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Move for health Paramedics under attack Orphaned rhino thrives
RITY NE QUARTERLY MAGAZINE
ISSUE 1 - MARCH 2016 WWW.ER24.CO.ZA
Patient safety Introducing CCRS Meet Dr Moodley
Every drop counts ER24 changes lives across South Africa
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CONTENTS
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Front page stories
5 Introducing CCRS 6 Dr Moodley joins Fixed Wing Services Move for health 9 13 Paramedics under attack 19 Patient safety 21 Catching up with Thor 23 Every drop counts ER24 staff
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AEA Selection 13 Willem Rossouw takes the reigns
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Trauma Support changing lives in Khayelitsha
Health and awareness
10 Shake off excess salt 11 Zika virus - What you need to know 12 Lassa fever - Are we at risk? 15 Take bullying seriously 17 How to treat a scar
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Clinical
18 Critical Care Retrieval Services
Community involvement
25 Discovering your passion Events
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Dusi 2016
Company interest
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27 28 ER24 Global jets off to PDAC 2016 ER24 to attend ICEM
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ER24 staff
Ten students recently completed the Ambulance Emergency Assistant (AEA) course. The graduation ceremony was held at the ER24 Head Office on 3 February. Karl Prinsloo was handed the Best Student certificate and Abel Selekoe was handed the Most Improved Student certificate. Speaking at the graduation ceremony, Training Officer, Nicole de Montille, said, “These 10 individuals made big sacrifices and commitments and achieved the final goal. It was trying times. Students missed time with their families. But in the end, it was worth it. We are proud of you.� ER24 commends all the graduates and wishes them well.
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AEA Selection 13 Priority One | Issue 1, March 2016
ER24 staff
Ntombekhaya Kelemana
Rees Webber It was a good course. It was interesting and we learnt a lot. The simulation exercise, where a “patient� is treated and transported to hospital, was stressful but a good learning experience. The Emergency Medical Services in Hostile Environments (EMSHE) part of the course was the most challenging. It was tough but we worked as a team and got through it. I am looking forward to going back on the road to treat patients.
The course was good and challenging. I learnt a lot. It was a good experience. EMSHE was challenging but I enjoyed it. The simulation was also challenging but it was a great learning experience. It felt like we were attending to a real incident. Being away from home was challenging but I made it.
Jason Thomas Abel Selekoe The course was nice but challenging at the same time. It was mentally and physically draining. Mid-term and final examinations were challenging but we pulled through. The simulation was stressful and EMSHE was a good experience. Our teamwork was tested. Graduating feels great but I will miss everyone.
Daneel Scheepers The course took a lot of tears and sweat but it was fun. EMSHE was physically and emotionally challenging. The simulation was nice. It gave us an idea as what to expect. It felt good graduating. The course made a big difference in my life. It made me grow as a person.
Priority One | Issue 1, March 2016
The course was stressful and a lot of hard work but enjoyable. The most challenging part was the examinations. The simulation exercise gave us an idea of what to expect on the road. EMSHE either makes or breaks a team. For Selection 13, it strengthened us as a team. The AEA course taught me to become a better and stronger person in my field of work.
Dean Anderson The course was tough, stressful and enjoyable. I enjoyed EMSHE. The challenging part was being away from home and having to deal with everything without the support structure I usually have. The course has made a huge impact on my life. It has given me a different perspective on EMS in general.
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ER24 staff
Introducing the team
CCRS Critical Care Retrieval Services (CCRS), a division of ER24, is a specialised and dedicated unit that was established to limit risk to intensive care patients being transported between hospitals. The teams, based in Cape Town and Johannesburg, consist of Advanced Life Support (ALS) paramedics with advanced critical care training and international certification. These paramedics, who also had extensive ICU nursing
training, are certified with the Board for Critical Care Transport Paramedic Certification (BCCTPC), an American-based standardsetting body that tests paramedics across the world to ensure they are of exceptional standard. A paramedic who holds this certification is recognised as part of an exclusive group of paramedics with superior knowledge in transport medicine and critical care. The CCRS ambulances were designed and built to ensure
safety, efficient workflow and access to the patient. Both the Cape Town and Johannesburg vehicles are equipped with state of the art life support equipment. When transporting a patient, the CCRS ALS is accompanied by an Intermediate Life Support (ILS) medic who is trained in the technical aspects of critical care transport medicine and specialises in the management of the wide range of technical equipment used to treat and monitor these patients.
ER24’s Critical Care Retrieval Services team. Back: Ilze Milbert, Marthine de Kock and Louis Jordaan. Front: Stefan van Tonder, Maxine Dickson-Hall and Maryna Venter. Insert: Willem Stassen. 5|
Priority One | Issue 1, March 2016
ER24 staff
DR MOODLEY joins Fixed Wing Services ER24 recently welcomed Doctor Kumeshan Moodley to the company’s Fixed Wing Services. Dr Moodley, working for ER24 Global as a flight doctor on primary calls for international callouts and repatriation, obtained his MbCHB degree at the University of KwaZulu-Natal. Dr Moodley rotated his time through the various specialities during his internship at the RK Khan Hospital. Although he had a special interest in obstetrics, orthopaedics and general surgery, he enjoyed working in the field of emergency medicine and casualty as well. The erratic hours and severity of cases in an emergency centre did not deter him.
Dr Moodley also completed Basic Life Support, Advanced Cardiac Life Support, Paediatric Advanced Life Support and Advanced Trauma Life Support
the family GP and chat about being a doctor. I have always wanted to become a doctor and I am appreciative that God has blessed me with the opportunity to be what I have
“I have always wanted to become a doctor and I am appreciative that God has blessed me with the opportunity to be what I have always wanted to be.” courses, and focused on his resuscitation skills. When asked why he chose to become a doctor, Dr Moodley said, “I decided to become a doctor because it is all I ever knew. “As a child, I used to sit with
Priority One | Issue 1, March 2016
always wanted to be,” he said. Dr Moodley said he is committed to providing quality medical care. “I feel I achieve something everyday when I make a difference in someone’s life. From
treating an elderly person’s back pain to reversing a myocardial infarction… if I help someone, I feel that I have accomplished something great,” he said. When asked why he chose ER24 and what he has planned for the future, he said, “Why ER24? Why not? I was fascinated by this job following discussions last year with Dr Robyn Holgate, the Chief Medical Officer for ER24. I love medicine and travelling. This job combines both aspects. And it is emergency medicine in a fully equipped setup. I am committed to working with and growing the ER24 Global division while building a Global network and Global brand.” |6
ER24 staff
Willemtakes the reigns Rossouw Some of the Newscastle team members.
With tenacity and the necessary know-how, Willem Rossouw is fast becoming a trailblazer in Newcastle. The 35-year-old was appointed as ER24’s Branch Operations Manager in the region recently; breathing new life into the local emergency We put Rossouw on the spot, and asked him eight personal questions. Here’s what he had to say: What word describes you best? Dynamic. How do you spend your free time? I don’t have a lot of free time. I like mountain biking, and going to the gym. I also enjoy woodwork and playing golf.
service field. Rossouw is a trained firefighter, who worked previously as an Intermediate Life Support (ILS) paramedic. “I was 15 years old when I first volunteered at the fire department. I was permanently employed fresh me how to work, not how to make money. He always said it doesn’t matter what you do, as long as you do it well. I think I’m living up to his standards.
out of high school. After 21 years in the industry, there’s nothing I haven’t seen,” he said. A quintessential day in the life of an operations manager includes; the basic management of staff, abiding by stringent labour laws and ensuring all the clinical aspects of emergency care are in place. “I still go out to collisions and big scenes, but it’s not my primary job,” he explained. With offices is both Ladysmith and Newcastle, Rossouw certainly has his work cut out for him. He has remained loyal to ER24 for the past six years, and firmly believes he was promoted because he is good at what he does. “The highlight of my day is saving a life. I think the highlights will change somewhat now,” he said. Since taking over from Johann McDermott, Rossouw has had
the opportunity to interact with his staff while out on calls. “From what I have seen, my guys are very professional. They’re good at what they do,” he added. Sticking to his personal policy of living with no regrets, Rossouw said he was satisfied with his job every minute of every day. While the expansion of the ER24 brand is inevitable, Rossouw hopes to facilitate further growth, and acquire more ambulances to provide more a cutting-edge service. “I plan to get more involved and show the public that we are here for them,” he said. His streamlined approach will entail hosting marketing days, helping out at sporting events, as well as providing assistance to schools and charities. “ER24’s number one priority is safety. I’m looking forward to serving the community,” Rossouw concluded.
