MetRO eMS
FEATuRE
first response T h e
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r. Cleeve Robertson is a remarkable man and has been heading the Western Cape’s first response service since it was constituted in its present form in 2001. Its evolution under his directorship has been extraordinary though he is quick to acknowledge that its inspiration and shape can be credited to Dr Alan McMahon who was instrumental in bringing the 20 rural, local authority based ambulance services together with Cape Town in 1973 to form a unified service. “Alan started the Metro EMS system we know today,” he says. EMS is the frontline arm of the Provincial Department of Health, providing quality emergency care to over six million people. For operational purposes the ambulance service is organised into two divisions – the acute service, which deals with emergency calls, and Healthnet (Health non-emergency transport). Between them they respond to 40,000 calls a month.
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Ca p e ’ s
Currently EMS has a fleet of 516 emergency vehicles (some 250 ambulances), an operational staff of 1500, and stations throughout the Province. At any time 150 to 160 ambulances are on the ground, over half in Cape Town, the rest deployed across five rural districts. For flexibility a proportion of its vehicles are hybrids, says Robertson. Response times are all important. The current CAD (computer aided despatch) system both controls and monitors performance and has made a huge differenced in performance. A slight operational re-organisation has helped too. “We now achieve 70 percent of priority one – emergency cases - within 15 minutes. Our performance target for priority one is 90 percent within 15 minutes.” So CAD has done a good job, but several years of working with it has revealed gaps and it is due for replacement by a more comprehensive system. “The new system which is being introduced this year will
Metro EMS Focus lifestyle
Metro EMS head Cleeve Robertson talks to South Africa Magazine. By Ian Armitage include electronic patient records and a lot more data. We have reasonable despatch and performance data that shows how well we are responding but we do not have very specific data around the conditions of the patients we are treating and conveying. “In Cape Town in April 2010 our response to priority one was 27 percent within 15 minutes, so to get it up to 70 percent is fantastic. We did that following reorganisation – imagine what we’ll achieve when we put the new system in. “We’re waiting for final approval on the system we have chosen and from the perspective of quality patient care, we’ll be able to rationalise the clinical care that we provide for patients, not only the response time performance. That’s the real major issue for this financial year. “We expect another 10-15 percent performance improvement. And then we shall use the business intelligence that comes out of the system to better place and dispatch ambulances throughout
the Province. Obviously we need further resources in terms of manpower and vehicles to bring response times up but this will help us achieve it.” The re-organisation, which has enabled EMS to already improve response times, involved changing, amongst other things, the method of dispatch in the city, Robertson says. “We now link 10 ambulance units to a dispatcher. It confines ambulances to a defined geographic area and therefore limits their travel distance and limits their mission time and we therefore buy time for response time. The less time you spend on every mission the more time you have available to respond. We’ve divided Cape Town up into hospital dispatch areas, geographic areas that drain towards a hospital. “We still maintain almost 40 rescue units along major arterial routes in the Western Cape and those are mainly for road traffic accidents along major highways, particularly the N1 between Cape Town and Joburg, which is very busy and experiences high www.southafricamag.com
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volumes of mixed traffic loads including commuter traffic, private vehicles and commercial traffic in terms of heavy trucks. The ratio of heavy trucks to cars – there’s probably about 10 trucks to one car on that road – so there are some very serious accidents involving multiple patients in taxis, or you could have 50 patients in bus accidents. We maintain those rescue units along that route to be able to provide paramedic and quick release rescue response to those incidents.” EMS also operates several aircraft. The system provides ICU aeromedical transfer of patients from rural hospitals into the City and a Wilderness Search and Rescue Service. Tourists, believe it or not, are the main beneficiaries of the rescue component of the service. “We rescue many tourists, both domestic and international tourists, from Table Mountain,” says Robertson. “You’ll be astounded to know it’s the busiest rescue venue in Africa! We rescue more people off Table Mountain than anywhere else in Africa and that is just because people can go up by cable car and look down and think they can walk down. On the way down they fall. Injury rates are actually increasing and we’ve done 4
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in the last season more rescues off Table Mountain than in the history of the service, so that’s unique, and most of those rescues are now actually being done by helicopter. With the advent of cell phones, and particularly smartphones, people can identify their exact location and we are able to send a helicopter to a patient that’s injured in a remote environment within a very short time frame. It’s working very well.” One challenge facing EMS is a shortage of paramedics. A paramedic’s starting salary is about R200,000 a year, but they can earn significantly more overseas. In Dubai, for instance, they can earn R100,000 a month, tax free. “We lose a number of particularly intermediate and advanced life support trained staff to overseas markets,” Robertson says. Metro EMS staff are a very talented and clinically experienced bunch and it is easy to see why they are poached from abroad. The job requires much more than drivers with some first aid training. They have to understand clinical care, hazardous materials, have the engineering ability to free patients trapped in machinery or crashed cars and since they might have to attend accidents in mountainous or wilderness areas they need training in
surviving hostile conditions. Medical rescue vehicles are equipped with very sophisticated tools too. Medical skills come first though. Most deaths occur at the scene of accidents and stabilising patients is just as important as getting them to hospital quickly. The original training centre set up in the 1970s by Alan McMahon moved several times before taking over a building at the former Otto du Plessis Nursing College at Tygerberg Hospital. It now offers a full range of emergency care courses - these were provincial qualifications until 1992 when they became registerable with the Medical and Dental Council, now the Health Professions Council of South Africa, says Robertson. The emergency service has become increasingly demanding and he anticipates further rationalisation in training: “We can expect tertiary level qualifications to become the norm.” One thing is clear, the achievements of the last decade mean that the citizens of the Western Cape have an emergency service that stands in comparison with the world’s best. “We are proud of the service we deliver under challenging circumstances,” Robertson concludes. END
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