Priority One | Issue 4 | December 2018

QUARTERLY MAGAZINE

ISSUE 4 – DECEMBER 2018 | WWW.ER24.CO.ZA

MAKE IT YOURS

This is why bystander CPR can SAVE A LIFE

TRAUMA AND CHILDREN:

Treating at the scene of a collision FIND US ON

IN THIS ISSUE Front page stories 6

Trauma and children: Treating at the scene of a collision

Paramedics deal with collisions on a daily basis. Even more, collisions where children are involved.

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This is why bystander CPR can save a life

Company interest 5

ER24’s second NAAMTA accreditation

Clinical 24

Revolutionary procedure brings new freedom to amputees In a first for South Africa, a 28-year-old patient with a previous trans-femoral amputation has received a successful osseintegration prosthetic limp implant.

Awareness 14

ER24 Air Angels Breast Cancer Awareness Campaign While studying for her grade 11 exams, schoolgirl Jenna Skews absent-mindly played with a necklace she was wearing. This is when she first felt a worrying lump in her breast.

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What to do when someone has an asthma attack

ER24 staff 11

Dad’s front row bed at wedding

For the past six months, Frikkie Grobbelaar (62) has not been able to leave the house. He’s been confined to his bed as a result of a debilitating disease. But, on 6 October with a little help from the community, he was able to experience his son’s wedding.

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Passionate about stroke education Making real help faster and smarter

ER24 events 16

ER24 out and about

ER24 recently assisted with the transport of patients from Mediclinic Cape Gate back to Groote Schuur Hospital, following pro bono urology surgery. This forms part of a collaborative partnership between Mediclinic and different provincial departments of health.

CONTACT:

Email: communications@er24.co.za Tel: 086 1084124 Web: https://er24.co.za Emergencies: 084 124

DESIGN AND LAYOUT: Mediclinic Design Studio Ineke van Huyssteen

COPY COMPLETED BY: Ineke van Huysteen

STOCK IMAGES: iStock (Getty Images)

MAKING REAL HELP FASTER AND SMARTER This year, ER24 officially embarked on the implementation of a new roster scheduling tool for ambulances - a first for EMS internationally.

The objective of this project is to ensure that we deploy our resources at the best time and at the best place to ultimately operate faster and smarter. Grove, who has been appointed as the implementation partner for this project, specialises in innovative data analytics and technology. In 2017, they ran a pilot at three Western Cape branches which clearly showed that the optimised rosters increased the performance of branches whilst maintaining the same amount of staff and shifts.

Due to the success of this pilot, ER24 decided to roll this solution out to more of its regions and implement optimised rosters across 14 of our branches in the Western Cape, Gauteng, and KwaZulu-Natal over a two year period.

Although this project will bring about a new and improved way of working, it will not change our overall business operations.

Big strides have been made in 2018: the first versions of the revised rosters were implemented in Gauteng and Western Cape and it is now also being tested in KwaZulu-Natal. The Grove team, who are working alongside the ER24 Branch Managers, are focused on ensuring relevant feedback is incorporated to ‘fine tune’ the rosters even further. Here is some feedback from the branches so far: “After some initial challenges, we made roster adjustments including changing twelve-hour shifts to two nine-hour shifts.

Grove was able to show the best times for these shifts to run that have resulted in my branch achieving around 70 extra billable calls per month.” Grant Stewart (Branch Manager: Western Cape - North Metropole) “Grove’s first recommendations included moving our 12 hour daylight vehicle from 06:00 -18:00 to 09:00 -21:00 because their optimised rosters suggested there were more calls available in early evenings. We have been running this for the past couple of weeks and have generated at least 2 additional calls per shift, calls that we would otherwise not

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have been able to service.” Dewet Jooste (Branch Manager – Gauteng North) A big thank you and well done to all the teams involved so far!

The project team would like to take this opportunity to wish everyone a safe and happy festive season.

ER24’S SECOND NAAMTA ACCREDITATION

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R24 is proud to announce that we have been awarded National Accreditation Alliance of Medical Transport Applications (NAAMTA) accreditation for a second 3-year term.

More about NAAMTA: NAAMTA Accreditation is an important step in ensuring safe and transparent working relationships between suppliers and

customers as well as ensuring that international standards are met and complied with. We have an independent international accreditation that allows customers to feel confident in the service that they receive.