Willem Rossouw, ER24 Newcastle Branch Manager. Photograph and story credit: newcastleadvertiser.co.za
How do you want to be remembered? I want to be remembered as someone who was passionate about what they did. What’s your most unappealing personality trait? My wife, Chantelle, would say my Obsessive Compulsive Disorder (OCD).
What’s your greatest fear? My greatest fear is being called out to a scene where my Is there a word or phrase you family has been involved. have been known to overuse? I like to say cool bananas. Who do you admire most in life, and why? What’s the best advice you’ve My father. He set a good ever been given? example for me. I always tell My fire chief lived by the rule: people my dad only did one “Proper preparation prevents thing wrong in life - he taught poor performance.” 7|
Priority One | Issue 1, March 2016
ER24 staff
Trauma Support Changing lives in Khayelitsha by At Grobler Children in desperate need of counselling continue to receive the help they need at a local school in Khayelitsha. Madoda Mahlutshana, the principal of the Chris Hani Arts and Culture School, approached ER24 for help in June 2015. Mahlutshana, committed to helping children, desperately wanted to increase the chances of progress among the youth at the school. As the principal of a non-paying school, Mahlutshana faced numerous challenges including a poor social environment aggravated by various cultural differences. When he approached ER24, the school had an enrolment of 1 336 learners and 54 teaching staff members. Nearly all the children come from a disadvantaged background. It is important to highlight the immediate environment of the school. This is the place that learners call “home”. This is where they spend majority of their spare time. Khayelitsha, with a population of 391 749 people (as per the 2011 census), is located along the N2, in Cape Town, covering an area of 43.51 square kilometres. Khayelitsha has a young population with fewer than seven percent of its residents being over 50 years old and over 40 percent being under 19 years of age. Khayelitsha is one of the poorest areas of Cape Town with a median average income of R20 000 a year per family. Roughly over half of the 118 000 homes are informal dwellings. Chris Hani Arts and Culture School enrols learners who
are predominantly from Khayelitsha, offering them a chance to rise above their circumstances. Pregnancy, abortion and drug abuse are among the challenges faced by the youth. Hampering Mahlutshana’s efforts to assist troubled children were limited social work and psychologist resources. ER24 committed to support and assist the children. With the backing of Mediclinic, a programme was initiated. A room at the school was converted, painted and equipped by Mediclinic to serve as a trauma room.The trauma room was fully functional on the 1st of October last year. As the trauma counsellor appointed, I realised the need for committed help was a priority. A number of children who are exposed to unthinkable trauma visit the trauma room every Thursday. Young girls have reported cases of rape and sexual assault. Some of the girls are allegedly abused by their own fathers and family members and accused of consent and/or overreaction. Drugs and gangs are another disturbing influence with the youth in the area. Popular in the area is marijuana and methamphetamine. My objective is to identify and where possible, intervene or refer to other services in difficult situations such as abuse. Child abuse is more than bruises and broken bones. Child abuse or child maltreatment is any act, or failure to act, by a parent or other caregiver that results in actual or potential harm to a child. It includes all forms of neglect, physical, sexual or psychological abuse, and can occur in a child’s home, school or community they interact with. While physical abuse might be the most visible, other types of abuse, such as emotional abuse and neglect, also leave lasting
Priority One | Issue 1, March 2016
scars. The earlier abused children get help, the greater chance they have to heal and break the cycle. The trauma room has had success. Among the good endings is that of a child who came back to the school post matric with amazing feedback. I wish to share the story as it was told by the principal at a meeting: A learner was raped during the last week of September 2015. She was injured and emotionally scarred and had to be medically supported. She enrolled on an HIV programme to prevent possible infection. She was referred to the counsellor.
Necessary support and counselling was offered. The learner wrote her final exams and passed matric. She returned to school to express her gratitude towards those who supported her. She had sufficient support to “rise above her situation”. If we have made a difference to one soul, our life is worth living! Since October 2015 to date, I have listened to so many stories of hurt. Numerous questions were asked. I have often asked myself similar questions. One often feels the need to say to the environment “this is unfair” and yet, the lesson for all is to stay focused.
Meet the team
People experience trauma as a result of a number of things including crime, death, illness, disability and retrenchment. These events affect an individual either immediately or in the future as post traumatic stress disorder. When this happens, the affected individual needs assistance be it from family, friends, colleagues or professionals. ER24 established a Trauma Support Team in December 2010 to help people in their greatest time of need. Over the past five years, the team has grown and developed into an experienced, caring, professional and steadfast team of full-time and
dedicated ad hoc counsellors. The team is led by Dr Robyn Holgate, our Chief Medical Officer. Henning Jacobs is the team’s co-ordinator and counsellor for Gauteng. Alan Neilson is the counsellor for KwaZulu-Natal and Adriaan (At) Grobler is the counsellor for the Cape. These counsellors, offering trauma debriefing and counselling, visit the individual in need of assistance within 72 hours of a traumatic incident. One of the key differentiators is that our team will visit you at your home, a coffee shop nearby or any other suitable venue. For example, we may conduct sessions for our own staff at their base of operations.
Henning Jacobs (Trauma Support Co-ordinator Gauteng)
Alan Nielson (KwaZulu Natal and Inland)
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ER24 staff
Behrmann encourages healthy living
World Move for Health Day, May 10, encourages people to take responsibility for their wellbeing. People are encouraged to participate in physical activities and eat healthy to reduce the risk of health-related issues. While some find it easy to stay fit, others struggle. Saul Behrmann, ER24 Joburg North Branch Manager who keeps fit by living an active lifestyle, said the key to being healthy is to have fun while doing so and not to rush the process. Behrmann, who loves living an active lifestyle, does at least 45 to 60 minutes of cardio per day and trains at least five days a week. He has been participating in the Jeep Warrior “Elite Black Ops” obstacle races for more than two years. Behrmann has completed a number of races thus far. “I love the fact that the race is outdoors in nature. 9|
It involves trail running combined with extreme obstacles. The race tests both physical and mental strength and the will to push through and complete the race,” he
“The saying ‘slow and steady wins the race’ is definitely a suitable saying when it comes to dieting.”
said. Behrmann generally finishes in the top 17 out of 100 participants in his category. His advice to people is get someone to join in their healthy choices. “This makes the healthy lifestyle easier and enjoyable. By not doing
any form of exercise, you put your general health at risk. If people live unhealthy lifestyles it could lead to severe illness and possibly result in death. Illnesses include diabetes, hypertension, congestive cardiac failure and chronic obstructive pulmonary disease. It usually starts with gaining some extra kilogrammes and then the unhealthy lifestyle compacts on previously acquired illnesses and diseases. This unhealthy lifestyle makes it a lot more difficult for the body to get better and healthy easily,” he said. Behrmann said he treats patients on a daily basis who could have changed their medical outcomes by adjusting their lifestyles and eating habits. “A lifestyle adjustment could potentially change deadly illnesses into controllable situations,” he said.
