Priority One Issue 1 | 2017

O

PRI Make it yours

RITY NE QUARTERLY MAGAZINE

ISSUE 1 - APRIL 2017 WWW.ER24.CO.ZA

Taking to the skies

The scrum of his life

Understanding Medical Insurance Products

O

PRI Make it yours

RITY NE

IN THIS ISSUE

Page

Front page stories

2

2

ER24 and OnePlan taking to the skies

17 Understanding Medical Insurance products 6 The scrum of his life

Company interest 3 5

Vodacom 112 operated by ER24

Page

Getting ready for major incidents

Clinical

10 Vaccine guidelines for international travel 7 Achieving clinical excellence 9 Important travel information

9

Seasonal

13 Are you prepared for the winter ailments?

15 Tourism Blue Flag Beach Stewards CONTACT:

Email: communications@er24.co.za Tel: 0861084124 Web: https://er24.co.za Emergencies: 084 124

DESIGN AND LAYOUT:

Werner Vermaak

COPY COMPILED BY: Caryn Ross Mediclinic Infohub

NEXT EDITION:

The next edition of Priority One will be published at the end of the second quarter of 2017.

STOCK IMAGES:

iStock (Getty Images) TriggerFinger Photography

NEXT CONTENT DEADLINE: Content for consideration may be sent to the ER24 Communications Department by any staff member or client. Send content to communications@er24.co.za

ER24 staff

23 Welcome to our family 19 Patients lives at risk 20 Armed robberies

Awareness

21 22 16 4

Human Rights fight against cancer Fighting the ‘midlife fat attack’ Emergency Help students maintain healthy eating habits

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ER24 and OnePlan

Cover Story

taking to the skies

Jonathan Killik, OnePlan Health Insurance Chairman (left) and Ben Johnson, ER24 Chief Executive Officer (right).

On 16 March 2017 ER24 and OnePlan Health Insurance took to the skies of Gauteng and surrounds to deliver a dedicated emergency medical helicopter service.

The emergency helicopter will be used when ground crew requires specialised equipment or expertise, or where vehicles cannot access the patient.

The service was officially launched at Casalinga in Muldersdrift, west of Johannesburg. Key industry role players and various stakeholders attended the launch.

ER24 will provide specialised emergency care to evacuate patients that meet the flight criteria. The services are operated by our partner Flight Share. This essential service will be based at Grand Central Airport in Midrand, Johannesburg.

‘South Africa has a critical shortage of medical helicopters, with only a few deployed nationally,’ says Ben Johnson, CEO of ER24.

‘Daily, there are numerous requests for air evacuations and we are proud to add to local capacity and deliver this vital service with the new OnePlan ER24 Helicopter.’

OnePlan Health Insurance provides affordable healthcare to many South African that cannot afford medical aid.

OnePlan and ER24 are two companies that make the lives of South Africans their number one priority and they have joined forces to provide

Priority One | Issue 1, April 2017

The ER24 OnePlan Medical Helicopter, a B105 operated by Base4 Aviation.

individuals with affordable accident cover.

logical extension, for the least expected situation.’

The Air Angels product is a supplement to the normal operations of the emergency medical helicopter. Air Angels is an insurance product created by OnePlan Health Insurance to ensure that South Africans are covered while commuting to their desired destinations.

Ford South Africa also sponsored five Kugas as rapid response and operational vehicles for the newly launched helicopter service in Gauteng.

Flightshare, in joint venture with Base 4 Aviation and ER24, will be rolling out additional aeromedical services over the next 18 months.

Jonathan Killik, Chairman of OnePlan Health Insurance says, ‘We provide South Africans with affordable health cover and this is a

“The fleet of rapid response vehicles is crucial to the operation of the helicopter emergency medical service, as the ground crew are responsible for ensuring rapid delivery of support staff and effective control of emergency landing zones at the scene of accidents and at risk-involved sporting events, providing the aircrews with efficient logistical management to operate safely,’ Killik added.

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Company interest

Vodacom 112 operated

by ER24

Vodacom and ER24 have partnered, bringing the latest 112 call centre online.

The new Vodacom 112 call centre, based in Paulshof, Johannesburg was launched on 1 March 2017. Various regions of the country were switched over to the newlybuilt call centre during the evening, with the remainder of the country being transferred over the following days.

ER24 is proud to confirm that 35 stations, with a number of highly-trained call centre agents, will now be handling the incoming calls to the Vodacom 112 centre.

The 112 Emergency Service is available to all Vodacom customers. By dialing 112 from a Vodacom cellphone in an emergency situation, the caller will be connected by the operator to the closest emergency service, including the police, traffic, ambulance service and fire department.

The ER24 operator will obtain all relevant information from the customer to determine their location, after which the customer will be connected to the most appropriate emergency service and the most appropriate course of action will be taken.

ER24 is providing value to Vodacom by granting greater access to the ER24 services and products as well as the world class Computer Aided 3|

Dispatch System. The call centre team brought across to ER24 will also have access to broader growth through ER24’s Training Academy and Mediclinic education in addition to increased staff development opportunities.

ER24, along with Vodacom 112, is ready to provide realhelprealfast to all Vodacom customers.

“The 112 Emergency Service

is available to all Vodacom customers. By dialing 112 from a Vodacom cellphone in an emergency situation, the caller will be connected by the operator to the closest emergency service, including the police, traffic, ambulance service and fire department.�

Priority One | Issue 1, April 2017

J9

The scrum of his life

Healthy Living

Help students maintain healthy eating habits Leaving your children to fend for themselves when they enter their student years can be worrying. Despite your best efforts to teach them healthy eating habits from a young age, there’s a chance they’ll leave these at home along with their signed matric blazer. Here are expert tips to help your student offspring maintain good eating habits.

Jeske Wellmann, a registered dietitian who consults at Mediclinic Sandton, offers the following good habits to instil while your teenager is still under your roof: • • •

Eat together as a family around a table.