NAAMTA, an (ISO) 9001:2008 Quality Management System Certified company, is the accreditation standard bearer for the medical transport

industry, offering procedures that include guidelines for developing a quality management system focusing on transport safety, patient care, and continuous improvement. Since NAAMTA’s inception in 2009, great strides have been made in identifying best practices to improve the standard of performance among medical transport systems at the global level.

ER24’s Chief Executive Officer, Ben Johnson (middle), Amy Arndt Program Director NAAMTA (left), and Roylen Griffin, Executive Director NAAMTA (right).

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TRAUMA AND CHILDREN: TREATING AT THE SCENE OF A COLLISION Paramedics deal with collisions on a daily basis. Even more, collisions where children are involved. We take a look at the vulnerability of a child when it comes to collisions and ask ER24’s Vaal Branch Manager and ER24’s Trauma Coordinator if it’s more difficult to treat children than adults.

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The World Health Organization’s Global Status Report on Road Safety 2015 rated the African continent’s roads the world’s most dangerous.

After pedestrian injuries, passenger injuries are the most lethal. Children have specific anatomical and physiological limitations that render them more vulnerable to serious injury.

(Childsafe, 2017) In 2017, 1 300 children were killed on South African roads. This is according to research conducted by Childsafe under its UNICEF-backed Prevention of Road Injuries Impacting Children in South Africa (PRICSA) programme.

Yolande Baker, Executive Director of Childsafe South Africa, furthermore states in an article titled ‘Safer Streets for Children Campaign Launches to Save Kids’ Lives’ that their research shows most of the children injured or killed on South African roads are passengers or pedestrians. “They are injured or killed as a direct result of reckless or negligent driving by drivers who drive too fast, who drive drunk or take risky decisions on the road,” she said.

“Over weekends we typically see collisions involving families, and during the week we see taxi collisions involving school children,” says John Ramcharan, ER24 Vaal Branch Manager.

According to John, in about half of the incidents they respond to the children sustain either serious or fatal injuries.

As first responders to the scene, paramedics are fully equipped to handle traumatic situations, but it can be a particularly challenging task where children are amongst the injured.

“Most of the staff within the EMS are mothers or fathers themselves. When you see a little kid on the scene, you tend to think that this could have been my child. You are more emotionally involved, and while you provide treatment, you provide comfort too.

We’ve been on scenes where we’ve had to hold and comfort babies anything between 8 months to a year old. Your parenting instinct kicks in,” said John.

Trauma and ways to treat children A scene of a collision (or any type of incident) can be a terrifying and traumatic experience for anyone, but for a child even more so. Some patients might also compare the arrival of paramedics with a sense of relief, that help is at hand, but when the patient is a child, it can be a daunting and frightening experience.

John explains how he goes about treating children at a scene. “Most of the time when we get to a scene where children are involved they are usually scared or sad and ask for their parents.

Their parents might not always be nearby, and you have to ensure that you provide the comfort they might need at that moment. There is a specific way you go about treating a child. It does come with years of experience within the service. Your mannerisms are different when you work with a child. You have to be soft-spoken and also choose words that a child will understand. Make them feel comfortable in an otherwise stressful situation.

“It is crucial to talk to the child and to talk to them continuously. Tell them what you are busy with now, even if you are taking their blood pressure or checking for any injuries. This is the only way you can gain their trust and help them to remain calm so that you can treat them.

“I’ve always maintained that when you treat a child, you always go down to their level. Kneel and treat the child.

Look them in their eyes and introduce yourself before you even attempt to ask where they are hurting,” said John.

The communication part is essential to John.

“I find that repeating a question is important. A child might be thinking of a million different things at the same time and might not open up immediately.”

This doesn’t just speak to the immediacy of the treatment provided at the scene, but also the lasting effects the traumatic ordeal can potentially have on the child.

At Grobler, ER24 Trauma Coordinator, explains further: “The reality is the perception of the child. The perception of his/her experience is on their level. A child will most likely remember the gentle person on the scene who spoke to him/ her or asked if I was scared. Children are clever, they can read body language, and they can understand different tones of voices. Absolute honesty is required when speaking to children. If the child asks where his/her mother or father is, tell them she is being looked after in the ambulance, or he is still entrapped in the vehicle. If a scene is horrific, that is when you will keep a child away from it as that will be what they will remember for the rest of their lives. But, for the most part, be as honest as possible.”

