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QUARTERLY MAGAZINE

ISSUE 2 – JUNE 2018 | WWW.ER24.CO.ZA

MAKE IT YOURS

Front line training for those protecting our RHINOS

FLIGHT OR WRITE Medic Johan does both FIND US ON


IN THIS ISSUE Front page stories 4

Obsessing over flight medic Johan

Johan van der Berg, an ECP at ER24, has recently given his writing dreams wings.

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Front line training for those protecting our rhinos

Company interest 32

Lifesaving ER24 partnerships

Clinical 30

Kidney function in epic events

Awareness 22

Malaria: A risk too big to ignore

“We were under the impression that he had flu. All of a sudden, within a few days, he was in the hospital and shortly afterwards in a coma...”

24 Hypothermia: Stay warm this winter 33 Don’t let it leak into your home


ER24 staff 16

A new degree led Heinrich to save lives

“I worry about him, but I also know that he loves what he is doing. I just stay on my knees and I pray...”

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Never off duty

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Then I can cry

ER24 events 26

IN PICTURES: ER24 out and about

From the opening of the new helipad at Mediclinic Midstream to the successful 2018 KAP Subaru sani2c event held in KwaZulu-Natal.

20 Yolandi’s special day at the beach 21 ER24 takes part in the Cape Town Beach Cleanup

CONTACT:

Email: communications@er24.co.za Tel: 086 108 4124 Web:https://er24.co.za Emergencies: 084 124

DESIGN AND LAYOUT: Mediclinic Design Studio Ineke van Huyssteen

COPY COMPLETED BY:

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The next edition of Priority One will be published at the end of the third quarter of 2018.

Content for consideration may be sent to ER24 Communications Department by any staff member or client. Send content to communications@er24.co.za


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OBSESSING OVER FLIGHT MEDIC JOHAN Only after having no more reasons why not to do it, did Johan van der Berg (left), an Emergency Care Practitioner (ECP) and currently working as a flight paramedic for ER24’s helicopter service, put pen to paper and start his lifelong dream to become a published author.

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On the 26th of April 2018, his first book titled Obsessions was published by Pegasus Publishers. The process of writing took 7 months, but from the start of the writing to the date of publish took almost two years. Johan is an Emergency Care Practitioner (ECP) and currently working as a flight paramedic for ER24’s helicopter service. “My job involves treating critical patients and taking care of some of the managerial tasks for our helicopter service. As a team, we run the unit and Gareth Staley (ER24’s Gauteng Regional Manager) oversees us,” said Johan. Johan is also part of the ER24 Clinical Committee and the ER24 Young ECP mentorship programme. Apart from his ER24 responsibilities, he is also an ICU Strategic Tutor for the University of Johannesburg (UJ) and has also applied to do his MPhil in Emergency Medicine next year. Although Johan’s passion for medical care is evident, his book isn’t about the medical service industry. Although looking at the front cover image, you might initially think otherwise. “The story is fictional and largely about a serial killer. From a young age, I’ve had a vivid imagination, and I’ve always liked books that fall either under the thriller or fantasy genre. The Hannibal series written by Thomas Harris and the Harry Potter series by J.K. Rowling remains two of my firm favourites,” said Johan. Spot the difference The book Obsessions is written under the pen name of Johan Parker, but this is still Johan van der Berg. Johan explains that during his university career at UJ his writing was mostly dedicated to scientific writing. He even received an award for his research and presented at the University of Johannesburg Research Symposium. “I wanted to draw the line between Johan, the science writer and Johan, the fictional writer. I, therefore, decided to use the pseudonym Johan Parker for my creative writing.”

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Finding balance Johan, who has been employed by ER24 for almost four years, explains how he managed to balance being a paramedic during shifts and a writer during his off days. “Balancing my work and writing has been quite a comfortable process. Because we work shifts, it makes it easier to plan, and I would mostly write on my off days,” said Johan. The only balance it did disturb, was his relationship with his wife Charné, also an ECP at ER24. “When Johan and I started dating back in 2015, while I was a 3rd year ECP student, he told me that one day he’d like to write a book. Initially, I thought it was just a phase, but Johan started spending a lot of his free time writing, which limited our time together as I was also very busy at university,” she said. “The writing did come between us a little,” Johan said laughing. “On the days I was off from work, I was writing all day, and this meant I couldn’t spend my free time with her. Luckily, she has been very supportive throughout the whole process.” “I thought his book became an obsession, hence the title of his book. However, I believed in him and knew he could do it especially after I started reading the prologue and the first few chapters. I decided that time is a small sacrifice to make,” said Charné. The realisation Johan initially kept his book writing under wraps. Only after he got a publisher did he tell his friends about his new venture. “When I received the book it was such a great feeling holding it in my hands. Only when I could physically touch the book did the realisation kick in; the work was done, and it is mine,” said Johan. “Even though people doubted him, he persevered and followed his dream. I am not the biggest fan of reading, but his book was so captivating that I ISSUE 2 - JUNE 2018 | PRIORITY ONE |

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couldn’t stop reading it. I am even more amazed and intrigued by his imagination now than I ever was. Being in the EMS, I know how limited time is and how tiring shift can be. I will continue supporting, encouraging and loving him until death do us part,” said Charné. The future for Johan Parker “While writing the book, my imagination was my only limit. I could do whatever I want, create the characters the way I see them and let the story flow how I saw it happen in my mind. “Creating your own story is a journey, one that I enjoy more than reading. I don’t think I’ll be able to work in the medical field forever. My dream is to be a full-time author and have the world read my stories,” said Johan. *Obsessions is the first book in the trilogy, and Johan is hoping to have the sequel titled Confessions written by the end of the year. **Obsessions is available online from Amazon.com and through Pegasus Publishers.