Eat a variety of fresh foods and experiment with new healthy foods.

Focus on fresh lean foods

and avoid processed foods.

• Teach them to love their natural body shape and have a healthy relationship with food.

• Empower them to prepare their own meals.

• Teach them to stick to meal times and avoid frequent snacking.

• Explain that half their plate should consist of vegetables at lunch and supper.

When dropping your child off at a flat-share or residence for their first year of university, you can help them by filling up the freezer or taking them for their first grocery shop.

Jeske advises that they should always have the following in their kitchen: •

Priority One | Issue 1, April 2017

Lots of fresh vegetables

•

• •

• • • • •

• •

(and frozen vegetables for quick meals) Cocktail tomatoes and cucumbers – they last longer in the fridge than lettuce Fresh fruit such as berries, apples, bananas and papayas Dairy such as milk, plain yoghurt and cheese (unless they are sensitive to dairy products) Eggs and poultry Dense seed bread or rye bread Savoury crackers such as ProVita Oats for breakfast Nuts and seeds (or show them how to make a trail mix to keep on hand as a snack) Baby potatoes, sweet potatoes and brown rice Frozen meals that you

prepared in bulk, such as soups, muffin-pan quiches and stews Ready-prepared meals can be bought for times when they don’t have time to cook, but choose healthy options – for example, a ready-roasted chicken, then just add baby potatoes and a salad.

Make sure your child has enough lunchboxes available to take leftovers to class the next day. You could suggest that they work out a roster system at the commune so everybody takes a turn to prepare a home-cooked meal, instead of resorting to cheap and unhealthy takeaways.

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Company interest

Getting ready for

MAJOR INCIDENTS During the preparations for the Soccer World Cup 2010, the National Department of Health decided to implement the UK developed Major Incident Medical Management and Support course for both EMS and hospitals across the country in order to get these institutions geared up to deal with potential major incidents in a structured and standardised way. A significant amount of training took place however following the World Cup the momentum waned.

ER24 has been at the forefront of major incident response and the success of our interventions has largely been ascribed to the experienced staff we have within our service, many of whom have come from the government EMS or Fire Services and therefor familiar with incident command structures. We recognise however that a training programme to up-skill all staff within our service in Major Incident Management will be required. As the MIMMS course has already been accepted as a standard by the Government EMS structures as well as being endorsed by the Emergency Medicine Society of South Africa (EMSSA), it was decided to roll out the one day MIMMS course. The challenge has however been to identify sufficient instructors to make this a success.

Fortunately Colonel (retired) Theo Ligthelm as MIMMS 5|

Course Director in South Africa volunteered to get the momentum going again and revive the MIMMS training programme.

In February 2017, two advanced MIMMS and HMIMMS courses were hosted within ER24 and Mediclinic, one in Johannesburg and one in Bloemfontein. Another advanced MIMMS and HMIMMS course is scheduled for May 2017 Cape Town. The aim of these courses is to develop a core group of instructors who can roll out the one day provider MIMMS and HMIMMS courses to all operational staff within ER24 as well as the Mediclinic hospitals.

In addition some of the participants in the advanced course were selected as Instructor Candidates to also run the advanced course.

These candidates need to undergo an instructor course and be monitored on two courses prior to becoming fully fledged instructors within the MIMMS faculty.

The 3 day MIMMS and 2 day HMIMMS courses are structured similar to other clinical short courses like ACLS and PALS to be practically oriented, with participants expected to study the course material prior to attending the course. Much of the course is focused on practical table top exercises and workshops including a practical exercise without

Dr Vernon Wessels

“ER24 has been at the forefront of major incident response and the success of our interventions has largely been ascribed to the experienced staff we have within our service”

MIMMS Tabletop Exercise

Forensic Pathology mass corpse unit

casualties (PEWC) held on the last day of the 3 day MIMMS course.

Various mnemonics are utilised to remember key principles, like CSCATT (Command, Safety, Communications, Assessment, Triage, Treatment, Transport) which focuses on the essential components of a successful major incident response.

Course participants had “robust” discussions on

triaging, bending their heads around concepts like Triage Sieve and Triage Sort.

ER24 will be implementing the one day MIMMS course early in the new financial year and based on the enthusiasm displayed on the multi day course, this course should be very well received within our service and ensure that our staff have the skills to manage major incidents with confidence.

Priority One | Issue 1, April 2017

J9

Company interest

The scrum of his life

A light in the dark

Joost van der Westhuizen (Photo: J9 Foundation)

Joost van der Westhuizen’s performance in the number 9 jersey was legendary, but his battle against motor neuron disease made him a true hero.

Here’s the story behind the condition.

Joost has been described as one of the best scrumhalfs of all time. He was a key member of the World Cupwinning Springbok team in 1995, making some legendary tackles against the virtually unstoppable All Black Jonah Lomu in the final. But just five years after retiring from international rugby in November 2003, he started noticing a weakness in his right arm, which he put down to an old rugby injury. Joost described his journey to being diagnosed with motor neuron disease (MND) on his J9 Foundation website: ‘It was a sunny afternoon in Johannesburg in March 2011. I was in the pool with a doctor friend of mine, playing games with my son.

‘Dr Henry Kelbrick noticed that my right arm was lagging slightly and he asked me if I had experienced weakness in my arm. He also noticed that my speech was slurred

and decided to send me to a neurologist for tests.’ Joost’s diagnosis was a devastating blow, but his winning spirit and optimistic outlook saw him outlive the original prognosis of two to five years – until he gave up the fight on 6 February 2017.

What causes MND? ‘There is a suggestion that professional sportsmen and women have a slightly increased risk of developing the disease, but this is not yet clearly established,’ says Dr Izak Burger, a neurologist at Mediclinic Panorama.

