PROGRAMME 3 EMERGENCY MEDICAL SERVICES EMERGENCY MEDICAL SERVICES AND PATIENT TRANSPORT SERVICES PURPOSE been able to access medical services. To render an efficient, effective and professional Construction of two satellite bases at Mthatha and emergency medical service to the citizens of the Queenstown was completed Eastern Cape Province Challenges in the priority areas Programme description The EMS programme saw more challenges than The emergency medical services (EMS) programme achievements. The challenges included the reduced operates primarily from five main stations namely East funding which inhibited the construction of EMS bases. London, Mthatha, Queenstown, Mt Ayliff and Port The Fleet contract was not finalized and this impacted Elizabeth. A network of 61 satellite stations throughout on the number of vehicles that was readily available for the Province is linked to the five main stations. The service delivery. Response times were negatively operation of the EMS has previously not been aligned affected to a large extent due to fewer vehicles being to the health district boundaries; five bases had been available among other reasons. operating across seven health districts with the Establishment of new ambulance bases at Cacadu Cacadu and UKhahlamba districts managed from the and UKhahlamba districts was not achieved due to NMMM and Chris Hani bases respectively. The main limited funding components of the EMS programme are: The much needed Computer aided Call-taking and 1. Emergency services (Ambulances and Aero-medical Dispatching Systems was not finalized due to services) limited funding 2. White fleet (senior official and administrative 2010 FIFA World Cup Readiness was compromised vehicles) by uncertainty around Fleet Africa contract 3. Patient Transport Service regarding the number of vehicles to be availed; the 4. Paramedic and Rescue services department had to explore other avenues to the extent of securing own fleet to deal with the problem. Programme Objectives The Fleet Management system was not To provide a reliable and efficient EMS service for implemented due to limited funding the Eastern Cape communities 309 EMS professionals did not maintain their To ensure preparedness and adequate readiness for HPCSA registration requirements and had to be the 2010 FIFA World Cup EMS needs taken out the staff pool. This impacted negatively To develop effective EMS systems that will support on availability of staff. However, the department health care delivery service instituted a recovery plan. To strive towards achievement of National Norms Further challenges regarded integration of staff & Standards from the municipalities; the department is addressing the specific labour issues Service delivery achievements relating to Achieving targeted ambulance response times priority areas remains a challenge due to fleet and staff issues. Forty six new vehicles were procured to replace Rostered ambulances decreased significantly some of the ageing fleet and damaged vehicles; partially due to the ageing fleet and non- whilst this has not improved the number of replacements following accidents. vehicles however, the vehicle available was The aim of the EMS programme nationally is to improved as the older vehicles are constantly eradicate single-man crew in ambulances; the under repairs. percentage of ambulances with single-man crew in Aero medical services provision benefitted 105 the EC province remained consistently at about needy patients who otherwise would have not 20% over the years 191 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Despite this, the number of hoax calls received and to priority 2 and 3 clients (figure 3.1) that constituted responded to remains significantly high (4 210 as the bulk of the calls (45.5% and 37.9%) respectively. against 4 843) in the previous year These are patients with moderate and minor ailments Of major concern to the programme is the large and could be responded to within one hour of number of calls (23 492) with patients who cannot receiving the call. Patients relating to 23 492 calls be located could not be located and this is largely due to To address these two latter concerns, road shows infrastructural challenges in human settlements whilst were planned to profile appropriate utilization of the large number of hoax calls (4 210) remains a EMS Toll free line but was not undertaken due to challenge to the EMS health programme. shortage of human resources. Delays in awarding the Provincial Fleet contract to a A total of 354 927 calls (Table 3.1) were received and service provider resulted in fewer ambulances than these comprised a 14% reduction in number of calls anticipated, with an average of 169 rostered per compared to the previous year. The proportions of call month; this compromised the ambulance response categories however, were similar to those seen in times. 