TOP RIGHT: The front cover of Johan’s book. BOTTOM: Johan chatting with some of his fellow ER24 colleagues. His wife Charne is standing on the right.

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ER24 GLOBAL ASSIST

ADVERTORIAL

Patient safety in aero-medical care, are we doing enough? initiatives at ER24 Global Assist. In order to ensure patients received, the safest, most reliable care, we needed to move beyond a mechanical type environment with checklists to an integrated Quality Improvement programme which embraced the opportunity to provide compassion, dignity, discussion and empathy for our client base. Our programme thus includes a culture of safety, adverse event management, medication safety, teamwork and communication, Trigger Tools, and much more. For example weekly safety meetings/ team interactions, combined safety training and attending crew resource management sessions. We have a confidential reporting system for adverse events, and the emphasis during our reviews has shifted from a traditional model of blame to that of a just culture. Following adverse events where a trend is identified we have taken to releasing patient safety alerts internally. The very nature of our emergency business leads itself to adverse events, the human factor ever present. Examples of recent adverse events include dispatch delay and medication error. Although we receive less than 1% of call volume as adverse events, less than international trends, we take every reported incident seriously, the ultimate goal being to conclude our investigation and implement improvements to avoid a recurrence of such events. One such example is a recent adverse event where an opioid analgesic was used in place of Adrenaline (Epinephrine) in an infusion. Fortunately without any adverse effect for the patient. As a result thereof, all schedule analgesics are now kept in a separate pouch inside our drug bags, and resuscitation drugs are readily accessible. A small change as a result of patient safety reporting systems being implemented. We have developed trigger tools to

further support our passion for patient safety. These are our red flag incidents as well as prospective triggers to evaluate the health within our environment and these are reported monthly. Clinical cost efficiency is critical to sustain our business. We must strive to provide the best possible care while managing costs in order to keep our exceptional clinical reputation, in a cost sensitive environment. Clinical indicators such as response times (a 2 hour activation time for international air ambulance cases subject to clearances and other logistical challenges), intubation (> 80% first pass intubation success) and intravenous insertion success (99% inserted

in less than 3 attempts) are proudly equivocal to the best in the world. We have researched and acknowledge that mechanical ventilation is the gold standard for all our intubated and ventilated patients, hence we have invested in the best equipment to empower our team to do their best clinically, examples include the Hamilton T1® ventilator, Draeger®Oxylog 3000 plus and Zoll/ Phillips ECG monitors with invasive pressure transducing and 12 lead ECG capability for cardiac/ haemodynamic monitoring, and point of care arterial blood gas monitoring. Our neonatal successes should be celebrated: Our smallest baby transported by our speciality neonatal team weighed just 500g and we were able to initiate high flow ventilation. We re-intubated 6% of our babies due to blocked or inappropriately sized tubes, and subsequently began weaning high percentages of oxygen (which is toxic in premature neonates) in the majority of our babies. So where to next for patient safety initiatives at ER24 GLOBAL ASSIST? Our goal is always to achieve and then to maintain or exceed our standards. We have international accreditation via NAAMTA, an achievement we are proud of, that will take significant effort to maintain. We have installed state of the art software in our Contact Centre to ensure a faster, more accurate dispatch to any emergency with additional clinical resources to ensure our staff understand patients’ emergencies. The foundation for reviewing quality clinical performance has been achieved at ER24 Global Assist, our next step is to automate our reports, research and present our findings internationally. Feel free to contact our Chief Medical Officer, Dr Robyn Holgate, on robyn.holgate@er24. co.za should you wish to discuss this further.

WORLD-CLASS CLINICAL CARE IN AFRICA AND ABROAD ER24 Global Assist is uniquely positioned to provide end-to-end integrated healthcare solutions worldwide. 0581MFCS

Patient safety forms the basis of any clinical quality performance review nowadays. Since the 1999 report by the Institute of Medicine (USA), titled “To Err Is Human,” which estimated that as many as 98,000 patients die annually from preventable medical errors, many hospital based health care providers are focusing on improving patient safety efforts. Growing financial pressures globally are forcing us to re-examine how we can better provide improved value in aviation medicine. These trends of more affordable service delivery are becoming the new norm. In light of these cost constraints and affordable health care solutions, are we doing enough to promote patient safety and clinical quality in the aero-medical environment? A small error in judgement could change the health of a country, hence it is critical that we implement systems within our aeromedical environment to keep our borders, healthcare providers and our patients safe. The health care sector initially looked towards the aviation industry to assist and implement checklists for our patient safety initiatives. No doubt checklists have been instrumental and invaluable in assisting us to achieve our patient safety goal of preventing human error in health care. Examples include Emergency Medical Care and Resuscitation checklists and the recent surgical safety checklist by the World Health Organisation. In our own aero-medical environment, we have implemented checklists to manage equipment, preflight, inflight and post flight checks and these checks have decreased the incidence of near misses. I recall a flight many years ago where I forgot the monitor, forgivable at 2am? Fortunately the flight was without incident. Checklists, discipline and teamwork that we have adapted have formed a critical part of all our patient safety


NEVER OFF DUTY

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hen medical professionals are on leave or even taking a sick day, they are never merely off duty. A medical emergency may arise at any time. ER24 paramedics have on multiple occasions either come across an accident scene or been in the right place at the right time when someone needed medical help. Suzanne Olivier an Advanced Life Support (ALS) medic from the ER24 Vaal branch experienced exactly this on 1 May 2018. Suzanne was off sick and catching up on administrative work. Her partner, Dawie Oosthuizen, who works as an ALS for Volupta anotherdoluptam, medical idel service, just stopped at their home in a gated complex in Vanderbijlpark to check up on her. invellature, picipsa eptatiam. A few minutes later, they heard a knock on their door. “We opened the door to see a young boy standing in front of us. He looked very panicked and scared, and I could sense something was wrong. He asked if this was the apartment where the paramedics lived and immediately we said yes.