‘Significant research is taking place – especially regarding the causes, pathogenesis and genetics that underlie this disease – in the hope that this will one day lead to an effective treatment.

No imminent breakthroughs are on the horizon, though,’ he adds. Despite ongoing research, no one can say for sure what causes MND. It is, however, suggested that it could be the result of an environmental toxin, trauma, a latent virus, or even a defect that causes premature degeneration of the nerves.

Priority One | Issue 1, April 2017

After he was diagnosed with MND, Joost launched the J9 Foundation, which aims to raise awareness, provide support and improve the quality of life for those affected by the condition. The foundation also helped initiate MND research in South Africa, where none had existed

There are also some forms of the disease which appear to be hereditary, but these are rare.

What are the symptoms?

In the early stages of the disease, MND generally only affects one side of the body. ‘The early symptoms are painless,’ says Dr Burger.

‘MND presents as a slowly progressive weakness of a limb, sometimes it starts with swallowing and speech problems. ‘While MND is easy to diagnose, its unfavourable prognosis means that most neurologists would consult with their colleagues before making a final diagnosis,’ adds Dr Burger. ‘There is no curative treatment and the management is focused on support both physically and psychologically with focus on nutrition, maintenance of function and respiratory health.’

As there isn’t a single diagnostic test for MND. A neurologist would have

before. Similarly, The South African Motor Neuron Disease Association is dedicated to providing a voice for and offer support to MND patients and their loved ones.

Visit www.joost.co.za and www.mnda.org.za for more information.

to conduct a series of assessments to rule out other conditions that present with similar symptoms. Who is at risk? MND affects men and women more or less equally.

The incidence and prevalence is very much the same throughout the world, with an incidence of 1-3 afflicted in every 100 000 people. ‘The disease can start as early as in a patient’s 20s, but the most common onset is after age 60 – after the age of 85 it becomes very rare,’ says Dr Burger. Dr Burger adds that the mean time from onset of MND to death is three years.

But patients with certain subtypes can sometimes live for more than 10 years.

What is MND? MND or amyotrophic lateral sclerosis (ALS) is when the nerves (or motor neurons) that send messages to the muscles progressively weaken. This is known as neurodegeneration.

Words - Nicci Botha

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Clinical

Achieving

clinical excellence

by Dr Robyn Holgate, Chief Medical Officer: ER24

At ER24, clinical excellence is non-negotiable. Some say this is a luxury in the pre-hospital emergency environment, we say it is a necessity despite other challenges such as security and safety, weather and shift work in our dynamic, uncontrolled environment.

We continue to put the patient and clinical care at the heart of our business and we are blessed to have an incredible team of specialist operational staff sharing our values.

Despite growing financial pressures, clinical quality remains our key focus.

Here is a look at what we are doing to ensure clinical excellence beyond that of our competitors, some of the clinical quality initiatives we have taken to ensure we are upholding our promise of clinical excellence despite the financial pressures and the additional cost of a clinical governance programme.

Patient safety Patient safety forms the basis of any clinical quality performance review. At ER24, we have a confidential reporting system for adverse events and the emphasis during our reviews has shifted from a traditional model of blame to that of a just culture. The very nature of 3|7|

our emergency business leads itself to adverse events, the human factor ever present.

Examples of recent adverse events include attacks on our paramedics and vehicle accidents. Although we receive less than 1% of call volume as adverse events, less than international trends, we take every reported incident seriously, the ultimate goal being to conclude our investigation and implement change to avoid a recurrence of such events.

One such example is the instillation of in-vehicle panic devices and the rollout of Emergency Medical Support in Hostile Environments (EMSHE) training for our staff following the recent attacks on our crews. We have developed several retrospective indicators and trigger tools to further support our passion for patient safety.

These indicators are reported monthly. We are one of the first emergency medical service companies to report on pre-hospital trigger tools.

Examples include death during transport, same person response within 24 hours and intubation failure.

Clinical cost efficiency Clinical cost efficiency is critical to sustain our business however, we must provide the

best possible care in order to keep our exceptional clinical reputation.

Clinical indicators such as response times (average 12 minutes primary response time in urban areas), intubation (70% first pass intubation success) and intravenous insertion success (99% inserted in less than three attempts), are proudly equivocal to the best in the world. We have researched and acknowledge that mechanical ventilation is the gold standard for all our intubated and ventilated patients.

Hence, we have invested in the best equipment to empower our team to do their best clinically. Our Critical Care Retrieval teams utilise the Hamilton T1ÂŽ ventilator.

We were the first emergency medical service company in the world to receive delivery of the upgraded model in 2014. Our standard adult transport ventilator is the DraegerÂŽOxylog 3000 plus and we have another 15 transport ventilators for our B Tech paramedics.

Electrocardiogram (ECG) monitoring is equally a critical skill and we are proud to have standardised on the Phillips MRX monitor since 2010. We not only monitor our patients, but can evaluate

chest pain by providing our Advanced Life Support (ALS) crews with 12 lead telemetry.

We can diagnose and transmit an ECG to a cardiologist and ensure they are ready for the patient in the Cath Lab if need be. This is what should be expected from a world class emergency medical service company.

Taking cost efficiency and value seriously Intensive Care Unit (ICU) and ventilated patient transports only account for 6% of our total advanced life support call volume at ER24. These patients require expensive equipment during transport.

They also require highly specialised ICU trained paramedic staff to care for them and special vehicle modifications to further avoid the risks of moving such a critical patient in a smaller everyday ambulance.

These services come at a cost, hence the decision to rationalise this resource and create speciality ICU Critical Care Retrieval transport vehicles for our critical patients. The South African infant mortality rate is 10 times that of Europe.

