Draft Clinical Practice Guidelines

England has 23 519 registered paramedics, servicing a population of 65 111 143.  That is one paramedic per 2 768 members of the English population.

In 2011, the USA had 229 454 paramedics servicing a population of 311 700 000.  That is one paramedic per 1 358 members of the USA population.

In October 2016, South Africa had 1 586 ANT paramedics registered with the HPCSA, 468 ECP providers registered with the HPCSA, and 1 082 ECT providers on the register.  That is a total of 3 136 advanced life support providers registered to service a population of 55 900 000 South Africans. This equates to only one ALS provider per 17 825 members of the South African population.

Clearly South Africa has a very serious lack of ALS providers, and too few registered institutions capable of providing ALS training. Essentially, with the current number of graduates that are produced by our existing ALS training institutions, and the number of ALS staff either retiring or emigrating on an annual basis, it will be impossible to increase the number of ALS staff members to a point where advanced life support care is consistently available throughout South Africa.

What is urgently needed in South Africa is a proactive vocational training approach in order to ensure that existing BLS and ILS providers receive further training in order to boost our ALS staff numbers.

In sharp contrast with that need, the draft Clinical Practice Guideline document that was released by the Professional Board for Emergency Care has proposed that our existing ANT staff complement should have their skills downgraded, and be limited in the care that they are able to offer to the South African population.

SAPAESA, working alongside a group of diverse and talented practitioners at the Clinical Practice Guidelines Advisory Commission recently composed and submitted a very detailed submission on the draft Clinical Practice Guidelines to the Professional Board for Emergency Care as well as the Department of Health.

The submission suggests that instead of the proposed downgrading of certain key ALS skills for ANT providers, these providers should instead undertake additional vocational training in order to upskill themselves so that they are able to provide additional ALS skills to the South African population.

This would ensure that our EMS system does not collapse due to a shortage of staff members that are the only providers available to undertake the numerous primary medical emergency cases and critical interfacility transfers that occur on a daily basis all over South Africa.

It is important for both the HPCSA and the Department of Health to remember that South Africa is terribly short of both ALS providers and ambulances, in comparison to a number of first world countries with more established emergency medical service systems.

In order to avoid a complete crisis within the emergency medical services, the Minister of Health must intervene; to ensure that our industry develops, instead of degenerating into a complete public service failure.

One thought on “Draft Clinical Practice Guidelines

  1. Wel said.

    But From prior experience, I think that government is going about this the wrong way.
    Asside from the lack of In duty training and further development.

    Instead of just removing the existing short-Course route, they should implement scope enhancement programs for existing personnel. Especially BAA and AEA personnel.

    If we want to improve the Emergency Medical Field in our Country, I believe the best way is to Implement Scope enhancement Short Courses to existing BAA and AEA personnel.

    According to the Health Profession Council of South Africa the most recent data show us that:

    BAA- 54943 Personnel are still registered (Active) Health Care Providers

    AEA- 9911 Personnel are still registered (Active)
    Health Care Providers.

    This Shows that the largest percentage of the existing workforce are the Short Course Personnel. The largest percentage of these providers, can not afford to enrol for further Education and Professional development. Especially due to lack of funds from their low Annual Income. BAA personnel (Especially/Specifically in The Private Sectors) get a Monthly income of Around R5200. 00 in Total. And AEA personnel get a Monthly income of around R9000.00 After Tax, Unemployment Fund, etc have been deducted. These providers also have families, children and other living expenses. Leaving either – none, to insufficient Funds/Savings for further proffesional development and education.

    And if the funds were made available, these providers cannot afford to take leave from work, to enrol in full-time studies for neither 4 Months AEA (Currently Still Available) , 9months CCA (No longer Available) , 12 months ECA (New) , 24months ECT (New) nor 48months (4 Year Bachelors Degree). Due to their responsibilities and lack of education (Minimum Requirements – NSC Subjects [Mathematics, Biology, Physics] for Advanced Life Support Qualifications) amongst other requirments).