He then told us that a young man was having a stroke and if we could please assist,” said Suzanne. Suzanne and her partner immediately rushed to the home where they found the 19-year-old lying on the couch completely unresponsive. From there they moved him to the floor so that they could assess him better. The 19-year-old was in such a critical condition that Suzanne and Dawie decided to call an emergency medical helicopter to airlift him to hospital. After treating and stabilising him in his home, he was transported in a critical condition by ambulance to the waiting medical helicopter. “Even when you are booked off sick, in a situation like this your body and mind immediately goes into help mode. You know someone needs help, and you try and see what you can do for them. I also feel grateful that my partner and I were at home during this time and that together we could offer much-needed assistance,” said Suzanne.

Volupta doluptam, idel invellature, picipsa eptatiam. Suzanne Olivier and her partner Dawie Oosthuizen.

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Advertorial

WHEN NAMOLA NEEDS NAMOLA

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eing part of the Namola team, we get daily job satisfaction seeing how many people across South Africa we are able to #GetHelpFast. It’s a very personal job, as one is constantly thinking about how the person in trouble could one day be you. That one day came on a sunny Saturday morning for Namola Team member, Siobhan.

they were still concerned about the child and requested the paramedics still come to the scene. “It was great not to need the pre-arrival service that the ER24 medically trained professional offered me over the phone, but it was such a comfort to know that had I needed to perform CPR or offer any medical assistance myself, a qualified medic was on the other end of the phone to talk me through it.”

Siobhan was used to hearing screams of delight from her neighbours’ kids as they swam in the pool, but when she heard her neighbours shouting for help she knew that there was something terribly wrong. “A child drowning is any parent’s worst nightmare. So, when I heard them screaming about a child who had fallen in the pool, I grabbed my phone before I ran over to their house. On my way I opened Namola and requested assistance”, says Siobhan. “The Response Centre Agent called me within seconds and I requested an ambulance.” The Namola Response Centre Agent dispatched an ER24 ambulance to the scene.

ER24 also dispatched a vehicle with Advanced Life Support (ALS) system aboard. “The vehicle got there in 12 minutes from the time that I made the call,” says Siobhan. “The ambulance got there about 4 minutes later. This is a great service from ER24 which is very reassuring in the case of very serious incidents like possible drownings.”

“ER24 were great,” says Siobhan. “They phoned me minutes after Namola had logged the call with them. They said that they were 20 minutes away and asked me if I needed pre-arrival medical assistance.” Luckily when Siobhan arrived the parents had managed to resuscitate the child, but not knowing how long the child had been in the pool,

The little girl was checked out and had luckily sustained no injuries. “There is no time to waste when a child is in distress,” says Siobhan. “I am so glad that I knew how Namola worked and how to use it quickly. Even though all of our employees work with Namola on a daily basis, we encourage them to test Namola. We want to make sure getting help fast is a habit.” Namola will ensure that you #GetHelpFast every time. Be prepared, download Namola for any emergency.

Volupta doluptam, idel invellature, picipsa eptatiam.

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FRONT LINE TRAINING FOR THOSE PROTECTING OUR RHINOS Safeguarding and protecting our diminishing rhino population from poachers is of utmost importance, but so is the safety of our rangers braving the battle from the front line.

The training is also specifically adapted for the rangers to best suit the first aid requirements they may have.

his is why ER24 has, since 2016, collaborated with Stop Rhino Poaching to offer Tactical First Aid Courses for the rangers that work in high risk and hostile areas.

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Peter explains further that, “many of the commercially available courses cater for the domestic standard requirement, whereas ER24 has the tactical component that is offered by the ER24 - ERT (Emergency Response Team) section, who specialise in the development and facilitation of speciality training where tactical medical training is required.”

ER24 has, up to this point, trained more than 300 rangers and more courses are scheduled locally and internationally for the remainder of 2018.

The training has proven valuable as there have been a number of cases where rangers have been required to use their newly acquired skills in real-life incidents.

Peter van der Spuy, ER24’s General Manager of Quality Assurance and Support Services, who has recently returned from one of these training courses, further explains ER24’s involvement.

“The rangers have been involved in many incidents posttraining, and I can report that the outcome has been effective as a result of the training,” said Peter.

“ER24 provides the speciality training (tactical first aid) to the rangers for emergency first aid in a hostile or high risk environment. The training is very flexible and is normally presented in the respective wildlife parks to keep the training relevant to the environments in which the tactical first aid will be utilised,” said Peter. Training includes a classroom-based element as well as in-field realistic simulations and evaluations. “The students cover all the required first aid requirements and have the additional tactical medical training incorporated into the scenarios. They also learn about emergency action drills, early activation, and communication skills for the request of appropriate resources,” said Peter.

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Further to the initial training, ER24 also assists the rangers in other aspects. “There is a system for the provision of consumable stocks that are used in-field, from the tactical first aid kits that are issued to the rangers that have completed the training, all of the replacement stock is provided by Stop Rhino Poaching and controlled and managed by ER24 – ERT. We also have a few extended programs that we render assistance to Stop Rhino Poaching and the support of the orphaned rhinos,” said Peter. ER24 proudly supports the fight against rhino poaching and we salute the brave rangers across South Africa.