Diet Behrmann said there is a misconception that sudden dieting and excluding certain things will make a person healthy. “The saying ‘slow and steady wins the race’ is definitely a suitable saying when it comes to dieting. “The key is to eat healthy and gradually cut out the unhealthy foods. You should not hate that you have to eat healthy. Everything in moderation is what I always say,” he said. So how do you kick-start your journey to a healthy lifestyle without taking on extreme exercises that you are not in the mood for or without bursting your bank account? A cheap way to keep fit is to take the stairs instead of the lifts at work. Park a bit further when visiting at a shopping mall. If safe to do so, take a 30 to 45 minute walk/jog around the area in which you live. Join the park runs in your area. It is fun and done by like-minded people. In the comfort of your own home, Google “own body weight exercises”. General housework and cleaning is a simple way to pick up your heart rate. A light walk or jog around the neighbourhood, sweeping the patio and mowing the lawn are guaranteed to raise your heart rate. Anything that exerts the body and allows you to break a sweat. Most people become more motivated if they do things that are group focused. If you are around people who are looking for the same results then you may be more inclined to exercise. Do things that you will enjoy doing. The moment you do not enjoy it, you will start finding ways not to do it.
Priority One | Issue 1, March
Shake off excess salt Health and awareness
Before you head for the salt shaker, ask yourself… do I know how much salt manufactures used to preserve and modify the flavour of the food I am about to eat? You may say that as long as your taste buds are happy you are to, but is it worth it to compromise your health over taste? With March highlighting the effect excessive consumption of salt has on a person’s body and with next month focusing on health awareness, ER24 is urging people to cut down on their salt intake if they are guilty of going overboard. Salt has been linked to a number of conditions including kidney disease, kidney stones and obesity and is said to aggravate diabetes and asthma symptoms. Salt is also one of the contributing factors to hypertension, which is said to be the leading cause of heart attacks and strokes in South Africa. Explaining further, Jandri Barnard, a registered dietician based at Mediclinic Newcastle, said, “Your blood pressure rises gradually as you get older and you can also inherit a tendency to have high blood pressure. If you are diabetic, your blood pressure is likely to be higher and thus you need to keep an eye on it. “A high salt diet contributes as the leading cause of high blood pressure, which is the most important risk factor for stroke. Since hypertension is one of the main contributors to heart attacks and stroke, it makes sense to cut down on the amount of salt you eat.” Children An unhealthy lifestyle, which includes a diet high in salt, puts children into a greater risk of developing severe
health problems like heart disease, stroke and kidney failure as young adults. Barnard said at least one in 10 South African children have already been diagnosed with hypertension. “In South Africa, one of three individuals over the age of 15 suffer from hypertension, and this can be seen as one of the leading causes of death worldwide, increasing yearly. “Although the estimates for salt intake of South African children are unknown, salt intake among adults is high, leading many experts to believe that the same is true for children since they follow the habits of their parents. “Dietary habits formed in childhood and adolescence influence eating patterns in later life. Liking salt and
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salty foods is a learned taste preference and thus it is vital that children do not develop a taste for salt in the first place as it can develop into a habit that will stay with them for the rest of their lives,” said Barnard. Recommended salt intake Table salt is made up of 40 percent of sodium and 60 percent of chloride. 5g of salt equals about 2 000mg sodium. It is recommended that adults not eat more than 6g of salt per day, or 2.5g sodium (which is the harmful component of salt). “Don’t worry about going too low, as we only need 1g of salt in our diet, and it’s virtually impossible to reduce intake below that if you eat any manufactured foods at all,
which also includes bread,” said Barnard. The following is the recommended maximum intake of salt for young children: • Less than 1g a day for babies until the age of six months. • 1g a day for babies seven to 12 months. • 2g for children aged one to three years. • 3g for children aged four to eight years and 5g for children more than eight years. According to Barnard, boys eat an average of 6.1g of salt a day. This is more than the recommended maximum for a man. Girls eat an average of 5.1g of salt per day which is also more than the recommended amount. | 10
Zika virus what you need to know Health and awareness
While South Africans are urged not to panic, people, especially travellers to countries where there is a Zika outbreak, are advised to familiarise themselves with the symptoms and possible effects of the virus. An outbreak of the virus (spread to people through an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions) has been reported in several parts of Latin America and the Caribbean. Recent news reports stated that a businessman visiting South Africa, has apparently been diagnosed with the Zika virus. Doctor Robyn Holgate, the Chief Medical Officer for ER24, urges South Africans not to panic. “Bear in mind that illness is relatively mild. However, the concern for an unborn child’s wellbeing cannot be ignored. If any travellers are concerned, they should consult their GPs or contact their Emergency Centres,” she said. Effects of the virus on an infected person are said to be usually relatively mild. Symptoms people may experience include skin rashes, fever, muscle and joint pain, conjunctivitis, malaise and headache. Symptoms last between two and seven days. It is not common for people 11 |
infected with the Zika virus to need hospitalisation. There is no treatment or vaccine available at this stage. According to the National Institute for Communicable Diseases (NICD), no definite causality can be attributed to Zika virus infection, but investigations are ongoing. However, concerns have been raised about potential neurological and auto-immune complications. According to the World Health Organization (WHO), health authorities in Brazil observed an increase in Zika virus infections among the public as well as an increase in babies born with
microcephaly, a congenital condition associated with incomplete brain development. Microcephaly results in an affected infant’s head being significantly smaller than expected. However, more investigations are being conducted to determine a possible link between the Zika virus and microcephaly in babies as well as other potential causes. As a precaution, the NICD has advised that pregnant women delay travel to areas with current outbreaks of the Zika virus. The NICD also stated that personal protection to avoid mosquito bites is essential
for travellers visiting areas where the Zika virus is circulating. Protection includes the use of insect repellent, wearing clothes that cover as much of the body as possible, using mosquito screens or nets and closing doors and windows. The NICD stated that even though the possibility of an infected traveller introducing the Zika virus to South Africa does exist, the short viraemic period (virus present in blood) would lessen the chance of the virus being transferred to a susceptible mosquito, particularly because local Aedes aegypti mosquitoes have limited flight ranges.
Priority One | Issue 1, March 2016
Health and awareness
Lassaarefe ver we at risk? News reports state that over 100 people have died as a result of Lassa fever in parts of Nigeria since August last year. According to the World Health Organization (WHO), four of the most affected states reported are Bauchi, Edo, Oyo and Taraba. Professor Lucille Blumberg, the deputy-director of the National Institute for Communicable Diseases (NICD), said there has been an increase in the number of cases in Nigeria and cases have also been reported in
Burkina Faso. “These are not common areas that tourists generally visit. It is important however, for people to be aware,” she said. Lassa fever is an acute viral haemorrhagic illness. The arenavirus is transmitted to humans through contact with food and objects such as household equipment that has been contaminated by urine or faeces of a rodent of the genus Mastomys, known as the multimammate rat. Person to person transmission
Measures in place to detect Lassa fever Measures put in place to detect Lassa fever and other VHFs in South Africa according to Prof Blumberg include training of health workers to ask patients for a detailed travel history and possible exposures, provision of specialised lab tests, protective measures for health workers, asking detailed histories regarding
occupation and possible exposures to rodents, ticks, mosquitoes and animals. Doctor Robyn Holgate, the Chief Medical Officer at ER24, said ER24 continues to screen all patients for a travel history to West Africa. “It’s critical we detect a potential VHF case before transfer or admission to hospital. Basic appropriate personal protective equipment
Priority One | Issue 1, March 2016
occurs through direct contact with the blood, faeces, urine and other bodily secretions of an infected person. Not all Mastomys rats are infected with the virus. Most are not, and Lassa has not been found in rodents in South Africa. Initial symptoms occur about one to three weeks after a person contracts the virus. In cases where people have symptoms, these may include high fever, vomiting, diarrhoea, weakness, a sore throat, cough, back pain and conjunctivitis. In severe cases, the virus could result in facial swelling, coma, seizures, bleeding from the nose or mouth and can affect body organs such as the liver and kidneys as well as lead to death. There is no vaccine against Lassa fever, which is endemic to many parts of West Africa including Sierra Leone, Guinea and Liberia. A drug called Ribavirin is used to treat infected people. “Lassa has not been found in rodents in Southern Africa and South Africa. A new related virus, Lujo virus, caused a small outbreak in 2008. One case imported from Zambia infected four health workers in a Johannesburg hospital due to direct transmission from body fluids. The specific virus was
not found in rodents studied in Zambia and has never been seen again after this small outbreak. The source remains unknown. So, overall there is a very low risk of introduction of Lassa into South Africa. There was one imported case of Lassa in 2007 in a patient who was sent from Nigeria to Gauteng for treatment. Fortunately, the possibility of Lassa was considered very quickly and appropriate infection control precautions were taken rapidly to prevent any spread within the hospital setting to health workers,” said Prof Blumberg. She added that rapid recognition of possible cases of any VHF is key in preventing spread. “The NICD has a specialised high security laboratory where testing can be done for a range of these viruses including Lassa fever. “Overall the commonest cause of fever in patients or travellers from Africa remains malaria. Any acute fever with flu-like symptoms is more likely to be due to malaria rather than Lassa,” added Prof Blumberg. She said travellers should be aware of the importance of preventing malaria. People who have malaria need urgent testing and treatment as malaria progresses rapidly to complicated disease.