Part of the training paramedics undergo is how to treat a child, but John explains that the classroom is very different than being on the road.

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“In a classroom environment, you are told how to treat a child. With exposure and experience on the road, you learn the art of treating a child and how to gain their trust in order to treat them,” said John.

Although the training equips paramedics on how to handle different situations or scenes, some of the scenes also necessitate for At to be there.

“I usually get called to the scene when the impact is of such a nature that someone’s way of life will likely change for the rest of their lives. For example, at a suicide scene.

Paramedics are equipped to heal someone or put them on a path of healing, but they are not equipped to offer therapy.

We come in when it is no longer bodily injuries that need to be treated, but rather injuries pertaining to the heart or the soul,” said At.

DAD’S FRONT ROW BED AT WEDDING For the past six months, Frikkie Grobbelaar (62) has not been able to leave the house. He’s been confined to his bed as a result of a debilitating disease. But, on 6 October with a little help from the community, Frikkie was able to experience his son’s wedding.

In September, Johann Prinsloo, ER24 Southern Cape Branch Manager, received a call from Frikkie’s wife, Maria, asking what the chances would be of hiring an ambulance for the day.

“I explained to her that, unfortunately, it is quite expensive but that I would try and make a plan. Only afterwards did she explain why she needed it and for who. So, I decided to pay the family a visit in Sedgefield,” said Johann.

At the start of 2018, Frikkie was diagnosed with motor neuron disease (MND), and within nine months his condition had deteriorated drastically. In the first few months Frikkie, to some extent, had mobility with the help of a wheelchair but he is now completely confined to a bed.

It’s been a difficult time for him and his family, and the good news of his youngest son’s engagement soon brought some much-needed happiness after a challenging year.

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“After meeting the family and realising the full extent of Frikkie’s illness, I knew I had to help the family some way or another. I told them that ER24 would sponsor the ambulance for the day and we would make sure that he is taken care of from the beginning to the end. Everyone started crying, and

he would be able to see his last son get married.

“We transported him from the house to the church, to the venue and back to the house again. We were at his side the whole day. It was an emotional daynot just for the guests but

Jaendré and Nicole pictured here with Jaendre’s parents and his two brothers.

it was just a very emotional moment for all especially for Jaendré who desperately wanted his dad to be at the wedding,” said Johann.

About five months ago, Jaendré quit his job in Cape Town and moved to Sedgefield to stay with his parents and to help around the house. He has always been very close with his dad and to see his dad deteriorate daily has been very tough. Not knowing how much time he has left with his dad also prompted him and his now wife to speed up the preparations for the wedding. Having his dad at one of the most significant events of his life was very important to him.

for us too. It was a privilege to be able to help,” said Andrew.

“My dad couldn’t stop smiling. At first, I was worried that our wedding might be a bit difficult for him as he wouldn’t be able to dance or sit, but I think everything worked out wonderfully. I think he genuinely appreciated being at the wedding and feeling safe knowing that ER24 was at his side.

“We are thankful to the service providers that helped us organise the wedding fairly quickly. Having my dad at my wedding truly made it the best day of my life, and I am ever thankful to ER24,” said Jaendré.

“Initially, we wanted to transport my dad to the wedding in a vehicle, but he wasn’t too keen about it. We started phoning around for an ambulance, but the quotations we received were completely out of our budget. We started feeling quite defeated. It meant so much to us as a family when Johann delivered the news that dad would be able to attend our wedding and that he would be cared for,” said Jaendré.

The day of the wedding The morning of the wedding, ER24 medics Andrew Botha and Darryl Syster, spring cleaned the ER24 ambulance and replaced the standard white sheets with a dark grey to fit with the colour scheme of Jaendré and Nicole’s wedding.

Frikkie was picked up from home dressed to perfection with a pink rose pinned to his pink shirt. Upon arriving at the church, Andrew and Darryl wheeled him to the front where

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Frikkie Grobbelaar being led to the ER24 ambulance.

WHAT TO DO IF SOMEONE HAS AN ASTHMA ATTACK ASTHMA ATTACKS COME ON SUDDENLY AND CAN BE CRIPPLING. THE PERSON SUFFERING REQUIRES IMMEDIATE ASSISTANCE.

WHAT TO DO 1. Stay calm. Someone with an asthma attack will look for reassurance. Panicking will make them feel more anxious, and aggravate their symptoms.