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ABOVE: The training is very flexible and is normally presented in the respective wildlife parks to keep the training relevant to the environments in which the tactical first aid will be utilised,” said Peter van der Spuy, ER24’s General Manager of Quality Assurance and Support Services.

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ABOVE: ER24 has, since 2016, collaborated with Stop Rhino Poaching to offer Tactical First Aid Courses for the rangers that work in high risk and hostile areas.

ABOVE: The training is also specifically adapted for the rangers to best suit the first aid requirements they may have. The training has proven valuable as there have been a number of cases where rangers have been required to use their newly acquired skills in real-life incidents. Here the rangers are using a simulation doll as part of their training. ISSUE 2 - JUNE 2018 | PRIORITY ONE |

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Heinrich Africa, an Advanced Life Support (ALS) medic at the ER24 North Metro branch in the Western Cape.

A NEW DEGREE LED HIM TO SAVE LIVES 16

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ine years ago, Heinrich Africa enrolled at the University of Stellenbosch as a student specialising in BSc Mathematical Science. His dream at the time was to use his degree in the field of Computer Programming to create new software. But today, Africa only finds himself behind a computer when he is not on the road responding to a medical emergency or saving the lives of those who find themselves in life-threatening situations. At the age of 17, Africa was selected as one of roughly 15 students from Malibu High School in Blue Downs to study towards the dedicated field of Mathematics. This opportunity arose after he performed exceptionally well in higher grade math during his high school years. “Mathematics was a subject I enjoyed. I did fairly well in academics at school, although I never did any homework,” Heinrich said smiling. Presently, the 27-year-old saves lives in a red flight suit as an Advanced Life Support (ALS) paramedic at the ER24 North Metro branch that is located at Mediclinic Louis Leipoldt in the Western Cape. It wasn’t his impressive academic skills that paved the road to his ER24 paramedic journey, but a burning desire to work with people from all walks of life. After completing high school in 2008, his plan was to use a tertiary qualification in a computer environment so that he could eventually create his very own computer or PlayStation games.

Today Heinrich and his aunt often save lives together when he arrives at the Emergency Care Unit with patients who urgently need medical assistance. Heinrich is also one of two children who both seem to have a strong relationship with their mother, Wilma Africa. The close-knit family of three live together in Forest Heights in Eerste River and it is evident this is where the three of them spend their mornings and evenings together, supporting one another in their different fields of work and study. By qualifying as a paramedic, Heinrich has been his younger brother Jason’s motivation for pursuing a medical career. Currently, the 20-year-old Jason is a BHSc Medical lab science student at the Cape Peninsula University of Technology (CPUT). Wilma says that even as a child, she could see that Heinrich had an immense love for people and that this was something that only grew stronger over time. “When he worked at King Pie in the mall, we thought that he would think it as some form of punishment for not studying, but he enjoyed it. Everybody in that mall knows him. We can’t go to the mall with him because everyone we walk past will stop and greet him.”

… I worry about him, but I know that he loves what he is doing.

But Heinrich only studied for a few months when he could no longer avoid the inevitable - he knew that he could not spend his life working behind a computer. As much as he enjoyed the challenge of creating innovative software, he still wanted to help and work with people. “After deciding that I was not going to continue my studies, I worked at King Pie for about two years and that’s where I gained a lot of interpersonal skills. I always say, once you’ve dealt with a hungry customer, you can pretty much deal with a dying patient. It can be a very similar situation,” Heinrich said while laughing. Heinrich’s parents are not medical professionals, so when he entered the world of medicine he actually decided to follow in the footsteps of his aunt who is a nurse. He registered for a Bachelor of Emergency Medical Care at the Cape Peninsula University of Technology (CPUT) after working for King Pie.

Wilma is proud of Heinrich for qualifying and working hard as an ER24 paramedic because at first, she was concerned that he might not be able to deal with what he was going to be seeing every day. “I’ll never forget the day he told us he wanted to do something in the medical field. He said he didn’t want to be a doctor. At that moment I thought to myself, what is this child going to do? Then he said, I want to be a paramedic and all I could see was blood,” said Wilma. Wilma says she knows that being a paramedic is more than just a job for her son because it truly is his passion. “I worry about him, but I also know that he loves what he is doing. I just stay on my knees and I pray,” said Wilma smiling. Heinrich’s video is the first episode of ER24 ‘Who Is’ Season 2. The first series can be found on ER24’s YouTube page. To watch ER24’s video on Heinrich, scan the QR code or visit https://youtube.com/er24ems

His aunt, Melanie Goeiman, is also the Emergency Care Unit Manager at Mediclinic Durbanville and Heinrich says it is her hard work and determination that ultimately led him to seriously consider working in the emergency medical services industry. “I saw how my aunt saved my uncle’s life. He suffered from asthma and growing up I remember that my aunt always knew what to do to help him,” said Heinrich. ISSUE 1 – JUNE 2018 | PRIORITY ONE |

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THEN I CAN CRY

A poem submitted by ER24 Medic ALAN RUDNICKI

Alan Rudnicki, a medic from the ER24 West Metro branch. Alan has been a medic in the EMS for the past 28 years.