Locally, a lack of neonatal care services in non-urban areas necessitates transfer to tertiary centres. In our Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Clinical

service, neonatal transfers are undertaken by a Critical Care Retrieval Services (CCRS) team consisting of an emergency care practitioner (degree paramedic) with further training in neonatal intensive care, and an intermediate ambulance technician as assistant and driver. Review of the past 11 month’s data showed we transported 225 patients, around half being speciality neonatal calls. Our smallest baby transported during this time period weighed just 620g. 22% of these babies were on neonatal continuous positive airway pressure ventilation, half initiated by our dedicated retrieval team. We reintubated 6% of

our babies due to blocked or inappropriately sized tubes.

We managed to successfully begin weaning from high percentages of oxygen (which is toxic in premature neonates) in 6% of our babies transported during the time period reviewed.

So where to next for achieving clinical excellence at ER24?

Our goal is always to achieve and then maintain or exceed our standards. We have international accreditation via the National Accreditation Alliance of Medical Transport Applications (NAAMTA), an achievement we are proud of and will take significant effort to maintain. We have installed

Priority One | Issue 1, 2, April June 2016 2017

state of the art software in our Contact Centre to ensure a faster, more accurate dispatch to any emergency with additional clinical resources to ensure our staff understand your emergency.

The foundation for reviewing quality clinical performance has been achieved at ER24.

Our next step is to automate our reports, research and present our findings internationally. The business model of the future successful emergency medical service will be different to what it is today. Ambulance transport for our basic life support patients (approximately 50% of call volume) will require development of a cost effective solution and

home-based intervention for our medical scheme partners.

The new clinical practice guidelines now out for industry comment are exciting and an enthusiastic attempt to further professionalise emergency medical services.

It is so exciting to be part of a dynamic, changing profession. We will keep you updated of the clinical changes in the industry as they are made available and continue to put our patients first at ER24 by delivering the best possible clinical care no matter what your emergency. •

With special thanks to Dr Ronnie van der Merwe for his clinical leadership and guidance. | 84

Clinical

Important

Travel Information

Before you travel, consider and assess the risks one may encounter. Whilst away, be responsible, aware and take logical precautions in order to make your trip a pleasure and not a disaster.

Travel, whether international or local, is not without risks.

The principle causes are due to travellers moving outside their comfort zones – exploring regions with unfamiliar and different environmental conditions.

This often leads to a change in risk behaviour or may involve failure to take necessary action to respond to these factors, sometimes resulting in injury or disease whilst abroad or on return.

An easy way to remember the types of risks is the rule of “Six I’s” which you may find valuable: Insects Often travel to unfamiliar surrounding involves exposure to insects that can cause or carry disease.

Mosquitos transmit Malaria, Zika, Dengue and Chikungunya fever. Ticks carry a host of spotted and 3|9|

haemorrhagic fevers as well as encephalitis. Flies transmit disease via food but can also bite and on occasion, lay eggs under the skin! Certain bugs bite and others cause toxic or allergic reactions.

Ingestions Food and water are essential, but are a source of water borne diseases often via the faecal-oral route. Unsanitary conditions and poor hygiene practices predispose to travellers’ diarrhoea, Hepatitis A, Typhoid fever, Cholera.

Numerous developing countries harbour so called “superbugs” with limited antibiotic sensitivity. Drink alcohol in moderation.

Alcohol dulls the senses and disinhibits, leading to risky acts.

Injuries Injuries abroad frequently occur when travellers throw caution to the wind whilst

engaging in adventure sports or unusual activities. A typical example is when an inexperienced biker/ scooter rider explores unfamiliar roads without crash helmets.

18-24% of deaths among travellers to foreign countries are caused by injury. Avoid animals that bite or carry disease.

Irresponsibility Travellers engage in a variety of risky behaviours whilst travelling, which include adventure activities, decreased seat belt use, illegal drug use and sexual indiscretion. More often than not these activities would never even be considered within the safety of the home environment. Think twice before doing something that can change your life forever!

Immersion Drowning cases feature far too often whilst abroad.

Swimming in unfamiliar waters, associated alcohol use and adventure activities are the main contributors.

Children left unattended are sadly part of this group. It is estimated that over 300,000 people die from drowning every year. Also, assess the cleanliness and state of the water before taking a dip.

Numerous creatures, germs and parasites lurk within.

Insurance The cost of medical services abroad, especially hospitalisation can run into millions of Rands. Don’t assume that your travel insurance that is included in your credit card payment will be sufficient for your travel needs. Analyse your family’s needs critically and purchase top up insurance as deemed necessary.

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Vaccine guidelines for international travel General advice: Seek travel health advice from your local Travel Clinic at least four weeks prior to your departure.

There are recommended guidelines depending on where you are travelling to and from. The following vaccinations are advised in accordance with clinically accepted guidelines: Yellow fever vaccine mandatory for: • Countries with risk of Yellow fever transmission. ( Mosquito borne – Aedes aegypti) • Countries requiring yellow fever vaccination.

• Pilgrims to the Kingdom of Saudi Arabia. (Hajj and Umrah) Meningococcal disease, spread via person to person transmission. Vaccine is strongly recommended for: • High density populations or regions with endemic prevalence.

• Countries in the meningitis “belt” - West, Central and East Africa • Pilgrims to the Kingdom of Saudi Arabia. (Hajj and Umrah) • Students in hostel / university accommodation Typhoid and Hepatitis A, spread through contaminated water and food, or person to person via the faecal-oral route where personal hygiene and sanitation is poor. Vaccine strongly recommended for:

High risk areas such as South East Asia, but also Asia major, Africa and South America • Adventure travel or prolonged visits to endemic areas.

Tetanus, spread through contamination of cuts, scratches, burns and wounds. Vaccine should be recommended to: • Adventure travel and also persons who have not had a booster in last ten years.

• Often combined with Diphtheria, Pertussis and Polio (four in one) for any lower socioeconomic environments.

Hepatitis B is transmitted by blood and human secretion contact. Vaccine is recommended for nonimmune persons: • At risk for blood borne and sexually transmitted transmission.