is mandatory at ER24, and we have an escalation process which addresses any clinical concerns after history and examination,” she said. Dr Holgate said there is no need for South Africans to be alarmed. “We live in a global environment. South Africa receives regular visitors from West Africa, including healthcare workers, asylum seekers and business travellers and there is no current need for us to panic. The virus
is not airborne and it is not transmitted by insects such as mosquitoes,” she said. Dr Holgate recommends that non-essential business travel to affected areas be avoided as a precautionary measure. Visitors to affected countries are advised to avoid contact with rats as well as to ensure that food eaten is stored in rodent-proof containers. Proper hygiene is vital. You should ensure that your hands are washed thoroughly. | 12
Health and awareness
Paramedics under attack by Peter van der Spuy
How often do we repeat that mantra during clinical simulation scenarios? In my experience, it’s heard from crews during nearly all of my testing days with EMS providers. In getting to the meat of clinical practice, we gloss over the fact that a scene indeed might not be safe. Consider the following: Scenario one - Driving through a residential suburb at night, an ambulance crew looks for a police staging area while responding to a domestic dispute call. Thinking they are away from the scene, the ambulance crew parks at a curb in front of a row of houses only minimally lit. Suddenly a man with a rifle appears on the deck of one of these homes. He raises his gun toward the ambulance crew, but is shot and killed by unseen police before he can fire. Scenario two - A five-yearold boy is laying on a couch 13 |
in his parent’s living room complaining of a severe headache. His mother advises EMS that he has had a high fever as well. Before the crew has time to consider a possible infectious disease exposure to meningitis and put their masks on, the father arrives on scene and is irate. He does not want his son going to the hospital and orders the crew to leave the house. When they seem slow to carry out his command, he becomes angrier and advances to within a foot of the crew while threatening violence if they do not leave. They quickly exit the home. Violent patients or bystanders The subject of scene safety is extremely broad, encompassing body substance hazards, roadway traffic control and chemical exposures, to name a few. For this article, I want to narrow the subject to scenes
Characteristically high-risk scenes include: • Assaults • Domestic disputes • Overdose cases • Situations involving recreational drugs and alcohol • Psychiatric problems especially ones involving
potential or threatened suicide • Gunshot wounds or stabbings • Calls with limited, or no information or involving “a man down” • Outdoor roadway scenes
involving potentially violent patients or bystanders. These situations are representative of the potential risks faced by EMS, firefighters and police on a regular basis. While national statistics on threats and violent acts perpetrated on EMS crews do not seem to be available, the occurrences are likely commonplace. Indeed, any cursory review of internet media reveals frequent accounts of assaults on EMS crews. Every experienced provider I spoke to while researching this topic had
several harrowing stories to relate regarding some of their encounters in these circumstances over the years. But the reality is that no scene is safe. That’s what instructors teach crews in our EMS service. Approach all scenes with this in mind for maximum safety. A call that seems routine with no apparent danger to crews can escalate rapidly into one that does involve threat. Moreover, a patient familiar to EMS and previously thought to be safe can become a risk on the next call.
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Health and awareness Things to remember There are a few things that we can do in our interaction with patients and bystanders that may reduce the likelihood of making a potentially bad situation into a very bad one. Remember that all of us want our “personal space.” The closer we get to a hostile individual, the more likely he or she may react negatively. Try to give them space while talking with them in hopes that they may calm with conversation from a distance.
Additionally, realise that a patient or bystander who gets too close to you may be a threat. If a potentially violent individual invades our personal space, our ability to protect ourselves from an assault is reduced. Be flexible in your approach to patients, keeping in mind that sometimes cultural differences may play a role in difficult interaction. While our patients often come from very divergent backgrounds
or lifestyles, it’s best not to be judgmental. Maintaining eye contact with the patient and others in the conversation is important. It’s usually a good idea to verbalise and explain to the patient and bystanders what is being done and what is planned. Non-verbal communication cues can either help or hinder a situation. Try to avoid sending negative cues, no matter how unintentional. Sometimes subtle things like
a roll of the eyes in response to a comment from a patient may in fact be perceived by the patient as an insult and provoke a reaction that was avoidable. Conversely, be alert for the non-verbal cues that patients or bystanders send us. Darting eyes, sudden movements, pacing or clenching and unclenching of fists suggests a potentially volatile individual who may be close to exploding.
Despite our best efforts at limiting provocation of patients or bystanders, sometimes negative interactions may not be avoided. Here are some basic scene tactics that can be used on all calls that may reduce the risk of injury to providers: • Stage safely away from a high-risk scene until law enforcement permits EMS entry. • Even if law enforcement has cleared a scene, recognise that this does not guarantee that the scene is safe. • As a rule, don’t park the EMS vehicle directly in front of the scene. • Avoid standing in front of windows.
• Don’t stand directly in front of an entry door. Stand to the side of the door. • If a voice from inside a building says “come on in, the door’s open,” strongly consider waiting for law enforcement. If you think that it is likely safe, open the door from the side and enter cautiously after pausing for a brief time. • Light up a dark scene. But if you are using a flashlight,
keep it to the side and not in front of you as potential assailants will target the flashlight. • Always locate an alternate exit than what you entered through, if one exists. • Keep yourself between the patient and bystanders and an escape exit. • Avoid assessing patients in a kitchen whenever possible. There are many potential weapons in a kitchen.
• In addition to using the secondary survey as a physical assessment tool, be alert for the possibility of a hidden weapon at that time. • Maintain scene awareness throughout the call. At least one crew member should be primaril assigned to observe the scene for potential physical threats and other safety hazards.