We choose our career for many reasons. From day one we know it’s chosen us. It’s not just a job; it’s not merely a career; it’s a passion, our passion. No day is the same, no patient is the same, no scene is the same, but we handle it. It’s not normal for a human being to be exposed to daily sadness or tragedy, but somehow we manage. No routine shift; no routine breaks - grab food, junk food mainly at any given opportunity to take that break. Why do we just swallow our food, why don’t we chew and enjoy it like “normal” human beings? It’s our life; it’s our lifestyle. “Organised chaos” has popped up many times before. We become immune to the sights we see. “How can you show no emotion?” I have heard before...It’s our way of coping, our coping mechanism. If it weren’t there, we wouldn’t be able to do it. “What do you earn?” I’ve heard too.. it’s not about the money. I don’t do

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this job, this career for the money. Yes, I’d love that double storey house along Millionaire’s Paradise over-looking the ocean; Yes, I’d love that sports car with pop up lights and a spoiler on the boot... But what matters to me is I’m happy, I love what I do; I appreciate life and don’t take things for granted. I survive; I live, I’m happy and healthy. Tragedy strikes so many people daily, some of us cope just fine, others can’t. But we are a family, brothers and sisters of the Emergency Medical Services (EMS) who somehow and amazingly do cope. We have to... On a scene we can’t show emotion, we focus on that one thing and that one thing only...our patient; knowing full well they might not make it or telling the family their child is dead. You may see us smiling or joking around after completing a very sad call; no we

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aren’t heartless, it’s just who we are and how we cope. “Cowboys don’t cry” has slowly faded over years where it was “normal” not to show emotions on scenes or around loved ones who have just lost someone. We are human after all, not robots and just sometimes we need that cry; that chat with colleagues. It’s become a cliché that “the public won’t understand” and maybe that is true. It’s difficult to explain. We love our paths in life we chose, our careers. We seem emotionless at the carnage, smiling near tragedy but it’s who we are and that much used “coping mechanism”. We aren’t heartless; we do care - we care a lot. Our main concern is the well being of that stranger trapped in a car or that homeless person lying on the wet streets on a freezing night after collapsing due to not being able to eat.


We care for anyone come rain or shine. We tend to victims out in the elements, nature testing us with torrential rain; drenched to the bone in our uniforms; cold; tired and hungry. But it’s our patient we need to worry about first. They need us; they need our help...we can eat later; our clothes will dry. We cope with stress; we cope on empty stomachs, we cope cos we do. Our job; our career, our path we have chosen isn’t easy; it isn’t always pleasant, it isn’t the best-paid job, but we don’t care because at the end of the day we can go home and say “I saved that person’s life”...A feeling that cannot be described to anyone who hasn’t experienced it. Even though that same day you declared a 2-year-old boy gunned down by a stray bullet or the 95-year-

old granny that fell down the stairs while out shopping and won’t walk again for a long time, due to fracturing her pelvis and now is too unstable to undergo an operation. Or the teenager overdosing on tablets because he had an argument with his girlfriend.

been killed the previous night in an accident, but we still have to carry on - this shows that we are somehow ‘chosen’ to do this. You carry on knowing that just yesterday you spoke to him and now he’s no longer here, but we carry on.. .somehow we carry on.

The stress of getting to scenes where the public doesn’t move out of our way, and sometimes deliberately. But we keep our thoughts to ourselves and not scream and curse to the selfish driver. No, we don’t abuse lights and sirens, but public tend to think we do. It can sometimes be a thankless job, but we don’t take that to heart. It’s the career and our passion which chose this path for us. To see happiness even if once a day makes it just that little bit worth it.

Why didn’t I choose that Monday to Friday desk job with little stress and have every weekend off; like “normal” people...well...I’m not normal...I don’t want that normal job. Appreciate life and live it; is all that matters. I get to see almost daily how fragile it can be and one can be taken away in an instant. And then you are no more... When I get home from shift... THEN I CAN CRY.

AND THEN to be told a colleague has

FIND US ONLINE CONNECT WITH ER24

To find out more about ER24’s offerings online, including the latest news and products, you can find us on the following platforms:

facebook.com/er24ambulance

twitter.com/er24ems

instagram.com/er24ems

youtube.com/er24ems

soundcloud.com/er24ems Volupta doluptam, idel invellature, picipsa eptatiam.

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YOLANDI’S SPECIAL DAY AT THE BEACH

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olandi Uys (38), who resides in Ermelo, has cerebral palsy and had never been to the beach. Seeing the beach and feeling the water on her skin had always been a dream of hers. On the 9th of March this year, ER24 Durban, VEMA Medics and Amanzimtoti lifeguards helped to make her dream come true.

“Fortunately, with the lifeguards having a special stretcher available for patients like herself, we could take her to the beach. We had a fun day full of laughter. The family was so happy that we could arrange it for her as they were leaving for Johannesburg the following day. It was amazing to experience this with her,” said Jannes.

“We were contacted by Yolandi’s parents and family members asking if we could assist in helping her experience the beach for the very first time,” said Jannes Prinsloo, ER24 Durban Branch Manager.

Watch the touching video on ER24’s Facebook page under the ‘video’ tab. (https://facebook.com/ER24Ambulance)

Yolandi Uys is seen here with Jannes Prinsloo, ER24 Durban Branch Manager, as well as VEMA Medics and Amanzimtoti lifeguards.

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ER24 medics have recently spent some time cleaning up the beaches in Cape Town as well as providing medical standby during these events.

ER24 PART OF THE CAPE TOWN BEACH CLEANUP

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R24 medics assisted with the Cape Town Beach Cleanup in May by collecting litter on Strand beach. The Cape Town Beach Cleanup dedicate every first Saturday of the month to cleaning up various beaches in and around Cape Town, contributing to keeping the beaches clean and keeping the oceans free from plastics. “The beach cleanups are open to the members of the community to participate and to learn more about littering on our beaches. It is also good to spend some time on our beautiful beaches,” said Greg Player, director of Clean C. Greg explains that they rely heavily on the community to assist in these initiatives. “We pick up loads of straws, plastic bags and plastic cups every time we clean the beaches. Everyone should be more intentional about their purchasing behaviours around single-use items like plastic bags, straws, coffee or smoothie cups, etc.,” said Greg.

http://www.cleanc.co.za/ or find them on Facebook @capetownbeachcleanup

A Cape Town Beach Cleanup in progress on Strand beach in the Western Cape.