• High risk geographical areas - Africa, Central and South Asia.

Rabies is a deadly disease which is spread via the saliva of an infected wild or domestic animal, is introduced by a bite, scratch, or lick of broken skin or mucous membrane. A course of three vaccines can be considered for: • Hikers, campers and adventurers to rural and remote areas.

• Veterinary workers or animal care workers / volunteers.

Clinical

•

Priority One | Issue 1, 2, April June 2016 2017

Cholera is generally transmitted by water contaminated with human faeces. Vaccine only advised for: • Relief workers to disaster areas (war / flooding / tsunami, earthquake) • Displaced communities / refugees Childhood Vaccine / boosters for non–immune persons are always recommended when travelling abroad: • Mumps, Measles, Rubella

• •

Varicella DTP and Polio

References Yellow Fever Countries: http://www.who.int/ith/ ITH_country_list.pdf Meningitis “Belt”: https:// www.cdc.gov/travel-static/ yellowbook/2016/map_311.pdf Country specific advice: www.fitfortravel.nhs.uk/ | 410

Seasonal

Are you prepared for the winter ailments?

Are you prepared for winter ailments?

It’s autumn, time to unpack winter woolies and blankets, and think about the flu vaccine. Time to start thinking about preparing for colds and flu.

Influenza is a contagious respiratory illness. Influenza can cause mild to severe illness. It can also make chronic health problems worse or lead to pneumonia for example which in turn could lead to death.

According to the National Institute for Communicable Diseases, flu kills between 6000 – 11 000 South Africans every year, and hospitalises many more. These deaths are most commonly amongst: • the elderly and individuals infected with HIV • children younger than 5 being hospitalised with severe flu symptoms • people suffering from diabetes, lung and heart disease and pregnant women During the flu season in South African about 14% of patients hospitalised for pneumonia and 25% of patients with flu-like illness (fever and cough) will test positive for flu. Vaccinating higher risk people can protect them from flu. People are urged to have the influenza vaccine as soon as the 2017 vaccine becomes available at a pharmacy or healthcare centre.

Doctor Robyn Holgate, from ER24, urges people to get vaccinated. The best time to get vaccinated is before the season starts, as it may take up to two weeks to develop 3 13 | |

sufficient protection for the winter months.

There are people who say they have in the past been vaccinated but still had influenza and therefore choose not to get vaccinated again. The flu vaccine does not cover you against all flu strains, it only covers you against those included in the vaccine. The reason why people develop influenza even though they had the vaccine is because they may be infected with one of the strains not included in the current vaccine.

Should I have the vaccine if I am pregnant? A recent trial conducted in South Africa proved the safety of the influenza vaccine for pregnant women. Pregnant women, irrespective of the stage of pregnancy, should get vaccinated.

Other high risk groups that should have the vaccine include: • High risk adults and children who are receiving regular medical care for conditions like chronic pulmonary and cardiac disease, chronic renal diseases, diabetes and similar metabolic disorders. People who are immunosuppressed (including HIV infected people) and those who are morbidly obese (BMI≥40 kg/m2). Adults and children who come into contact with those who are high-risk should also have the vaccine • People over the age of 65.

• Children between the ages of six months and

Symptoms of influenza include: • • •

Fever Headaches Cough

five years.

Healthcare workers must also have the vaccination • Healthcare workers, by the very nature of their work, may be more exposed to viruses than other members of the public. It is vital they ensure their own health by staying healthy, washing their hands and using appropriate barrier protection. The influenza vaccine is one way of ensuring they stay at work during the winter months.

It is important to note that influenza is different from a cold. The key difference between colds and influenza is the very high temperatures one gets with the associated symptoms of Influenza.

People usually develop influenza suddenly.

•

• • •

Runny or blocked nose Body aches Tiredness

A reminder that not all patients with colds and flu require an ambulance for transport, or hospital evaluation of their symptoms.

Call your health care practitioner or medical information service for advice on what over the counter or home care remedies are available. The most effective way to prevent the spread of influenza or a cold is to ensure meticulous hand washing practices, and of course, if you have influenza rather stay at home, ensure adequate hydration and keep warm.

ER24’s Emergency Contact Centre can be reached 24 hours a day on 084 124 for any medical emergency.

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Seasonal

Tourism Blue Flag Beach enhance beach-goers’ experience Stewardsover the summer season The recent summer season marked the start of an exciting 2.5 year coastal tourism and youth development initiative.

The Tourism Blue Flag project saw the deployment of more than 200 beach stewards at Blue Flag sites around the country, with the aim of improving the experience of both local visitors and domestic and international tourists at our beaches.

This project is an exciting partnership between the National Department of Tourism and WESSA (the Wildlife and Environment Society of South Africa), who manage the international Blue Flag Programme in South Africa. The project has already added value to fifty of our beaches along the South African coastline over the past four months through the active, onsite presence of the beach stewards who are being hosted by local coastal municipalities. Their role includes supporting beach managers with maintaining the high standards of

3 15 | |

the Blue Flag eco-label relating to environmental management, water quality and environmental education at their beaches. The stewards also provide assistance to lifeguards by improving water safety at the beach.

Some of the other activities they have been rolling out at participating Blue Flag beaches over the summer have included interactive environmental education activities for kids, monitoring of beach activities and data collection. They have taken to social media too, providing useful updates on weather and general beach conditions for beach goers via Twitter.

As part of their formal project induction, the Beach Stewards received special training from ER24 representatives on emergency services provided by the network, and guidance around the correct protocols to follow should an emergency situation arise. Knowing they have professional help at hand has given the Beach

Stewards great peace of mind.

Furthermore, they have been able to share their knowledge about the emergency service with beachgoers, which has really benefited the Tourism Blue Flag project.

As the 2016/17 summer beach season draws to a close along much of our coastline, the beach stewards will be taking time out from their duties to participate in WESSA’s accredited environmental education training

programme, with the aim of developing them for further employment in the coastal tourism sector on completion of the project.