In aviation, they use a term called “situational awareness.” Situational awareness is an excellent phrase summarising the concepts above with regard to scene safety. In short, it’s critical to maintain awareness of the scene situation at all times, in order to maximise protection of EMS crews and others. Many groups are now appropriately focusing on EMS safety. Typically, these efforts are directed at vehicular transport, providers and an emerging emphasis on patient safety. Less has been done to address scene safety as a part of these initiatives. Hopefully, there will be more focus on this important component of safety, including the establishment of a national database of these incidents. No matter what develops in the future, we should all strive for situational awareness on every scene. Be safe and know how your “CODE 999” procedures work. Be safe and always be aware of your surroundings. Priority One | Issue 1, March 2016
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Health and awareness
Take
bullying seriously A 15-year-old boy wanted to commit suicide as a result of being physically and verbally bullied at school. The boy was teased for being intellectual and not excelling in sport. He wrote a suicide note that was luckily found by his mother before he could go through with his plan. Fortunately, with the help of an ER24 counsellor and active steps that were taken by his parents and the school, the boy now lives a happy life. While there was a happy ending in this instance, sadly it is not the case for a number of other children who are bullied on a daily basis. Henning Jacobs, the trauma support co-ordinator at ER24, stated that parents must pay attention to their child’s behaviour to establish if they are being bullied. “Parents should be aware that bullying occurs in every school grade. The intensity increases with age. It is vital that steps be taken immediately to help a child who is being bullied. It is also imperative that immediate and effective steps be taken against the bully or bullies as their actions, if not stopped, could continue to affect a victim,” he said. Speaking about the effect of bullying on a victim, Jacobs said that the child could become withdrawn or undergo personality changes. A once bubbly and happy child may now be quiet and depressed. There may be a change in school 15 |
marks. They may also experience panic attacks and fear going to school. “In extreme cases, the child may resort to suicide. Bullying can also result in killings. It is essential that parents have a close relationship with their children. Children who are bullied mostly keep quiet about what is happening to them due to being ashamed. However, some speak up. It depends on the type of home they live in and the type of relationship they have with their parents. Parents and even teachers need to let children know that it is okay to come to them for help if they are being bullied,” said Jacobs. He said that it is wise to educate children and discuss bullying with them as early as possible. Grade R is a good time to start.
Difference in bullying among boys and girls While it used to be a case of girls displaying more verbal and emotional bullying and boys displaying more physical bullying, this has now changed. “These days we find that girls also display physical bullying and girl fights are common. Boys now display more emotional bullying than before. Reasons for bullying, however, do not differ between boys and girls,” said Jacobs. Explaining some of the reasons for bullying, Jacobs said these include anything
from physical looks, weight, height to the use of braces. “Reasons for bullying also include the difference in cultures, race and colour, being poor, speech impediments or anything that makes a child stand out negatively to a bully,” said Jacobs. Bullies could also be jealous of another child, unhappy with something in their own lives, feel a need to impress others around them and believe that bullying is the way to do it or they may have a big ego. Explaining further, Jacobs said, “Bullies may be insecure about themselves and use bullying to feel more powerful and successful than the person they are bullying. “Violence at home, on the television or TV games also has an effect to some degree. “Bullies can also be victims of bullying. There are cases for example, where children are bullied at home.”
Types of bullying Bullying, which refers to repeated behaviour by someone intended to hurt another person either through verbal, social or physical behaviour, could include anything from making threats, teasing, name calling, spreading rumours to pushing or tripping a person. “Emotional bullying is automatically part of the trauma experienced as a result of physical bullying. No bullying case is only physical. It is however, possible to have emotional bullying cases that do not result in physical bullying. Children are affected when they are teased or when nasty things are said to them. “Bullying usually starts verbally and emotionally and usually only goes over to physical bullying when the child that gets bullied stands up for themselves or displays behaviour that the bully does not like,” said Jacobs.
The effect of bullying on a victim According to Jacobs, victims never forget the bullying they experienced as a child but can overcome it. He said that while bullying has a negative effect on some victims for the rest of their lives, others become motivated to succeed in life. A child can overcome the effect of being bullied, provided however, that the bullying stops.
“Children can also overcome the effects of bullying if they receive lots of care, love and even counselling. Counselling is a great way to get help. “School counsellors or educational psychologists are trained to help children. Parents, teachers and children should seek their assistance,” he said.
Priority One | Issue 1, March 2016
Health and awareness
Priority One | Issue 1, March 2016
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Health and awareness
A closer look at mall robberies
How to treat
a scar
Information obtained from Mediclinic Infohub.
Pretty much everybody has a scar somewhere on their body – and while some scars can be ugly, they can all be treated. “The skin is a fascinating organ with incredible ability to heal,” says Doctor Sian Hartshorne, a dermatologist
Creams containing silicone help to improve healing. “These creams can be applied over the micropore plaster twice daily.” While the scar is still forming, remember to avoid direct sunlight (which can cause
collagen – and if your body produces too much collagen during the healing process, you’ll get a raised scar called a hypertrophic scar or, if it grows beyond the area of your original wound, a keloid scar. “Certain areas of the body
at Mediclinic, Plettenberg Bay. “Even scars can, over years, slowly improve until they almost disappear and become forgotten.” To prevent wounds from leaving ugly scars, you need to minimise the amount of work your body does in the healing process. “Giving support to the wounds by using micropore plasters for two to six months can help prevent bad scars,” says Dr Hartshorne. “You can also use creams or oils to massage the scar daily.
discolouration), or, if it’s on an exposed area of skin, use a daily sunblock. Don’t use harsh chemicals like hydrogen peroxide: these can cause irritation and slow down the healing process. Your skin has three main layers: the epidermis (a thin outer layer); the dermis (the deep, thick layer below that); and subcutaneous tissue (below the dermis). Scars form when your dermis is damaged and your body creates new tissue. That scar tissue is made of
such as the back, chest and shoulders, are more prone to developing keloid scars,” says Dr Hartshorne. “Some people are also genetically more prone to developing keloid.” Keloid scars can be treated with external beam radiotherapy or with certain steroids. “Keloid scars are difficult to treat, but cortisone injections into the scar, siliconecontaining creams or external beam radiotherapy can improve and decrease the scar,” adds Dr Hartshorne.
“Certain areas of the body such as the back, chest and shoulders, are more prone to developing keloid scars”
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A number of people are emotionally affected by crime and do not know who to turn to for assistance. The ER24 Trauma Support Team can assist. It has been noted for example that a number of people have been affected by robberies at businesses. Some cellular phone stores for instance, are robbed numerous times and in a matter of weeks. This is stressful and traumatic for staff members. Cellular phone retailers are usually targeted during trading hours. There are a number of ways in which criminals access these stores. It is common for example, for criminals operating in a group to pose as customers looking to purchase a cellular phone in stores not situated in shopping centres. As retailers will not turn a customer away, the perpetrators have easy access to the store. The perpetrators do not seem bothered by the amount of staff inside the store. Usually the store manager is identified and instructed to open the safe as the key is in their possession or they know where it is. The staff is then told not to do anything stupid, as the cellular phones and personal belongings are not worth dying for. The staff is usually forced into the back office and the door is locked from the outside. The perpetrators then leave the store with the stolen items and cash. Perpetrators usually leave the staff unharmed. In rare cases where physical injuries have been reported, they are usually minor. The incident however, is traumatising to staff. It is at this stage that the Trauma Support Team is required and our work begins. The team helps staff deal with the trauma.