If you’d like to get involved, you can visit their website at ISSUE 1 – JUNE 2018 | PRIORITY ONE |

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MALARIA: A RISK TOO BIG TO IGNORE “A lot of people might think like I do, yet look what happened to me.”

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hese are the words of 27-year-old Bert-Louw Versfeld, a businessman from Cape Town, as he recalls the traumatic ordeal of three years ago when malaria almost cost him his life. Bert-Louw didn’t take any prophylaxis (preventative medicine) for malaria before he travelled to Ghana in 2015. As with most travellers, the preconceived idea is that nothing will happen if you go for a short period. “I thought it was a quick trip and I didn’t want to start drinking pills so far in advance. I didn’t think that I needed to drink the pills if I was only going for a weekend. I have travelled widely in Africa and especially malaria-risk areas numerous times before. So it wasn’t even like it was my first time there,” said Bert-Louw.

coma,” said Bert-Louw. Lisa Versfeld, Bert-Louw’s wife, never moved from his hospital bed and still recalls how unreal this whole experience felt. “We were under the impression that he had flu. All of a sudden, within a few days, he was in the hospital and shortly afterwards in a coma. I felt so helpless and also uninformed of what exactly was happening to him. I kept asking myself how does this happen; he is so young? The whole experience felt so unreal but that being said, we never stopped believing in his recovery,” said Lisa. Four days later Bert-Louw woke up.

Bert-Louw recalls the exact dates from 2015.

“I was very confused when I opened my eyes. The first thing I could think of was how thankful I was for waking up and how short life is. It was a very difficult time for my whole family. It takes an ordeal like this to truly make you understand how fragile life is,” said Bert-Louw.

“I was in Ghana from the 5th to the 8th of January. I simply cannot forget the date. I arrived back in Cape Town on the 9th, but I only started feeling ill on the 17th,” said Bert-Louw.

On the 31st of January 2015, he was moved out of the ICU into a private room, and this, according to Bert-Louw, is where the hard work started.

These delayed symptoms are typically what happens when someone has been infected with malaria. The symptoms only present themselves once the parasites infect the red blood cells. This commonly occurs 10 to 14 days after an infective mosquito bite.

“I had to start with physiotherapy as I was so weak and I couldn’t do anything for myself. It felt like I had to learn to walk again,” said Bert-Louw.

“I experienced flu-like symptoms and on the 19th of January, while at work, I started feeling really ill. I went to a local GP and informed him about my travels to Ghana. He immediately tested me for malaria as well as for Ebola and tick bite-fever. That afternoon I packed my bag and checked into Mediclinic Durbanville for what the GP believed was malaria. “During the night, while in hospital, I remember the doctor coming into my room and confirming that it was malaria. However, later that evening my condition worsened and the doctors decided they would put me in a medically-induced

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While in the hospital he decided that he would try and read everything he could find on Malaria; whether online or in books. “I knew about malaria, but I didn’t think it was that bad. I knew it could make you sick, but I didn’t believe there could be fatal consequences. I have read a number of books dealing with Malaria as I wanted to expand my knowledge and find out just how close to death I truly was,” said Bert-Louw. According to the World Health Organization (WHO), in 2016 malaria accounted for more than 440 000 deaths worldwide.


Bert-Louw, who has since been back to at-risk countries, hasn’t stopped living his life to the fullest but, he has learned to be more careful before travelling.

“Read up about the country you will be visiting. Are there any risks? Take your preventative pills and wear long-sleeved clothing when you are outside. Equip yourself with the necessary knowledge. It takes an experience like this to truly make you thankful for a second chance,” said Bert-Louw.

The National Department of Health and ER24 offers some recommendations of how you can protect yourself against mosquito bites and malaria when travelling to high-risk areas: • • •

Wear long-sleeved clothing when outside at night Apply an insect repellent containing DEET (Diethyltoluamide) Sleep under a mosquito net treated with insecticide

Spray insecticide inside the house after closing windows and doors Take only medicines recommended by a health professional Start taking the recommended medicines before entering the malaria risk area and use as prescribed

Symptoms: • • • •

Fever A headache Chills Muscular pain

Seek medical attention if you have any of the above symptoms and inform the doctor of your travel history. For more information visit www.rollbackmalaria.org Thanks to Bert-Louw Versfeld for sharing his incredible story.

Bert-Louw and Lisa Versfeld

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HYPOTHERMIA: STAY WARM THIS WINTER The ever so friendly Heinrich Africa.

While the idea of soups, hearty meals and warm clothes might make you excited for winter, the risk for hypothermia remains high. However, according to Dr Robyn Holgate, ER24’s Chief Medical Officer, you don’t have to be freezing for hypothermia to develop. There are many ways we can lose heat from the body. What is hypothermia? Hypothermia is a condition where the body loses heat faster than the body can produce it. How does hypothermia occur? Accidental hypothermia: This is the unintentional drop in body temperature to less than 35°C when the body’s usual responses to cold begin to fail. Examples of those affected: unexpected exposure or someone that is inadequately prepared, for example, the elderly or homeless, someone caught in a winter storm, or even an outdoor sports enthusiast. Intentional: post-trauma or after a cardiac arrest, which we generally call therapeutic hypothermia. There are many ways where we can lose heat from the body, for example: • • •

convection when you have wet clothing on or a fan to cool down; conduction which is the transfer of body heat to other objects (for example sitting on a cold metal chair); evaporation which is responsible for about 20-30% of heat loss in temperate conditions, losing heat through the conversion of water to gas (evaporation of sweat); radiation is a form of heat loss through infrared rays. This involves the transfer of heat from one object to another, with no physical contact required. For example, the sun transfers heat to the earth through radiation.