The Tourism Blue Flag beach stewards can be easily spotted on the beaches in their ‘surf blue’, branded golf shirts. To see where you can find them along our coastline visit www. wessa.org.za/what-we-do/ ecotourism/tourism-blue-flag/

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Emergency

Dr Brian Gutuza, head of the emergency centre at Mediclinic Cape Town, shares some tips on how to handle an emergency and, most importantly, how to teach your children what an emergency is and when to call for help.

If there’s been an emergency at home, how do I call an ambulance?

• Call ER24 on 084 124 immediately. The contact response team will identify the emergency and alert the correct emergency service, i.e. the fire brigade, ambulance, traffic department, etc.

• Stay calm and give them as much information as you can. You’ll need to provide the location of the accident – the street name and number, plus any possible landmarks.

They’ll also need your name and telephone number, so they can call back if the line gets disrupted.

• Be prepared to describe the victims’ injuries and details of what happened – are there any hazardous materials on the scene, is the patient unconscious, etc.

• Don’t put the phone down; the emergency call taker will hang up first.

Here are some common reasons for calling an ambulance: • If someone has been injured in a road accident (for example, a car occupant, pedestrian, cyclist).

•

•

• • • •

•

•

Serious injuries at home that affect the brain, spin, chest and abdomen, as well as leg injuries that prevent the victim from getting up – for example, falling out of a tree or down the stairs.

Severe breathing problems and chest pain that doesn’t go away after five minutes.

Any severe pain that doesn’t go away after taking painkillers.

Persistent vomiting or diarrhea that makes the person weak and sleepy.

Sudden loss of ability to use one or both legs.

Accidental or deliberate overdose of medication, or suspected poisoning with chemicals.

Severe burns involving the face, or any part of the body where the burn area is larger than the area of your face.

If someone has been exposed to excessive amounts of smoke in a fire and is now coughing or short of breath that may be very serious and they should get to a hospital immediately.

Drowning (if someone has been rescued from the water and needed to be revived or is coughing severely).

How do I teach my children how to call for help?

How to call for help Teach your children the number for ER24 – 084 124 – they should be able to recite it like their home number.

Put this number next to your landline, save it onto your

Priority One | Issue 1, April 2017

E M E R EMERGENCY E N C Y cellphone or stick it onto the fridge; any place where they can easily find it.

When to call for help Children must never phone the emergency services as a joke. Here are a few good questions to ask them: • Should you call if a fire starts in the house? Yes. • What do you do if someone gets very sick, can’t speak or isn’t able to breathe? Call 084 124.

• What do you do if someone falls over or faints? Call 084 124.

• Should you call if someone falls off the

roof? Yes.?

Your child also needs to understand what isn’t an emergency. For example: • You’ve skinned your knee or have a splinter in your finger.

• You’ve lost your cat.

• A friend dares you to call.

Practise makes perfect Practise with your children so know how to react in an emergency. And keep asking them when they should call 084 124 until they’re confident enough to phone for help when you can’t. | 16

Products

Understanding Medical Insurance Products

A growing number of people are turning to medical insurance products for medical emergency cover.

This may be a result of cost considerations where medical insurance products are more 317 | |

cost effective than a medical scheme and younger people feel that they are healthy and only require cover in the case of an accident.

Whatever the reason, it is essential that those taking out

medical insurance product read their policy document very carefully as there are strict limitations on the type and value of benefits offered under the medical insurance products.

Medical Health Insurance usually covers the cost of an insured individual’s medical and surgical expenses within the guidelines of the policy benefits. Health Insurers have different terms and conditions Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Products e.g. certain insurers only provide cover for trauma related cases whilst other insurers provide cover for medical and trauma related cases. It is also important to note that all medical insurance products have limits as to the maximum coverage allowed under the policy.

Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed by the insurer or the insurer makes payments directly to the provider.

Certain hospitals do not accept medical insurance products and the insured needs to pay and claim back from the insurer.

Process for ER24 contracted Insurance Client In the event of an emergency ER24 should be contacted on 084 124 and an ambulance will be dispatched. Once the ambulance crew arrives at the scene, the patient will be stabilised and transported to the closest appropriate facility. Please note that ambulances are for medical emergencies only and should it be determined that a patient’s reason for calling an ambulance was not an emergency, they may be held liable for the account. In some

situations, patients that are critically ill or injured may be transferred directly to a State Facility as the limits on their policies are often too low to cover the extensive costs associated with a critically ill or injured patient in a private hospital. Please note that ER24 cannot be held responsible should a receiving facility not be prepared to accept an ER24 / insurer’s Guarantee of Payment (GOP). On arrival at the facility, the receiving facility is responsible for contacting ER24 for authorisation. No authorisation or GOP will be issued without consultation and acceptance by the receiving facility.

The ER24 Case Manager will ensure that the patient is a valid policy holder and determine whether the patient has benefits on their policy. If the member’s policy is valid and includes the necessary benefits, either ER24 or the insurer will issue a Guarantee of Payment.

Sometimes a hospital will not accept a GOP from either ER24 or an insurer. If this is the case, the member will be liable to cover the costs and claim back from their insurer or alternatively be moved to a State Facility. No authorisation or GOP will be

provided retrospectively by ER24 in order to cover any medical expenses incurred.

Should the hospital / member not contact ER24 prior to treatment being rendered, the member will remain liable for the costs and will be required to claim such costs back from the insurer if the claim is within the policy benefits.

Should the member require admission for their illness or injury, a separate GOP will be issued for the hospital admission inclusive of all ancillary costs in accordance with the policy benefits. The hospital will be responsible for providing ER24 with a cost estimate for admission and all ancillary costs. ER24 and / or the insurer will not be responsible for any costs that exceed the policy benefit limits or the amount reflected on the GOP. The hospital should provide daily clinical updates and interim consolidated accounts to ensure that the benefit limits are not exceeded. All procedures, CT scan / MRI scans and ICU admissions are to be authorised to ensure that sufficient funds are available.