Priority One | Issue 1, March 2016
Clinical
Critical Care Retrieval Services
It’s all in a day’s work to fetch a critically ill preterm neonate for ER24’s Critical Care Retrieval Services team. Imagine reaching a referral hospital and finding a 600g neonate, struggling with a respiratory rate of 90, significant distress, sternal and rib recession, saturations of 80 percent with oxygen at 5lpm via nasal cannula. Our Critical Care retrieval team initiated non-invasive neonatal Continuous Positive Airway Pressure ventilation with our Hamilton T1 ventilator. This tiny baby was soon relaxing in his incubator, on 30 percent oxygen, and showing no signs of respiratory distress. This is what Critical Care retrieval medicine is all about, taking specialised care to the patient who may have had to wait hours for intensive care. Inter-hospital transfers for critical Intensive Care Unit (ICU) patients anywhere in Africa pose an important risk for patients, but it may be the only solution for accessing definitive care. Things can go wrong if the quality of patient care is not
well-controlled during these transfers. The need to transfer these critical patients safely is non-negotiable, hence we’ve upskilled our team with international paramedic qualifications, ICU nursing and the best possible ICU transport equipment. As a result of our resourcepoor environment, ICU beds are reserved for patients who are so critical that they deserve this facility, hence the patient profile and level of care required to facilitate these patient transfers has changed over the years. It is no longer acceptable to arrive with a stretcher and bag valve mask resuscitator to transfer a patient from one facility to another. These ICU patients require skilled care to ensure their treatment plans for optimal clinical outcomes begin with the commencement of the patient transfer and not just once they arrive at a receiving facility, sometimes hours later. Although not common in South Africa, ER24 has managed Extra Corporeal Membrane Oxygenation (ECMO) transfers. A tragic
Priority One | Issue 1, March 2016
case with a wonderful outcome was that of a mother who had just given birth and become critically ill from a viral infection. Our team found her unable to be treated with conventional ventilation. She was dependent on cardiac stabilising drugs. ECMO was started in hospital and she was eventually discharged home to care for her baby. ER24 has implemented a safe,
appropriate means to transfer these patients. Our Critical Care retrieval team allows for the concentration of scarce expertise and resources around urban hubs in South Africa, with activation by means of an intensive care ambulance, helicopter or aeroplane possible, using a well-trained and experienced core group of clinicians and ICU trained paramedics. | 18
PATIENT safety Clinical
The pre-hospital setting poses a potential threat to clinical patient safety as emergency care takes place in a dynamic, uncontrolled and ever-changing environment and these factors translate to possible errors which may well compromise the health conditions and care of our patients. At ER24, our philosophy is that it’s not clinically good enough to simply transport a patient from A to B. Clinical excellence and quality are non-negotiables, but the demonstration of ultimate cost saving, and lives saved are not always easy to translate into writing. It’s about preventing harm to our patients and the public, and protecting our staff. So, how do we achieve this, and what have we done differently at ER24?
What is patient safety? The Patient Safety Institute in Canada defines patient safety as the reduction of risk or unnecessary harm associated with healthcare to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered, weighed against the risk of non-treatment or other treatment. Simply put, there are some key themes in the pre-hospital EMS we need to consider. These include clinical judgement, the biggest contributor to patient safety and sometimes overlooked in favour of general safety; adverse events and operational safety. It’s all about embracing an open, fair and just culture through learning, designing safe systems, managing behavioural choices and improving safety.
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How do we achieve our patient centred safe environment? Firstly, and most importantly, we have a leadership team that embraces organisational safety. It’s not just about governance. Some critical things have changed in EMS over the past five years and staying up to date is important. We’ve partnered with international suppliers and standardised on state of the art medical equipment in our custommade vehicles. Some of the equipment initiatives include 12 lead telemetry on most vehicles for patients
experiencing chest pain (this allows us to diagnose and ensure early treatment and referral of cardiac chest pain) and mechanical ventilation for patients requiring artificial breathing. A considerable cost for us, but we believe we’re creating a clinically exceptional environment for our patients that will ultimately translate into a financial and clinical benefit for our patients and funders. We’ve invested in a strong clinical team, strengthened through being aligned to our parent clinical structure at Mediclinic. Our clinical patient safety is so important
that we employ three fulltime doctors to assist. The team is headed by Doctor Robyn Holgate, our Chief Medical Officer (CMO). In addition to this, we have a clinical governance manager, several clinical quality claims assessors up to advanced life support level and six dedicated nurse case managers in our Contact Centre.This team is hands-on and helps make the best clinical decision for our patients. Education and training are critical to ensure staff is kept up to date on clinical matters. Our Training Academy embraces
Priority One | Issue 1, March 2016
Clinical the ER24 clinical initiatives, runs internationally aligned programmes, and also runs Continuing Medical Education (CME’s) courses for our staff. We distribute best practice clinical guidelines and policies, infographics, podcasts and videos to our staff on clinical areas of concern and interesting topics. We’ve implemented checklists for clinical practice where we know the potential for error exists, such as cardiac patient care and airway management. We don’t just review ourselves. We ensure we are audited internally and externally. On the external audit side, we
spent a gruelling week with the National Accreditation Alliance of Medical Transport Applications (NAAMTA) team reviewing our rotor, fixed wing and critical care retrieval teams. Thanks to a dedicated team, and ongoing commitment to clinical care, we were awarded our accreditation. We benchmark our clinical standards against international best practice, and can proudly report that our first intubation success rate for our practitioners is similar or better than international norms. Despite this achievement, we believe that airway management is critical, and as such have
Priority One | Issue 1, March 2016
recently enforced compulsory skills practice. On the retrospective side, each ER24 patient report form is reviewed by a team of paramedic specialists, and any clinical concerns are discussed with the CMO. Currently, our reported adverse event percentage is less than 10 percent. Although slightly lower than international hospital-based trends, the key issue is to ensure we’re doing something about our reported adverse events. Our clinical governance manager is handson with all cases, placing a strong emphasis on root-cause analysis and system change to prevent future adverse events.
There’s always a human element. We are not perfect and we do make mistakes. It’s the pro-active fixing that makes the difference. Ultimately it’s about our people ensuring patient safety that has made the difference at ER24. Without the dedication and commitment from every one of our team members, patient safety is just a word; we actively embrace a patient safety culture and passion at ER24. We remain humbled by our patients. If there’s any clinical concern or any more information on our indicators that you wish to discuss, please do not hesitate to contact our clinical team.
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Community involvement
Catching up withTHOR 21 |
Priority One | Issue 1, March 2016
Community involvement Thor, the orphaned black rhino that captured the hearts of many South Africans, continues to thrive at Care for Wild Africa. Thor was taken to Care for Wild in 2014 after he was found at his mother’s side. His mother suffered for a week after poachers shot her and took her horn. She had to be put down when she was found. Thor was stressed and dehydrated. He stopped breathing a few times while being airlifted but pulled through. While at Care for Wild, Thor went into shock one night. ER24 was contacted for help. Since then, Thor’s health has improved and today, can be found enjoying his time among several orphaned friends. Dehorning As a result of recent poaching threats, Care for Wild made the decision to dehorn all eligible rhinos. “Performed correctly, the dehorning process does not harm the animal. It is an unfortunate requirement to counter the recent poaching wave. We
ER24 CEO, Andrew Boden with some of the orphaned rhinos at Care for Wild
truly wish that such drastic measures will one day be unnecessary,” said Petronel Nieuwoudt, the owner and founder Care for Wild Africa who is passionate about nursing animals back to health and providing them with the love and security they need. After a day spent dehorning the rhinos, Nieuwoudt was happy to report that all the rhinos were in good health.
Rehabilitation Apart from the dehorning procedure, Nieuwoudt implemented a number of initiatives to bring about further security for the animals currently being taken care of at Care for Wild. Rehabilitation of the animals continues to take place. For Thor, the next step is to move him to a bigger camp with a few of the other rhinos. Just recently, three other
orphaned rhinos at the rehibilitation centre, Don, Oz and the playful Warren, another one of ER24’s favourites, were moved to a brand new boma. “This is the big next step in their rehabilitation process that will ultimately lead to their release,” said Nieuwoudt. ER24 commends Nieuwoudt and her team for the great work that they are doing.
ER24’s relationship with Care for Wild Care for Wild Africa, based in Mpumalanga, is committed to the preservation of South Africa’s wildlife. Injured, orphaned and abandoned animals are rescued and cared for at the rehabilitation centre. Wildlife is tended
at an animal hospital on the farm until they can be rehabilitated back into the wild. In cases where it is no longer possible for the animal to survive in the wild as a result of permanent injuries for example, these animals are housed at Care for Wild on
Andrew Boden (ER24 CEO), Petronel Nieuwoudt (Care for Wild), Ben Johnson (ER24 COO) and Dr Robyn Holgate (ER24 CMO).
Priority One | Issue 1, March 2016
a permanent basis. Andrew Boden, the Chief Executive Officer of ER24, decided to help Care for Wild following a visit to the farm in July 2014. Boden was impressed at the way Nieuwoudt and her team cared for the sick and hurt wildlife. He
decided to support Care for Wild by providing them with medical supplies, much needed equipment and other necessities. ER24 continues to support the rehabilitation centre given the exceptional work being done by Nieuwoudt and her team.
