In South Africa responding to medical emergencies can mean risking your life, possible assault and losing some of your belongings.
The Covid-19 coronavirus pandemic has exacerbated and added to these daily challenges faced by paramedics. Melissa Javan investigates.
It’s 6:38am at Prinshof Ambulance station in Pretoria on July 10.
On the grounds two ambulances are parked, washed and sanitised for the day’s call-outs.
Later, after this shift, the vehicles will be sanitised again.
The same morning, an emergency call comes through to attend to an accident scene.
Spotlight’s photographer hops into the emergency medical services (EMS) car with two paramedics – Ernest Motswai and Jane Kekana.
They say they use the EMS car because they can get to an accident scene quicker, especially for smaller response calls.
At the scene, Motswai and Kekana help stabilise a pedestrian who was involved in a motor vehicle accident.
The patient was knocked over by a passing trailer. He is bleeding from his mouth and lost some teeth during the accident.
Later, during an interview with the two paramedics after the incident, a loud voice rumbles and crackles through the emergency radio.
It is clear from the interview that call-outs to scenes are often not as “uneventful” as this one.
EMS and robbers
Kekana says although the lockdown started off as quiet because people were not on the road much, things changed drastically when level 3 started.
She says motor vehicle accidents, assaults and gunshot incidents multiplied.
Another challenge, says Kekana, is that there are prank calls coming in.
“We would go out thinking it’s an emergency call … when we get there, there is no caller nor patient.”
She says sometimes when they go into a house (often during a prank call incident), they would return to their vehicle and it would have a break in.
“When you return to the vehicle, your belongings have been taken, like your cell phone, wallets, money or rings.”
The department has now installed a panic button and a tracking system in EMS vehicles.
“The manager can call the paramedic to hear if everything is okay, but the worry is that sometimes in certain areas, especially rural areas, the radio won’t have a signal.”
They often have to educate communities on what it is they do as EMS, says Kekana, and rely on communities to help keep them safe. “Some people don’t understand what EMS is about. They think it’s like SAPS [SA Police Service] – that we have guns on us.”
She says although they have done awareness projects in communities before the lockdown, it is difficult now to do it.
Gauteng Health spokesperson Kwara Kekana says between January and March this year there were six attacks on EMS officials, between April and June there were four, and in July there was one.
She says the attacks on EMS personnel impacts on the mental state and overall well-being of their employees by making them anxious while on duty.
It can lead to post-traumatic stress disorder.
“It also impacts on response times to emergencies due to delays in getting police to escort emergency vehicles.”
Kekana notes there are financial losses with every robbery, especially losses of personal items by staff.
To mitigate these risks, the Gauteng department of health made a series of interventions.
This includes discussions with local police and community policing forums and circulating guidelines to EMS staff on what to look for and to assess each emergency call for possible attacks.
She says the department continuously communicates with communities and citizens on various platforms.
Motswai says like many frontline workers, paramedics also have fears about Covid-19.
“It’s very scary. Covid-19 is everywhere – it’s difficult to tell if you contracted it from home or work. You just have to stay positive that you will be fine.”
A big part of their job is now to educate people on wearing masks. Matswai says they have to make sure people wear a mask before they get into an ambulance, and as a precaution EMS personnel always have spare masks on hand in case someone else needs it.
Motswai says under lockdown regulations, EMS personnel also have to deal with difficult family members.
“We have to inform families who want to jump in to go to the hospital with the patient that only one of them can join us. We tell them to bear in mind there are restrictions in the hospital, they don’t allow more than one person to accompany the patient,” Motswai explains.
“That family member can go to open a (patient) file but as soon as they’re done, they have to leave the hospital. The patient will be attended to and then that person can be the contact person.”
Kekana, a paramedic, says the risk of contracting Covid-19 on the job is big because when the paramedics arrive, patients do not disclose that they have Covid-19 symptoms.
“Only later the hospital will trace the paramedics once they have confirmed that the patient is Covid-19 positive.”
She says they don’t always wear full personal protective equipment (PPE) on calls because it can slow them down, but they wear their masks and gloves on all calls.
President of the SA Emergency Personnel Union, Mpho Mpogeng, says one challenge is handing over confirmed Covid-19 patients.
“It’s so difficult. We had a case where an ambulance worker was with a patient four to five hours. Doctors were running around (in the hospital). Our members were just sitting in the ambulance waiting.”
Mpogeng says at some EMS stations, there is no PPE.
Only when they voice their concerns, PPE will be delivered.
The union also wrote a letter to Health Minister Zweli Mkhize, raising concerns about some EMS stations that remain open and operating when a staff member tests positive for Covid-19.
“We find that members are working while the fumigation is done, the station is operating as normal while the place is being disinfected.”
Mpogeng says the minister hasn’t yet responded to the union’s letter.
Up close and personal
Motswai says it is impossible for paramedics to practice social distancing.
He explains this is tough to do, especially when they suspect the patient has broken bones.
“There isn’t much social distancing happening when the paramedics are attending to a patient. Social distancing goes off your mind … One of us is holding the patient’s head, another is busy with the feet … We work together as a team. Like if someone has a broken extremity, someone has to hold the patient in line.”
Kekana says 134 EMS staff members in Gauteng have tested positive since April 2020.
“A plan and contingency were put in place for the eventuality we currently face, so the impact is manageable in line with operationalising the plan.”
Private Emergency Medical Services
SA Private Ambulance & Emergency Services Association chief executive officer, Oliver Right, says a shortage of hospital beds has been a key challenge during lockdown.
“Hospitals are becoming fuller as the infection rate increases. Out of 30 to 40 hospitals within a metro area, 10 to 12 are available. For a rural area, out of ten available hospitals, two or three might be available. It varies.”
Right says the shortage of hospital beds is a concern because the ambulance has to drive further to find an available hospital.
“This means they are taking care of the patient much longer [and] they are at increased risk of being infected because the ambulance has a small confined space.”
Right says another challenge is the costs of PPE.
“We’re strict about using PPE, because our members are being protected by PPE. The cost of PPE is expensive and very few medical aid schemes cover the utilisation of PPE.”
Right says none of his members has tested positive for Covid-19.
*This article was produced by Spotlight – health journalism in the public interest.