[MUST-READ] Emergency care: Life support or hindrance

Following the treatment of a patient on an Amanzimtoti beach last weekend who had suffered suspected neck injuries, the Sun has embarked on the first of a series of articles about what patients can expect by way of standards in emergency medical care.

Part one of the series was featured in this week’s South Coast Sun print edition, after local emergency healthcare professionals questioned the response of two basic life support (BLS) paramedics who responded to treat the injured commodore of Warnadoone Ski-Boat Club, Glen Jansen (58).

He was injured when retrieving a boat from the sea when the roof of the tractor collapsed and fell on him during a fishing competition on Saturday afternoon, 14 April.

Kingsway High School intermediate life support (ILS) paramedic, Chris Botha said BLS paramedics cannot work alone and have to be supervised by a higher grade of practitioner.

“A BLS paramedic has to be backed up by an ILS or ALS,” he said. “There are quite a few ambulance services operating in the area with only two BLS paramedics on board.”

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Botha said the public should know their rights in terms of patient care in an emergency. The public can choose which ambulance service they wish to use. Paramedics must display their name, Health Professions Council of South Africa (HPCSA) number and qualification. They also have to carry their HPCSA registration certificate to be able to prove they are currently registered. Paramedics apply for this certificate annually.

“People must also look at the ambulance service’s name and ensure it is the same company which bills you,” said Botha. “There was an incident when someone was billed by a completely different company. You have the right to complain. It is a rat race out there. You have the right to be treated by a qualified person and to receive proper treatment. It is your life or your family’s lives in their hands.

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You don’t have to accept medication, such as pain medication, if you don’t want it. That is how they escalate your bill. You can pay about R800 for BLS but if they use morphine, your bill may run into the thousands. And it is often unnecessary. If a service transports you when you asked not to be, it is abduction.”

Botha said he has seen up to eight people being crammed into one ambulance. “How can one medic treat eight people effectively? There are only two stretchers per ambulance. Where is your privacy? You are entitled to patient privacy.”

There is suspicion that ‘fly-by-night’ ambulance services pay people to call them when they learn of an accident or incident, so that they can be first on the scene to treat and bill patients.

A patient is entitled to ask at a scene how an ambulance service’s billing works and what it will cost them. Billing among the larger networked services are regulated by the Board of Healthcare Funders of SA but the smaller services aren’t governed by these. “I know of an incident where a patient was charged R7,500 to be transported from Lower Illovo to RK Khan Hospital without receiving any ALS treatment. The public doesn’t know they are allowed to choose their medical provider and they have the right to ask how much their billing will be,” said ER24’s Jannes Prinsloo.

Botha had also heard of certified first aiders with rescue equipment responding to assist at accident scenes in Toti, which is illegal.

So what treatment are the different grades of paramedics allowed to offer you?

* A BLS can stop bleeding, splinter a fracture, apply oxygen, immobilise you on a spinal board, check your blood pressure and pulse, and assist with an emergency delivery.

* An ILS can do all the above plus put up an intravenous drip, use nebuliser medication, use cardiac monitors and give intravenous medication.

* An ALS can do all the above plus give pain medication, sedatives and paralytics, and put you on a ventilator.

“You do not have to have medical aid for paramedics to treat you at an accident scene. If your injuries are life-threatening, they will treat you at the scene and transport you to the necessary hospital.