driver attending to and monitoring patients during the trips.

Air Ambulance

The air ambulance e are aircraft which have been specially configured to be able to transport patients. EMS operates two helicopters and a fixed wing aeroplane. The function of the air ambulances is to decrease response times, provide advanced life support and decrease the time taken to travel from the accident scene to hospital. The air ambulance travels faster than automobiles and can avoid traffic and other delays, they are staffed by advanced life support paramedics.

The helicopters have the advantage of not requiring a run way to land and are therefore often used in pre hospital emergencies where patients require rapid transport to hospital. The helicopter can land on the scene and the patient loaded in and the patient is then flown to hospital for further care.
The aeroplane, unlike to helicopter requires a run way to land and is normally used to transport patients over longer distances or in special circumstances.

Types of vehicles used by KZN EMS

Due to the different functions provided by KZN EMS there is are several different types of vehicles used. These include:

• Ambulances (each staffed with two paramedics), these vehicles are specifically designed and have been converted, so that a stretcher and medical equipment can be carried on board. Some of these vehicle are 4×4 vehicles. Some ambulance are solely used for the transportation of pregnant mothers and babies in an attempt to combat maternal and child mortality.
• Rapid response vehicles (normally staffed with one paramedic, but there is space for a second crew member), these are non-patient carrying vehicles but have a full set of medical equipment on board. Response vehicles are normally staffed with advanced life support paramedics and are used to respond rapidly to a scene and start treating a patient, while the ambulance comes. Due to the rural environment that KZN EMS operates in, mostly 4×4 vehicles are used.
• Rescue vehicles (staffed by one or two rescue medics) these vehicles do not carry patients but have basic medical equipment on board. These vehicles are specially designed and configured, to carry the heavy rescue equipment. The most well-known rescue equipment carried is the “jaws of life”, a collective term for several pieces of hydraulic rescue equipment. However this is not the only equipment carried on these vehicles, emergency lighting, rope rescue equipment and other pieces of rescue equipment are carried.
• Patient transport buses (staffed with a driver and patient attendant), these are standard busses ranging from 16-60 seats, used to transport patients to planned appointments. A new addition to the fleet of transport busses are busses that have had some of the rear seats removed and replaced with stretchers. A hydraulic lift at the back of the bus lifts the patients on stretchers into the bus.
• Helicopters, flight crew of a pilot and two paramedics) the two helicopters used have undergone a extensive conversion, to be able to carry one patient and medical equipment
• Aeroplane (staffed with one or two pilots and two paramedics), like the helicopters these aeroplanes have undergone extensive conversion so that two patients and medical equipment can be carried. Medical equipment used in the aircraft has to be specially certified.

College of Emergency Care

The KZN EMS collage of emergency care (COEC), provides in service training for KZN EMS staff. The training ranges from routine training updates to training for intermediate life support and emergency medical technicians. Courses in medical rescue are also conducted. There are two campus’s one in Durban and the other in Pietermaritzburg. District trainers are deployed to various bases in the province to do in service training for EMS staff in those areas.

For further information on EMS, please contact Robert McKenzie, media liaison for EMS on robert.mckenzie@kznhealth.gov.za