2008/09 (figure 3.1). EMS service was mainly provided 192 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 3.1: Number of EMS calls received distributed by client category *EMS call category 2008/09 2009/10 Deaths (in ambulance) 239 195 Hoax call 4 843 4 210 Rescued cases 5 444 4 707 Death (on arrival) 6 348 6 078 Priority 1 response 17 003 12 420 Priority 2 response 192 137 161 601 Priority 3 response 154 206 134 472 Patient refuse service 9 363 7 752 Cannot locate patient 23 624 23 492 Total 413 207 354 927 193 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Figure 3.2 shows the 10 leading health conditions transported by emergency services. Maternity and physical assault were the two leading conditions that contributed the largest numbers of patients transported (about 13% and nine percent respectively). Other trauma, MVA and Asthma each constituting about five percent of the total, form a significant group as well. 194 EASTERN CAPE DEPARTMENT - ANNUAL REPORT 2008/09 Table 3.2: EMS - Emergency Medical Service and Planned Patient Transport Compliance Indicators, 2009/10 2007/08 2008/09 2009/10 2009/10 Indicator Type Actual Actual Actual APP target INPUT Total rostered ambulances No 213 208 169 320 E ASTERN Rostered ambulances per 1000 people No 0.04 0.03 0.04 0.04 C Hospitals with patient transport vehicles (units not managed by EMS APE % 50 10 10 0 excluded) D EPARTMENT PROCESS Kilometres travelled per ambulance (per annum) Kms 109 587 150 080 190 829 152 000 195 - A - Locally-based staff with training in BLS % 59 73 74 60 NNUAL Locally-based staff with training in ILS % 39 25 23 35 R Locally-based staff with training in ALS % 29 29 3.9 5 EPORT QUALITY 2008/09 P1 (red calls) with response times <15 min in urban areas % 51 47.8 66.9 65 P1 (red calls) with response times <40 min in rural areas % 43 54.7 68.9 45 Percentage of operational rostered ambulances with single persons % 20.5 18.7 20.9 10 2007/08 2008/09 2009/10 2009/10 Indicator Type Actual Actual Actual APP target EFFICIENCY Ambulance journeys used for hospital transfers % 22 24.2 20.2 40 E ASTERN Green-code patients transported as % of total % 37.2 37 37.9 60 C APE Cost per patient transported R 802.69 754 1235 950 D EPARTMENT Ambulances with less than 200,000kms on the clock % 97 92 69 100 196 - A - OUTPUT NNUAL Patients transported (by PTV) per 1000 separations No 24 17 11 35 R EPORT VOLUME INDICATOR 2008/09 Number of emergency call-outs No 479 263 392 916 354 927 650 000 Patients transported (planned patient transport) No Not reported Not reported 207 528 463 601 *EMS manages all PTVs and dispatches these to institutions as per need Table 3.3: Performance against Provincial Targets for 2007/08 – 2009/10 Strategic Plan for EMS Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output Improve access to Number of additional 51 60 110 46 Expiry of existing service vehicles to be EMS contract and E ASTERN procured, including delay in awarding of emergency medical new one negatively rescue vehicles affected achievement C of target APE Ensure availability of Number of critical Ad hoc tender on Two year aero- 139 105 Expiry of existing D adequate aeromedical patients transported aeromedical services medical service EMS contract and EPARTMENT services to the with the aeromedical was implemented – tender awarded: delay in awarding of community especially services patients airlifted new one negatively the inaccessible were not reported 139 critical patients affected achievement 197 remote areas of the airlifted of target - A - province Improve response NNUAL Percentage of red 51 47.8 55 66.9 Installation of a times calls responded to computerized call within 15 minutes of taking and dispatching R call system will EPORT strengthen reliability of EMS data 2008/09 Percentage of red 43 54.7 55 68.9 calls responded to within 40 minutes of call Percentage of all calls 78 76 75 76.4 This is attributed for responded to within vehicle shortages and 60 minutes staff shortages To reduce callout Percentage of 20.5 15 20 20.9 This is attributed to serviced by one-man rostered ambulances failure to employ new crew with one-man crew staff during this financial year Programme Performance Actual Output Actual Output Annual Target Actual Output Explanation of Objective measure/ Indicator 2007/08 2008/09 2009/10 2009/10 variance between target and actual output Number of new staff 753 55 Total = 258 9 new Staff were Budget constraints on employed BLS = 242 employed i.e CoE prevented Managers = 5 7 ALS and 2 managers further employment ALS = 11 of new staff E ASTERN Development, Number of vehicles 259 259 417 230 All 46 new vehicles management, fitted with satellite (including 46 new were fitted with C monitoring & tracking system 110 new vehicles) satellite tracking APE evaluation of the 307 existing system.