Should a patient have been seen by a General Practitioner and require admission to hospital, the patient must be referred

directly to the specialist who will manage the patient’s hospital admission. No ER24 authorisation / GOP will be issued for Emergency Departments where the patient has been seen by a General Practitioner. No authorisation /GOP will be issued by ER24 where the member has been referred for a specialist consultation only. * ER24 Authorisations / GOPs will only be issued for hospital admissions on the day of first consultation / injury. No authorisation will be issued for elective or follow up hospital admissions, specialist out-patient visits, x-rays or any other ancillary medical services. * *Certain insurers may cover these costs as per the terms and conditions of their policy.

Medical Health Insurance vs. Medical aid • Health Insurance is risk cover for unforeseen events according to cover limits • Health Insurance falls under the Short-term Insurance Act • Health Insurance are not obliged to cover PMBs (Prescribed Minimum Benefits) • Health Insurance covers specific health events at a fixed amount which is defined per policy schedule

Priority One | Issue 1, April 2017

• Medical Aid schemes cover medical conditions according to scheme rules and managed health care protocols • Medical Aid schemes fall under the Medical Schemes Act and is regulated by the Council for Medical Schemes • Medical Aid schemes must by law cover at least PMBs (Prescribed Minimum Benefits) in full • Medical Aid schemes may have specified annual and benefit limits | 18

Staff

Patients lives By attacking EMS crews, not only are their lives in danger, but also the lives of those who are in need of medical attention.

Vandalising or stealing emergency vehicles means fewer vehicles are available in case of an emergency in the area.

This ultimately increases the risk to patients.

“There are instances, such as during protests for example,

at risk

where EMS personnel are either instructed not to enter a hostile area until it is cleared by authorities or are escorted by authorities to gain access to patients.

“There are also cases where the patient has to be brought out to EMS personnel.

“With this said, we also have processes in place to determine which crews, based on their experience and training, will go into these

areas should the need arise,” said Peter van der Spuy, General Manager of Quality Assurance and Support Services at ER24. By keeping quiet about crimes committed against EMS staff, it will eventually affect you and your loved ones. “Community members and leaders as well as other role players have a vital role to play in protecting the very same people who are there to take care of them.

“Criminals are putting your lives in danger and comprising your health. We urge the public to report criminals to the police,” said Van der Spuy. In addition, people are urged not to purchase any medical equipment or medical stock sold at second-hand shops or from medical companies, pharmacies or people who are not registered to provide such services.

We are here to provide medical assistance to those in need. Report those who commit crimes against EMS personnel to the authorities.

319| |

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Armed Robberies

Staff

During the last few years we have seen an unfortunate increase in the amount of armed robberies taking place within South Africa.

During the last few years we have seen an unfortunate increase in the amount of armed robberies taking place within South Africa.

As an ER24 trauma team we experienced that the most of the trauma counselling we are providing to patients is as a results of armed robbery.

However in the last few months we the shocking trend amongst our own paramedics

is that they are being involved in armed robberies while assisting patients. ER24 would like to assure our paramedics that we are here to support them through this experience.

TIPS IF YOU ARE INVOLVED IN AN ARMED ROBBERY: Our trauma team would like to share a few tips should you

Priority One | Issue 1, April 2017

find yourself in this situation: • Do not try to fight or resist the perpetrators as this may result in injury • Co-operate with the attacker request in a calm manner as this usually reduces the stress levels and does not provoke a violent reaction. By consenting to the demands you are ensuring that any loved

•

•

ones involved in the situation are being kept safe.

Material goods can be replaced and are not worth risking your life for Call ER24 immediately after the situation on 084 124 to receive any medical or counselling support required | 20

Awareness

Human Rights fight against cancer

by Dr Langenhoven, Panorama Oncology Centre

The rights assigned to every person on the planet is important in the battle against cancer

or well-being. Further, human dignity is protected as both a right and an underlying value of the Constitution.”

When thinking of human rights, it’s hard to connect them with cancer. How can the basic rights of every person on this planet impact on the fight against the spread of this disease? The answer lies in the Universal Declaration of Human Rights, and in the South African Constitution.

Dr Langenhoven, one of Cancercare’s oncologists at the Panorama Oncology Centre in Cape Town adds; “I do believe that the South African government is coming to the party, but I also believe there is a need to constantly raise awareness about the disparities and human rights issues that impact on cancer care and prevention in this country.”

In the Universal Declaration of Human Rights there are three issues which are of utmost relevance when it comes to the prevention of cancer: health and well-being, food and education. These rights are included in the South African Constitution, one of the most progressive in the world.

“When considering cancer prevention, we can look at how the Constitution provides for the right of access to healthcare, sufficient food and water as well as social security,” explains Cherese Thakur, an Associate at Cox Yeats Attorneys who has a special interest in Constitutional Law and Human Rights. “It also provides that everyone has a right to basic education and the right to an environment which is not harmful to health 3 21 | |

A closer look at the right of access to sufficient food and water is the first step in showing how human rights play a role in preventing cancer. Many people in the lower income groups cannot afford to buy healthy foods, often forced to use their meager funds to purchase items that have high sugar contents or low nutritional value. Unfortunately, a healthy diet and plenty of water go a long way towards preventing obesity and reducing the risk of cancer.

“Our Constitution requires that government do what it can to make it possible for people to access food and, where they cannot provide for themselves, put policies and programmes in place to provide for them,”

says Thakur. “Foods that promote health and are noncarcinogenic shouldn’t just be available to the wealthy.

The state has an obligation, as far as its means allow, to ensure that healthy foods are affordable so everyone has access to nutritious meals.”