It is important to note that hypothermia is not just having a low body temperature or someone who is shivering. Heat loss in cold, wet weather increases the risk for hypothermia and injury. Heat loss can occur in warm temperatures through conduction. Swimming or sitting in cool or cold water can cause the body to lose heat very quickly and increase the risk for hypothermia.

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According to Dr Holgate, there are different stages of hypothermia. She explains that “medically we classify hypothermia as a temperature less than 35 degree Celsius. Our normal body temp is in the region of about 37 degrees.” Mild hypothermia is the initial phase to stop the cold where you might shiver, have a fast heartbeat, have rapid breathing and blood vessel constriction occurs. Moderate hypothermia is where your body experiences a decreased heart rate, a changed level of consciousness, decreased respiratory rate, dilated pupils and decreased gag reflex. Severe hypothermia is when there is usually no perceptible breathing, the person is in a coma, they have non-reactive pupils, they don’t pass any urine, and they sometimes present with pulmonary oedema. Treatment for hypothermia varies according to severity. Here are some first aid guidelines for the treatment of hypothermia: •When you’re helping a person with hypothermia, handle him or her gently. •Move the person out of the cold to a warm, dry location sheltering them from the wind. •If the person is wearing wet clothing, remove it. •Cover the person with dry blankets and don’t forget to cover their heads too. Ensure they lie on a blanket or warm surface. If you have first aid, make use of warm compresses around the groin and chest area to provide warmth for the patient. •Provide warm beverages if the person is alert and able to drink fluids. •Monitor the patient’s breathing. A person with severe hypothermia may appear unconscious, with no apparent signs of a pulse or respiration. If the person’s breathing has stopped or seems dangerously low or shallow, begin CPR. Within the Emergency Medical Service (EMS), paramedics use a rescue blanket as well as a standard blanket to warm


patients up. The rescue blanket can prevent heat loss through convection or radiation. The standard blanket can prevent heat loss through conduction and convention. We may use passive or active rewarming techniques depending on the severity of hypothermia. These methods may include, blood rewarming, warm intravenous fluid use, airway rewarming and irrigation techniques.

and keep yourself warm. If a patient shows symptoms of mild hypothermia make sure they stay inside and keep warm so that the person’s condition does not worsen. Prevention remains better than cure. Medical attention must be sought immediately if someone appears to be suffering from hypothermia and is becoming lethargic and confused.

Seniors, children and the homeless are at significant risk of developing hypothermia this winter. Try and remain indoors

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ER24 OUT AND ABOUT

ABOVE: The helipad at Mediclinic Midstream was launched earlier this year. The ER24 Oneplan Medical Helicopter is seen landing on the new helipad.

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ABOVE: ER24 were the medical providers at the JoBerg2c event. After a long 9 days - 900km from Joburg down to Scottburgh it’s a wrap.

ABOVE:ER24 were the medical providers at the 2018 KAP Subaru sani2c event held in KwaZulu-Natal. Our medical team consisted of: 5 x Doctors, 40 pre-hospital paramedic staff, 3 x Race Hospitals, 10 x Ambulances, 3 x 4x4 response Ambulances and 4 x logistical vehicles. ISSUE 2 - JUNE 2018 | PRIORITY ONE |

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ABOVE: According to statistics, the leading cause of death amongst children between the ages of 5 and 14 is road accident related - motor vehicle accidents/pedestrian-vehicle accidents. It is alarming that these statistics are rising each year, so ER24 Plettenberg Bay joined forces with the Traffic Department as well as Fire and Rescue to educate our little ones on how to be road smart to avoid such unfortunate events.

ABOVE: The Knysna fires made headlines nationwide and caused so much devastation and heartbreak in the Garden Route Area last year. Further to that, 256 children get burned every day in SA. While younger children, toddlers and infants are at higher risk for burn trauma, and with the winter months approaching when burn incidents reaches its peak, ER24 Plettenberg Bay decided to visit Harkerville Primary School along with Fire Wise and Fire & Rescue to inform the young children about the dangers of fire and what to do in case of a fire emergency.

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EASTER WEEKEND STATISTICS

Total Number of Transportation Highest Incidents Transportation 13 -18 April Incident Day (545) 13 April (129)

EASTER WEEKEND TRANSPORTATION INCIDENTS

Highest Transportation Total Number of Incident Day Transportation 29 March Incidents (131) 29 March - 3 April (626)

ER24 attended to a total of 626 incidents during Easter Weekend 2018 involving transportation. These incidents include motor, pedestrian, bicycle and motorbike collisions. 81 incidents more than the previous Easter Weekend.

2017

EASTER WEEKEND CRIME-RELATED INCIDENTS

Total Number of Crime-Related Injuries Highest Crime 13 -18 April Incident Day (82) 15 April (18)

ER24 attended to a total of 97 incidents during Easter Weekend 2018 involving crime. These incidents include assaults, shooting incidents and stabbings. 15 incidents more than the previous Easter Weekend.