    Implementing university qualifications will not Be helpfull to the largest percentage of the existing workforce . Discontinuation of the short Course route has now developed the following Problems,
    -Inability To Continue Development to the Largest Percentage of providers
    -Continuation in Lack of Higher Qualified Personnel in EMC.
    -Qualifications resulting in a Lower Scope of Practice but Higher Course Duration. Increasing the lack of Higher Qualified Personnel and Treatment Required in The country.
    -Decreasing Job Opportunities for Existing Providers
    -Decreasing Emergency Care Personnel due to lack of Tertiary Institutions resulting in Lower ammounts of students yearly.
    -New Qualifications are to expensive to obtain causing existing personnel to either leave the Emergency Medicine Field or Stay. Resulting In more Providers with insufficient training and Scopes. Degrading the Quality of Healtcare in South Africa.

    My Proposition – (Motivated by The opinion of other Providers):

    Short Course – Scope of Practice Enhancements:
    Enhanced Personnel Identification.
    For BAA personnel:
    -Intervanious Intervention
    -Additional Drugs (ex. Pain Medication)(Via I.V)
    -Additional Rescue Prosedures (Similar to AEA)
    -Semi-Automatic Defibrillation
    -Basic Electrocardiogram Interpretation
    -Enhanced Biology (NQF 3)(Obligated to Do Before Further Scope Enhancement)

    The foreign country’s use their Identification as such: (example “EMT 1-2-3 etc”).
    Identification of These Personnel can look similar to the Foreign EMT identification:
    BAA 1-2-3 or BAA (B) -(i) -(A)
    AEA 1-2-3 or AEA (B) -(i) -(A)
    (Basic, Intermediate, Advaced)

    For AEA personnel:

    -Enhanced Rescue Prosedures (Intubation etc.)
    -Additional Drugs
    -Biology (NQF 4)(Obligated to do Before Further scope enhancement)
    -Advanced Electrocardiogram interpretation etc.

    AEA Personnel should have a Scope similar to the previous CCA Personnel.

    Implementation:
    Each of these can Either Be conducted as a 1, 2, 3 or 4 Week Full-time Short Course. And The Theoretical Learning Modules can Be implemented as Distant Learning, with exams at Designated Training Facilities. As HPCSA Accredited Courses, After the Completion of Each Enhancement Course the Providers Have to Update Their Registration at the Health Profession Council of South Africa. In which they will be Granted the right to Provide Health Care within Their Additional Scope and Assigned Scope Enhancements.

    These Enhancements will also Increase profits of Existing Training institutions, Especially to those tertiary facilities whose main income was generated from providing these short courses. (Asside from ensuring continuous growth in further education and professional development. And echonomical growth generated from tertiary qualifications/training and facilties , by providing income to uphold and expand existing facilities in the country).

    Only By Implementing such a System will the Quality of the Current Emergency Medical Personnel and Supply of Higher Qualified Personnel be Present. Provide a sufficient Development Of Emergency Medical Care and Its Personnel.

    Resulting in Increased Job opportunities for Existing Personnel. Preventing Unemployment of Current personnel who can not undergo Further Education and Development, due to Unfortunate Changes to the Law and Education in the Field of Emergency Medicine in South Africa.

    Such Proven by The Oversupply of BAA personnel that lack the necessary skills to render sufficient Patient Care and Life support in Numerous Circumstances that Required – Minimum Intermediate and Advaced Life support: Training, procedures and Personnel.
    The same Goes Vise versa.

    This will Decrease Casualties in the Field, due to the Lack of Personnel and Certain Skills Required, It will undoubtedly Enhance The Field of Emergency Medicine in South Africa. Aswel as Contribute to the lack of Educational Development In the County. Enhancing The Annual Income of These personnel, improving living conditions throughout the Country and Facilitate Echonomical Growth in South Africa.

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