2. Move the person away from where you were. The trigger that led to the attack might be hidden or unnoticeable. Lead them to an area that is air-conditioned or well-ventilated.

3. Look for an inhaler. Only use an inhaler that belongs to the person affected, or you could risk exposing them to unknown reactions or allergies.

4. Call for help. If the inhaler fails to work, or is unavailable, do not wait until the person cannot speak or has fallen unconscious – call ER24 on 084 124.

INDICATORS OF AN ASTHMA ATTACK

Uncontrollable coughing

Difficulty speaking

Rapid breathing

Sudden feelings of anxiety or panic

Chest pressure

A pale, sweaty complexion

Retractions of the neck and chest muscles

Blue lips or fingernails

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Severe wheezing

ER24 AIR ANGELS BREAST CANCER AWARENESS CAMPAIGN While studying for her grade 11 exams, schoolgirl Jenna Skews absent-mindedly played with a necklace she was wearing. This is when she first felt a worrying lump in her breast. A swift diagnosis revealed she had breast cancer – and a life-saving mastectomy followed.

“Cancer changed the way I see the world, the way I look at myself, who I am,” Jenna admits today. “The disease doesn’t discriminate. It can come out of nowhere – for anyone. But there is hope..”

On the face of it, Jenna’s story is one of triumph. But there is a deeper message: Young girls should routinely check for breast cancer.

One in 28 women in South Africa will be affected by breast cancer in their lives, but according to the Breast Cancer Health Foundation, there is a 90% survival rate if it is detected early and the correct treatment is followed.

It’s vital that women of all ages – especially young women, who might not consider themselves at risk – know about early detection and the importance of breast selfexamination.

To spread this life-saving message of awareness, ER24 Air Angels branded all its helicopters bright pink. During the month of October, for Breast Cancer Awareness Month, these emergency helicopters had visited schools across

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Gauteng.

The campaign kicked off with a fundraiser luncheon at Casalinga in Muldersdrift on the 5th of October. The luncheon included guest speakers such as Professor Carol Ann Ben, South Africa’s leading breast surgeon and Lillian Dube, cancer survivor and actress. This novel initiative is a collaboration between ER24, Air Angels Air Ambulance Services (the CSI division of Flightshare – ER24’s aeronautical partner), the Breast Health Foundation, Novartis and Oneplan Health Insurance.

At each activation, anyone whose life has been touched by cancer were invited to sign their name or the name of their loved one on the pink helicopters, signifying their support of this important message of early detection.

“ER24 has a visible presence throughout South Africa, specifically in Gauteng where this campaign took place, and leveraging that visibility with pink – a colour that is now synonymous with breast cancer awareness – is the least we can do to spread the message. We are proud to partner with Air Angels on this campaign to raise as much awareness as possible,” says ER24’s Communications Manager, Werner Vermaak.

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ER24 OUT AND ABOUT ER24 recently assisted with the transport of patients from Mediclinic Cape Gate back to Groote Schuur Hospital, following pro bono urology surgery. This forms part of a collaborative partnership between Mediclinic and different provincial departments of health.

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Minctate qui doluptae vel eum con prae volende stiusam, to tem lautempor aciatem quatiorrum faci blaciet omolo.

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Last month, staff from Mosselbaai Fire Department and Mosselbaai SAPS participated in an Emergency Seasonal Readiness Workshop presented by ER24 Southern Cape Branch Manager Johann Prinsloo. The workshop spanned over three half days where participants received training in a few basic emergency protocols. The training also included AED training.

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FIND US ONLINE CONNECT WITH ER24

To find out more about ER24’s offerings online, including the latest news and products, you can find us on the following platforms:

facebook.com/er24ambulance

twitter.com/er24ems

instagram.com/er24ems

youtube.com/er24ems

soundcloud.com/er24ems

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Mariliza Loubser with ER24 medics (left to right): Michael Herholdt, Celia Botha and Waldo de Kock.

THIS IS WHY BYSTANDER CPR CAN SAVE A LIFE What started as a regular Sunday morning quickly turned into a day that could have changed a young family’s life forever. This is a true story of how bystander CPR and early activation of Emergency Services can save a life.

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n Sunday the 14th of October Melt Loubser was in the living room at the family home in George, while his wife Mariliza was busy in the kitchen. He heard her scream his name before she collapsed on the floor. At first, he thought that she had fainted because of low blood sugar as she had looked a little pale the morning, but when he felt no pulse, he realised this was something else.