ER24 CEO, Andrew Boden, “conversing” with a lion at Care for Wild.
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Community involvement ER24 is proud to have been involved in initiatives that were established to help people living in droughtstricken areas. Initiatives supported include Operation Hydrate and JacarandaFM’s Project Water Drop. Several staff members saw firsthand in recent weeks the impact the drought has had and continues to have on people. ER24 paramedics made themselves available to offer medical assistance to anyone in need during the distribution process in the North West’s droughtstricken areas for example, helped hand out water to people in need and transported water (sponsored by ArcelorMittal), to the Vryheid Hospital for instance. Staff also visited The Nelson Mandela Foundation in Houghton recently to donate water towards the worthy cause. The ER24 Joburg North, Midstream and Newcastle branch as well as head office and events department staff, were among those who assisted people in need of water. ER24 is proud to be part of a nation that is coming together to help those in need.
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Priority One | Issue 1, March 2016
Every DROP counts Community involvement
Priority One | Issue 1, March 2016
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Community involvement
Discovering your passion “Never stop believing in yourself. When you have faith, nothing is impossible.” This is the advice from Duncan Swart (18), who despite challenges with a hearing disability, matriculated and now plans on helping people in their greatest time of need. The former Hoërskool Jim Fouché student, who spent time with ER24, is studying towards a Bachelors degree in Emergency Medical Care (EMC) at the Nelson Mandela Metropolitan University (NMMU) in Port Elizabeth. Swart, from Bloemfontein, was born with the hearing disability. He started using hearing aids at the age of seven, soon after his disability was noticed. “My hearing disability did have a huge impact on my life because I had to adapt myself to the world to have a ‘normal life’. But, I have learned that you have to accept the way you are and that you are never too weak to make a small difference in this world,” he said. In 2012 Swart realised that he wanted to make a difference in the community. He jumped at an opportunity to do a First Aid course held by ER24. The ER24 Central Region offers First Aid Level 1 training to children at schools in need. The First Aiders are then able to offer some assistance in an emergency as well as be runners at school events with some staff and an ER24 ambulance on site for example. Teachers at these schools are also offered First Aid Level 3 training. “I enjoyed the course so much that I completed First Aid 25 |
Level 3,” said Swart. Due to his eagerness to learn more about First Aid and how to help those in need, he decided to be a volunteer for the ER24 Events team. Swart has volunteered over 500 hours with the team. Apart from volunteering at the school’s sports events for example, Swart also took opportunities to share his knowledge. He hosted a First Aid project for youngsters for example at a local school. “I could not resist the opportunity to make the little ones smile and keep the ER24 name high,” said Swart. He added that he enjoyed working with the ER24 Events guys. “They are always friendly and they never complain about having to answer my questions. “Believe me, I have asked a lot of questions to gain more experience and to improve my skills in First Aid. For me to help those in need is like ‘walking on sunshine’ because every patient is different, has a different emergency and needs different care. To walk the extra mile with them gives me a smile. “It is my passion to help those in an emergency no matter how big or small the emergency is. What drives me the most is that I see every challenge as an opportunity to improve my skills to give the best medical care for my patients. If you give more, your results will be better,” said Swart. When asked about his future plans, Swart said, “My goal for the next five years is to graduate at NMMU, to be a success and hopefully work for ER24. I want to thank the people at ER24 for helping
Duncan Swart is following his deams of becoming a paramedic.
those in need and helping me discover my passion. Keep up the good work.” Sidney Venter, the ER24 Central Region Manager, said, “Swart’s willingness to do whatever he was given to do is his strongest point. He is so eager to be part of the EMS world. He never allows his hearing disability to stand in his way and never says that he cannot do something. He works hard and never complains.” Pieter Driscoll Bekker, Specialised Medical Services
Co-ordinator, described Swart as a person who is enthusiastic about what he does. “It took him less than a year to become the captain of his First Aid team at school. He used to visit the branch and ask advanced life support paramedics questions in order to learn more. His all round attitude amazes us. He never lets his hearing disability affect him. He is a confident person,” said Driscoll Bekker. ER24 wishes Swart all the best in his studies.
Priority One | Issue 1, March 2016
Events
DUSI 2016
The Dusi Canoe Marathon, said to be the toughest canoe marathon in Africa, lived up to its name this year. It is the biggest canoeing event on the African continent, and one of the world’s most popular river marathons, attracting between 1 600 and 2 000 paddlers each year. Paddlers not only had to battle the raging river waters, but extreme heat as well as muddy slopes during the portage sections of the race. Stage one of the race was 42km long, from Camps Drift in Pietermaritzburg to Dusi Bridge, a remote area near Nagle Dam. Stage two was the longest and hardest stage (46km from Dusi Bridge to Msinsi Resort on Inanda Dam outside Hillcrest), that ended with 11km of flat water on the dam. Stage three was 36km from Inanda Dam to Blue Lagoon in Durban. ER24 paramedics, along with Life Healthcare, set up clinics at the start and end of every stage, while emergency
vehicles were posted at key points along the route. Advanced Life Support practitioners were also placed on two helicopters to gain access to those hard to reach points on the map if needed. Various rescue services, including SAPS and NSRI, were also part of the team placed along the riverside for further safety. Though no serious or fatal injuries were reported during the marathon, ER24 paramedics were kept busy with paddlers experiencing all types of injuries from heat cramps, blisters, lacerations to general fatigue.This did not deter many of these paddlers as they were determined to succeed in completing the country’s oldest and most prestigious canoe marathon. Despite the number of hurdles faced by several paddlers, the cold beer at the end of the race managed to wash away the day’s hardship. Congratulations to all who participated.
Priority One | Issue 1, March 2016
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Company interest
ER24 to attend A number of international and local emergency medical care personnel, including representatives from ER24, will be attending the International Conference on Emergency Medicine (ICEM) in Cape Town. ICEM, the largest emergency medicine conference ever to be held on African soil, will take place from April 18 to 21 at the Cape Town International Convention Centre. The conference aims to promote and inform role players in the medical industry of the latest developments and research in the field. The conference will include emergency medicine, pre-hospital care, emergency nursing and clinical lectures. The theme of the conference is “Emergency Medicine Now: Knowledge, Action and Accountability”. ER24 representatives attending this conference include Doctor Vernon Wessels (Site Based Medical Services), Dr Robyn Holgate (Chief Medical Officer), Craig Wylie (Clinical Governance Manager), Willem Stassen (Senior Flight Paramedic) and Lucas Bezuidenhout (Branch Manager, Bloemfontein). Among the topics to be discussed by ER24 are: • Safety in EMS - Dr Holgate’s Master’s research project which sought to obtain the perceptions of emergency care personnel on the latent safety risks of working within the pre-hospital care environment. 27 |
ICEM
•
•
Coronary care networks - Stassen’s PhD research which aims at developing systems of care and referral networks for patients experiencing myocardial infarction (heart attacks) within the South African setting. This project discusses the lack of cardiac catheterisation theatres in South Africa and calls for a local solution to this problem. Traumatic Brain Injury (TBI) research - Stassen’s Master’s research that looks at the prevalence of hypotension and
•
hypoxaemia in the prehospital phase of care of patients who sustained moderate to severe traumatic brain injuries. The findings of a Gauteng audit will be presented. TBI HEMS improvement project - A clinical improvement project conducted in the ER24 HEMS service will be presented. The project aimed at improving the adherence to international guidelines of pre-hospital traumatic brain injury management. The effect that an online learning
•
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course had on ER24’s TBI management will be presented. Stroke recognition by ambulance personnel - A joint project between the University of Johannesburg and Stassen that aims to determine whether ambulance personnel are able to accurately identify symptoms of and diagnose stroke within the pre-hospital setting. Success in nasal Continuous Positive Airway Pressure (nCPAP) transportation of critically ill
Priority One | Issue 1, March 2016
Company interest neonates - ER24’s Louis Jordaan and Maxine Dickson-Hall will present their successes in implementing an nCPAP programme for premature babies from outlying hospitals. Starting this intervention earlier might avoid the need to ventilate these neonates in the hospital. • Emergency Medical Services in Hostile Environments - ER24 will be presenting the successful implementation of an in-service training programme allowing EMS staff to be better prepared when facing hostile environments during their duties. A project about infection control practices in ER24 will also be presented. This is a joint project between ER24 and the University of Cape Town (authors DicksonHall, L; Moodley, C; Patel, F; Harries, S; Chantrain, D; Balfour, L; Mdlenyani, L;
Clift, M; Evans, K; DicksonHall, M; Wylie, C; Jordaan, L; Stassen, W; Nicol, M) which saw a series of vehicles and pieces of equipment in the Western Cape being swabbed and cultured for any bacterial growth. The information
“By attending these conferences, our clinical decision makers are exposed to the latest developments. We benchmark our clinical standards against international best practice. Knowledge gained at these
obtained may inform ER24 on how to improve infection control policies towards safer patient care. The results of this study will be presented by the UCT authors. There are constant changes and improvements in the EMS world and staying up to date is important. Hence attending conferences for example and communicating with role players from around the world to hear about advancements made are important.