Walking hand-in-hand with a healthy diet is a healthy lifestyle when it comes to keeping cancer at bay. The more educated a person is, the more likely they are to eat the right foods, engage in physical activity, avoid obesity and pay attention to any of the warning signs of cancer. Education plays a significant role in cancer prevention, from state programmes outwards, and government has a responsibility to provide people with information about the risk of cancer. In providing basic education, lessons should be included about the signs and symptoms of cancer, along with insight into the diet and lifestyle changes people need to make to prevent it.

“Smoking, obesity, alcohol – these are three of the biggest modifiable factors when it comes to preventing cancer and disease,” says Dr Langenhoven. “Also, early detection and access to care – both of these are fundamental human rights that can save so

many lives. In South Africa, accessing a doctor at a day care hospital can take weeks – patients can’t just turn up and say they feel a lump, they have to wait months. And time means life when it comes to cancer.”

However, it is worth noting that the government only has limited resources so while these human rights are enshrined in the Constitution, the government isn’t obliged to provide them outright, but rather to have policies in place that can progressively realise them. It is also a space into which private bodies and members of industry must step in to fulfill the duties the Constitution places on them.

“Private bodies, corporations and members of industry are obliged by the Constitution to not conduct activities harmful to the public’s health, which includes a responsibility to not release potential carcinogens into the atmosphere,” concludes Thakur. “Finally, it is worth remembering that each right comes with a responsibility.

Each person should actively seek out educational materials about cancer prevention and do what they can to commit to healthy behaviours that can help prevent cancer.”

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

Fighting the

Awareness

‘midlife fat attack’

One of the main health concerns for those over 40 (midlife) is that hormonal changes will cause weight gain. A Mediclinic gynaecologist and obstetrician explains that while hormonal changes can indirectly cause weight gain, it’s not as simple as that.

‘Midlife obesity tends to be more prevalent in women than in men,’ says Dr Tobie de Villiers, a gynaecologist and obstetrician practising from Mediclinic Panorama. ‘While studies show that weight gain and age are unrelated, menopause does play a role in the body’s compositional changes. But this time in a woman’s life is more complex than weight-gain alone.

‘While obesity is indeed a major health concern, it is not directly related to menopause,’ Dr De Villiers explains. ‘At the same time, hormonal deficiencies such as low oestrogen levels don’t contribute to actual weight gain. Rather, it is the increased accumulation of fat in the abdominal and hip areas that roughly coincides with the time of menopause,

owing to lifestyle choices in response to an altered mood.’

And hormonal changes are known to have a direct effect on a person’s mood.

Midlife hormones and mood The onset of menopause sees a reduction in oestrogen, as well as other sex hormones like progesterone and testosterone. The time in a woman’s life immediately prior to menopause tends to coincide with a marked spike in fat mass and body fat percentages in general.

Known as perimenopause, it is the redistribution of fat during this time that causes wider waistlines, the cumulative effects lingering into the postmenopausal phase.

‘Yes,’ says Dr De Villiers.

Various antidepressant medications have a waterretaining and bloating effect. Contrary to popular belief, however, menopausal hormone therapy (MHT) does not cause weight gain. Evidence suggests that MHT therapy actually protects against excess body fat production and leads to a slimmer waistline. Added benefits include reduced insulin sensitivity and a lowered risk of diabetes.

Get active and eat right So with all of this in mind, what sort of preventative measures can assist in

beating the dreaded ‘midlife flab’?

‘Get active,’ says Dr De Villiers. ‘Daily low-level exercise goes a long way in safeguarding against obesity. Some form of resistance training also preserves lean muscle mass.

‘A nutritious diet complements a basic exercise programme. Avoid processed foods, caffeine and sugar. Timing of meals is important, so as not to interfere with the body’s natural rhythm. Making good lifestyle decisions is key in combating obesity at any stage of life.’

‘Essentially, perimenopause opens the door for depression,’ says Dr De Villiers. ‘Comfort eating and sugar cravings are the hallmarks of low self-esteem and anxiety – two symptoms prevalent in any hormonal change,’ he explains.

Does medication play a role?

Priority One | Issue 1, April 2017

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ER24 staff

Welcome to

our family

Bodene Barnes Corporate Sales Consultant

Naadira Abdul Rahman Assistant Accountant

Sudha John Contact Centre Coordinator

Gugu Mngomezulu Case Manager

Andre Bronkhorst Branch Manager: Potchefstroom

Nontombi Vilakazi Team Leader: Vodacom 112

Dewet Jooste Promotion: Branch Manager Johannesburg North

Pasquel Domburg Marketing Coordinator

Welcome to all our new employees in operations and branches across the country.

We are glad to have you part of our family.

A special welcome to the Vodacom 112 team that transferred to our ER24 family from 1 March 2017.

Photo not available: Johanna Smangele Sewela Team Leader: Vodacom 112 Annine Dormehl Multimedia Producer

3 23 | |

Shameema Adams Marketing Manager

Priority PriorityOne One||Issue Issue1, 2,April June 2016 2017

ER24 staff

CORPORATE ACCESS ER24’S CORPORATE ACCESS SERVICE OFFERS CORPORATES AN INTERGRATED MEDICAL EMERGENCY SERVICE.

ER24 is the solution if you need compliance on any of the questions below: • Do you know what number to call in the event of a medical emergency?

• Have you done your first aid training this year?

• Are you executing mock drills as per legislation?

While all ER24’s solutions can be tailored to suit the unique requirements of clients, the standard solution includes: • Emergency response and stabilisation • Medical transportation

• • • • • •

Emergency medical information Medical hotline Trauma counselling First aid training First aid kits Implementation training

ER24 is committed to offering tailored services that effectively serve the needs of clients and makes a positive contribution to the health and safety environment at corporates companies.

For more information, please email corporate.sales@er24.co.za

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With ER24’s Corporate Access service you can rest assured that you have the right partner on board for all medical emergencies.

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