“I immediately started with CPR. I asked my daughters to fetch my phone in the room, and then while keeping the phone on speaker on the floor, I phoned ER24. For me, it was unfortunate that our children saw everything. They were asking questions while I was busy with the CPR, so I tried to keep them busy by making them run little errands, like trying to see if our neighbour was at home,” said Melt.

A few minutes later Michael Herholdt and Celia Botha, ER24 medics from the George branch, arrived at the scene with ER24 medic Waldo de Kock following shortly afterwards.

“When I arrived Michael and Celia had already attached the Automated External Defibrillator (AED), and three shocks were delivered. I immediately initiated further advanced life support treatment. We defibrillated her five times before we got her pulse back,” said Waldo.

Dr Robyn Holgate, ER24’s Chief Medical Officer, explains why effective CPR is of utmost importance when a patient is in cardiac arrest.

“Cardiac arrest is synonymous with clinical death. Early CPR improves the flow of blood and oxygen to vital organs, an essential component of treating cardiac arrest. The earlier you give CPR to somebody in cardiac arrest, the higher their chance of survival. CPR should be started as soon as possible and interrupted as little as possible.

“The component of CPR which seems to make the greatest difference is chest compressions. Once chest compressions have commenced, place an AED on the patient’s chest if there is one available. This will help to analyse and identify a shockable rhythm. Early defibrillation (with an AED, or defibrillator as soon as the EMS arrives within the first few minutes of cardiac arrest) is the only effective treatment in the management of ventricular fibrillation.

“If defibrillation is delayed, the rhythm is likely to degenerate into asystole, for which outcomes are worse. The sequence of critical events most likely to improve survival includes early identification of the cardiac arrest and notification of emergency services (call 084 124), performing CPR with minimal interruptions to chest compressions, confirming the rhythm and early defibrillation if indicated, and advanced life support care. Learn CPR for the sake of your loved ones,” said Robyn.

… we reassured the children that we won’t stop helping their mother.

Waldo adds that her husband saved her life.

“Bystander CPR is a crucial component to give the person a good chance of survival. Not only does it supply the brain with much-needed oxygen, but it also gives time for the ambulance to arrive. We were on scene a few minutes after she collapsed, but without the initial bystander CPR it can sometimes be too late,” said Waldo.

This incident was particularly difficult on Waldo, Michael and Celia as the three of them are also in their late thirties like Mariliza.

“It was also quite difficult with the children there as they were crying and asking us to help their mother. The whole way through Celia kept talking to Mariliza, and we reassured the children that we won’t stop helping their mother,” said Waldo.

Mariliza was admitted to hospital later that day and was discharged on Thursday 18 October.

“There is no other way to describe what had happened than as a miracle. ER24’s team was amazing, and I am thankful for everything they did for my wife and our family,” said Melt.

How to perform hands-only CPR: 1. When you find someone unconscious and unresponsive, try and rouse them. Check whether they are breathing. If you cannot wake them and they are not breathing or gasping, emergency help must be called immediately. Lay the person on their back on a flat surface.

2. Call ER24 on 084 124. If possible, place the phone on speaker next to you. The emergency call taker will provide you with telephonic assistance. Remain calm and speak clearly.

3. Start compressions immediately if there are no signs of life. Push hard and fast at a rate of 100-120 compressions per minute. 5-6 cm deep for adults and 4 cm deep for children.

4. Continue to perform chest compressions until the person revives or when professional help arrives on scenes.

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PASSIONATE ABOUT STROKE EDUCATION On the 17th of November 2018 at an Angels Initiative Roadshow held in George, Johann Prinsloo, ER24 Southern Cape Branch Manager, was awarded the Angels Initiative 2018 Spirit of Excellence Award.

According to Carica Combrink, National Project Manager: Angels Initiative, the award was awarded to him for the following reasons: “Johann has successfully embarked on a journey to improve pre-hospital stroke services and create awareness with regard to stroke identification and care along the Garden Route. With great passion, he has assisted in establishing a hyper-acute stroke pathway between every hospital in the Southern Cape and played an essential role in ensuring optimal patient care at the respective facilities. Over the past year, he has dedicated an immense amount of time towards creating awareness about stroke, and the treatment options available for stroke patients at various nursing homes and hospitals along the Garden Route.”