conferences can be shared with ER24 staff to ensure the continuation of clinical excellence,” said Stassen.
“ER24 has an active clinical management team that consistently strives to identify and mitigate any risks to our patients.”
ASHFAS ER24 recently attended the African Symposium on Human Factors & Aviation Safety held in Cape Town. The symposium was hosted by Air Traffic and Navigation Services (ATNS) in partnership with the University of Witwatersrand, the University of Pretoria, Rhodes University and the
Ergonomics Society of South Africa (ESSA). The theme was “From Talking to Doing SAFETY.” Topics highlighted at the symposium included patient safety and aeromedical services. As part of the patient safety stream, Stassen spoke on organisational culture and its effect on patient safety. During his talk, he highlighted that the healthcare system is not without error, because it is a system that is designed by humans and run by humans. In order to improve the safety of the healthcare system, a system that actively searches for potential for human must be adopted. “Identifying the error is not enough. “One should put measures in place to avoid these errors from occurring. “ER24 has an active clinical management team that consistently strives to identify and mitigate any risks to our patients,” said Stassen.
ER24 Global jets off to PDAC 2016 ER24 Global and Mediclinic co-branded for the second time as an exhibitor at the Prospectors & Developers Association of Canada (PDAC) International Convention, Trade Show & Investors Exchange, which is the world’s leading convention for those involved in mineral exploration. The convention took place between 6 and 9 March in Toronto, Canada. ER24, the leading private emergency medical care provider in Africa, is a wholly-owned subsidiary of Mediclinic International. ER24 is a first party provider of emergency medical services specialising in on-site medical management, ensuring the health and safety of national and expatriate workforces in the mining, oil, energy and infrastructure sectors of the industry throughout the African continent.
Michael Emery, ER24 General Manager of Sales and Marketing, with Andrew Boden, ER24 CEO, at PDAC 2016 in Toronto, Canada.
Priority One | Issue 1, March 2016
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Advertorial
Article prepared by Flow Communications on behalf of the National Home Security Month High walls, razor wire, electric fencing, guard dogs, alarm systems and private security guards – adverts have referenced it, tourists remark on it and South Africans won’t live without it. Private security has become as South African as braais and biltong. According to the Private Security Industry Regulatory Authority (PSIRA), South Africans spent just under R70bn with security companies in 2013. And paying for protection against crime came, according to the Institute for Security Studies, a close second to putting food on the table for South Africans. “Security is the second basic need after food,” the Institute for Security Studies policing
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researcher Johan Burger told a newspaper last July. “Those that can afford it, even if it is difficult in the current financial times, will still hang onto private security. It’s not much use if you have everything else but you don’t feel safe.” Yet despite this, South Africans aren’t nearly as safety-conscious as they might like to believe. While South Africans are highly security conscious - so much so that we spend the fourth most on security in the world on average after Guatemala, India and Honduras, according to Africa Check we lag far behind the global curve on home safety. How many South Africans have invested in fire security, or first aid training? Outside of TV series, do people know what to do in the event of a heart attack or stroke? South Africans are
so focused on securing their persons and property against attack, that it’s easy to forget about overall safety in the home. That is why ASSA ABLOY, the global leader in door opening solution, is launching National Home Security Month in June. Imported from the UK where it has been successfully trialled since 2013, National Home Security Month is aimed at creating awareness around the importance of home security. NHSM will link homeowners to manufacturers and suppliers, insurers, retailers, installers and other helpful associations, and is designed to provide end users with advice, DIY guides, stories and solutions focused on improving home security. While it might seem akin to selling oil to Saudi Arabia, when we look at South African homes
and what security products homeowners are buying or investing in, it is clear that there is a need for guidance on the right products and solutions. National Health Security Month will meet that need by providing South Africans with impartial, independent information, advice and guidance on home security and safety. When it comes to security, many security-conscious South Africans are not well versed on the different options available, the importance of different security elements, or quality levels and how they differ, and often end up buying the incorrect product for the application, or being duped by unethical service providers. Also, unfortunately, the fitment of security and defence products usually occurs after a crime happens. That means the
Priority One | Issue 1, March 2016
Advertorial purchase is made in a panic, after a trauma, and may well not be the right decision, or not provide the whole defence. And the situation is even worse when it comes to safety in and around the home. While fire hazards are one of the most immediate dangers that any household can face – a Medical Research Council report estimated that each year 3.2 percent (1 600 000) of South Africans will suffer from burn injuries most South African homes have no fire procedures in place in the form of smoke and fire detectors, fire extinguishers, sprinklers and evacuation plans. Gas leaks too often go undetected until too late – because very few South Africans have gas
leak detectors installed. And the risks don’t stop there. In South Africa, drowning is one of the top causes of unnatural death among children, according to the Medical Research Council. An estimated 60% to 90% of drowning incidents occur in residential pools. Yet many pool owners fail to properly secure their pools or their Jacuzzis or sunken baths. Many South Africans are also not aware that they can be held liable or sued should someone have an accident on their property. That’s why they need personal liability cover – included in many normal household insurance policies – which provides for the legal fees and damages claimed against
Priority One | Issue 1, March 2016
as a result of something that happened on your residential property. National Home Security Month will provide information on all of this and more. It will focus on solutions rather than the problems South Africans are all too aware of.One such example is doors being broken down – which happens in 42% of housebreaking in South Africa. There are a number of possible solutions for this, and not all entail expensive installations. Simply fitting the right padlock on your gate can make it much tougher to cut the lock. Or, by making sure there is no gap between the door and frame, thieves cannot use a crowbar to break the door open. National
Home Security Month will also provide guidance for the average South African who cannot afford to hire a security installer – as to how to do things for themselves. But National Home Security Month will be more than an advice bureau, it is also an empowerment tool. South Africans have been afraid for long enough – it is time to solve the problems, and for everyone to work together to build safer neighbourhoods and homes. With the right security initiatives in place, we should see a decrease in opportunistic crimes and housebreaking. And with everyone in communities working together, we should see crime decrease significantly.
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THANK YOU TO OUR CONTRIBUTORS: Louis Jordaan At Grobler Alan Nielson Dr Robyn Holgate Peter van der Spuy Henning Jacobs Russel Meiring Werner Vermaak Werner Eksteen Gary Schneider Pieter Driscoll Bekker Willem Stassen Craig Wylie Michael Emery Yash Bridgmohan Saul Behrmann Dr Kumeshan Moodley
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