“I started awareness sessions with my staff. With the help of stroke awareness champions, we’ve rolled out the awareness sessions to nurses, home-based care nurses, other emergency workers, fire departments, as well as to members of the public, through the local municipality. I have reached my goal of educating more than 500 people, and I will continue creating awareness,” said Johann.

“In our line of work, we do not expect to be recognised or rewarded as this is part of our calling. However, if recognition does come our way, it is great to know that you are acknowledged by your peers or other institutions, such as the Angels Initiative. I want to dedicate this award to everyone that was involved in the stroke pilot project and the team members of ER24 Southern Cape. I would also like to thank Dr Robyn Holgate who was and remains a great motivator in this ongoing process,” said Johann.

The Angels Initiative, which is funded by international pharmaceutical company, Boehringer Ingelheim, comprises an international steering committee of neurologists with stroke treatment expertise. In South Africa, where the initiative was formally launched late in 2016, there is a steering committee consisting of neurologists, neurosurgeons, radiologists, and emergency medical specialists. The objective of this initiative is three-fold: To optimise stroke pathways and treatment in eligible hospitals, to educate pre-hospital services on accurate and timely stroke treatment and to increase public awareness in an attempt to increase recognition of signs and symptoms.

The journey ER24 and Mediclinic rolled out the stroke pilot project to two hospitals in the Southern Cape area earlier this year (Mediclinic Plettenberg Bay and Mediclinic Klein Karoo).

Johann committed himself to this project, exceeding what was expected of him. In the process, hundreds of medical professionals and members of the public were reached.

“In our area, especially on the outskirts, there aren’t really stroke ready centres/ hospitals (no CT scan facilities). I think it is so important to create awareness around strokes,” said Johann.

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Johann Prinsloo (middle) receiving his award from Carica Combrink, National Project Manager: Angels Initiative (left) and Leeverne Engelbrecht, Angels Consultant (right).

FIRST AID STROKE WHEN YOU KNOW THE SIGNS OF A STROKE, THE LIFE YOU SAVE COULD BE YOUR OWN OR SOMEONE ELSE’S.

Sudden numbness or weakness of the face.

Sudden trouble seeing or blurred vision in one or both eyes.

Sudden numbness of the arm or leg, especially on one side of the body.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden confusion, trouble speaking or understanding

You should never wait to dial 084 124 if you experience even one of the signs above. Remember, you could be having a stroke even if you’re not experiencing all of the symptoms. And remember to check the time.

Remember FAST Learn to spot the signs of stroke, or spot a stroke F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call 084 124)

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REVOLUTIONARY PROCEDURE BRINGS NEW FREEDOM TO AMPUTEES Volupta doluptam, idel invellature, picipsa eptatiam.

In a first for South Africa, a 28-year-old patient with a previous trans-femoral amputation has received a successful osseointegration prosthetic limb implant.

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he advantages of osseointegration implant surgery were showcased by surgeons from the Division of Orthopaedics at Stellenbosch University and the Institute of Orthopaedics and Rheumatology – currently being set up at Mediclinic Stellenbosch.

The surgery was performed by Professor Nando Ferreira, an orthopaedic surgeon at Stellenbosch University, as the lead surgeon. He was assisted by Dr Gerhard Pienaar, an orthopaedic surgeon at Mediclinic Stellenbosch. They were joined by Dr Munjed Al Muderis, an orthopaedic surgeon from Sydney, Australia, who specialises in osseointegration implant surgery, who has pioneered the technique and the device itself. Professor Ferreira travelled to Sydney Australia in 2018 to learn the procedure from Professor Munjed al Muderis and is currently the only surgeon in South Africa who is certified to use the implant.

“This is a revolutionary Volupta doluptam, idel technology,” says Dr Muderis. “It changes the whole invellature, picipsa philosophy eptatiam. of how to treat and manage someone with an amputated limb. Before we would use a ‘bucket’ prosthesis that encases the residual limb. With this procedure, we can directly attach the prosthetic limb to the skeleton. This reorganises the muscles and nerves to operate the limb.”

The patient who was treated is a medical doctor, who had her leg removed at the knee after a car accident, and has been living with a prosthetic limb for 10 years.

Osseointegration uses a skeletally integrated titanium implant that is connected through an opening in the stump to an external prosthetic limb. The procedure was originally used in bone- and joint-replacement surgery and is suitable for both above- and below-the-knee amputees. This procedure addresses a number of limitations of the traditional prosthesis approach, says Dr Muderis. “The vast majority of amputee patients will at some stage have trouble fitting a bucket or socket prosthesis. They will struggle with skin issues, as the contact can cause friction, heat and chafing, and over time lead to blisters and infections, as well as mobility and fit. The human body changes as time goes by, and a bucket prosthesis that fitted perfectly in the morning will often not suffice by the afternoon or evening, as the residual limb swells in response to weather and pressure conditions.”

Dr Muderis says an osseointegration prosthetic limb implant can also help amputee patients regain their sense of confidence. “With a socket prosthesis, there is a lack of feedback from the ground. So when you walk, you walk as if you are on a hovermat. They do not feel the ground. So they will need to look at the floor all the time as they move, and are unable to walk in dark rooms. With this technology, they get 100% feedback from the ground.”

It also addresses a number of long-term issues. “In a traditional socket prosthesis,” says Dr Muderis, “both the femur and hip joint are not loaded naturally, which results in degeneration and atrophy of the bone and can lead to osteoporosis.”

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The osseointegration prosthetic limb is modelled on the anatomy of the human body. “This prosthetic implant takes the load back to the femur and the hip joint when walking.

This allows for direct contact to the ground, which provides greater stability and more control, and minimises energy exerted.”

This means patients who have lost a limb can get back to their daily lives like never before. “If you work in any kind of physical labour capacity, losing a leg can have a disastrous impact on your ability to earn a living,” says Dr Muderis.

“Climbing a ladder or driving a heavy truck, for example, becomes impossible when you are fitted with a socket prosthesis. If your prosthetic limb is attached directly to the bone, however, you have the mobility and confidence to perform as you usually would, and return to the workforce sooner rather than later.”

During the procedure, surgeons will refashion the muscles around the implant, says Dr Muderis, using a technique known as myodesis. They will then implant the device into the bone, which over time will allow the bone to grow into the implant. This has the effect of allowing the muscles around the bone to operate the limb.

Only 750 cases of this surgery have been performed globally in the past 10 years. This procedure is still seen as revolutionary and only performed on a relatively regular basis in Sydney, Australia. Other centres in England, the Netherlands and Sweden are performing these procedures, albeit in limited numbers.

“When you consider that the bucket prosthesis method has been used for 600 years, relatively unchanged, then yes, osseointegration is still in its infancy,” says Dr Muderis. “But in that short space of time it has completely transformed how we think and talk about amputee treatment.”

PRIORITY ONE BIDS YOU FAREWELL It is said that change is as good as a holiday. Don’t panic, we are not changing a lot or going on holiday, but we are changing our Priority One Magazine distribution.

Sadly, the December 2018 issue of Priority One magazine will be the last issue as we re-developed the way we provide awareness and feature content.

ER24’s Priority One magazine was first published as an internal hard copy magazine and distributed to staff and branches in 2012. Over the years the magazine grew, and a need was identified to make it available to our clients as well as members of the public. During the planning and development phase the then Priority One took a two-year break from its monthly distribution. In 2016 the brand-new Priority One was launched on ER24’s Issuu.com channel.

All is not lost. Features and content will now be on a standalone basis and released as it comes in. Some features will still be published on ER24’s Issuu channel while others will be released in the format of a poster, infographic or standalone layout. This will provide you with the opportunity to focus on what you are interested in and share comments, and ideas directly relating to the specific content; instead of scrolling through pages searching for content you are interested in. For those that still prefer a magazine type layout, our Issuu channel offers a free combination tool which enables you to select various pieces of content and add it into a single stack.

Over the last two years, the online publication received a lot of traction, and we have received numerous requests from people as well as publishing houses to provide editorials before the public publication date of the Priority One. They aimed to use the articles in current affairs and feature channels on news sites. Unfortunately, we missed quite a few opportunities as the magazine was only published once a quarter. The last few months we have re-evaluated the requests and constructed a strategy to bring information to you and news sites quicker.

I want to thank each and every one for their contribution to the Priority One magazine. Your content inspires us as multimedia editors, copywriters and journalists. Remember, your content is still welcome, and we will again feature amazing human interest stories across all of our social media channels.

Have a great festive season and most of all travel safely.

ISSUE 4 – DECEMBER 2018 | PRIORITY ONE |

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