2018

Total Number of Crime Related Injuries 29 March - 3 April (97)

Highest Crime Incident Day 31 March (19)

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Kidney function in epic events 30

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During each ABSA Cape Epic, Mediclinic deploys a team of clinicians, ranging from doctors and nurses to ER24 emergency medical personnel, to assist any rider in difficulty. “Understanding our riders and their health is of the utmost importance to us. We are happy that the participants understand that we are here to help and are engaging with us on their health needs,” Dr Jann Killops, Mediclinic race doctor, believes that the overall health of the riders is a priority for the medical team. Because of the nature of the Epic – eight stages along intense routes, often in high temperatures – the chance of renal damage by riders remains a concern for medical staff. When riders are retrieved from the course by paramedics or present themselves to the race hospital with symptoms of dehydration, the team applies a well-oiled process to evaluate the rider and the risk to his/her organs. With the help of Pathcare, on-site during the race, Dr Killops’ team perform real time blood tests, which allows them to monitor the on-going hydration levels of the riders under observation. During an average epic race about 180 tests are performed to measure hydration of the riders. As part of the 2018 edition of the race, diligent care was placed on investigating riders’ health with daily tests for at-risk riders. Eight riders were removed from the race and referred to Dr Geoff Bihl, a Nephrologist at Mediclinic Vergelegen, for additional care. Most of these patients received treatment for a combination of severe dehydration (>7% body weight), rhabdomyolysis (the breakdown of muscle), and this can lead to life threatening blood electrolyte abnormalities i.e. potassium, acute kidney injury

or heat stroke. Judicious fluid was given intravenously, with cardiac monitoring in Cardiac ICU and paracetamol IV if no liver enzyme abnormality was evident. According to Dr Bihl, “Most riders spent 2-3 days in hospital. One patient presented with severe pericarditis/myocarditis with raised cardiac enzymes that required follow up by a cardiologist. One month later the enzymes were still not normal but the patient was feeling better and cardiac function was normal.” The concerns for such patients, participating in extreme events such as the Epic, is around repeated injury to organs. From a cardiac perspective myocardial damage can be permanent and thus any flu like symptoms pre-race must be taken seriously. “Acute kidney injury is a serious medical illness often ignored. There is up to a 10% mortality with a risk for recurrence and a risk of long term chronic kidney disease. If the condition has occurred before it’s likely to happen again. I suggest a full medical and pathology investigation by a sports physician prior to such competitors being permitted to participate again,” explains Dr Bihl. While the Epic is one of the best known extreme events in cycling, these risks are not isolated to this race. Any event in extreme conditions and prolonged time on the bike would fit the profile. Dr Bihl suggests simple adjustments like starting the riders who are likely to be on the bike for longer earlier in the day – or ensuring that there are strict qualifying criteria to participate in these extreme races.

considered. Geoff goes on to explain the impact, “It is important to monitor these patients in the acute setting especially if rhabdomyolysis has occurred. Hyperkalemia can continue or re-occur if muscle temperature is not controlled. The very nature of stage events dictates that repeated physical insults will occur and this is very dangerous and thus such riders should be withdrawn from the event.” According to Dr Bihl, pre-ceding illness (colds/flu/ infections), the use of antiinflammatories or performance drugs, over supplementation with over the counter medication need to be carefully monitored by riders because of the potential impact to the organs. In his view, Dr Bihl believes that all Epic training camps should include an in-depth course on fluid management, heat management and maintaining adequate hydration. “Those riders previously removed for such issues are well advised to undergo a full medical and then obtain a sports physician’s consent to ride again.” “I believe that it is essential that riders are encouraged to cooperate with all medical staff and the treating doctor’s decision should be final. Dr Jann Killops and her medical team should really be lauded on their professional and efficient approach to these patients.” We would like to thank Dr Bihl and his team at Mediclinic Vergelegen for the care of riders leaving the Absa Cape Epic.

Because the risk to participants is through repeated injury to their heart or kidneys, the longer term approach does need to be ISSUE 2 - JUNE 2018 | PRIORITY ONE |

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LIFESAVING ER24 PARTNERSHIPS Help is now an SMS away as Vodacom for the first time offers an Emergency Text service specifically for the Deaf, hearing and speech impaired: the Vodacom 082 112 SMS Emergency Service. These services include trained Emergency Call Centre agents who will put you in touch with police, paramedics, fire services, sea rescue services and an ambulance to assist you. The service addresses a serious need that currently exists in the market. Previously, Deaf and hearing impaired persons were unable to contact an emergency service centre as it could

only be accessed via voice calls. ER24 is proud to be the service provider for the Vodacom 112 Emergency Contact Centre. The disability/hearing impaired service was developed by ER24 in conjunction with Mediclinic Southern Africa’s ICT team and Tech Mahindra. We have dedicated and highly skilled staff ready to deal with any emergency. We are proud to be able to be part of this innovation in providing emergency services to Vodacom subscribers. To register for the service from your Vodacom phone, SMS the word

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‘register’ to 082 112. Accept the terms and conditions to indicate your type of disability; deaf, hearing or speech impaired. Your number is now registered, and you are ready to use this service. An Emergency Centre agent will contact you to confirm your name and surname. ER24, along with Vodacom, is ready to provide realhelprealfast to all Vodacom subscribers. To learn more, watch Vodacom’s video by visiting https://www.youtube.com/ user VODACOMTV

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DON’T LET IT LEAK INTO YOUR HOME Gas is a useful source of energy, but it is important to utilise it safely. Gas safety risks include; gas leaks, fires, explosions, carbon monoxide poisoning and lack of adequate ventilation. ER24 is reminding the public to be safety conscious when using gas cylinders during winter.

is done by a licenced or registered installer. Before the gas cylinder is fitted, remember to ask for the installer’s card. This card identifies what they are qualified to do. Gas cylinders need to be installed one metre or more from a door or window.

Take note of these tips regarding gas cylinders: Signs or symptoms from gas poisoning may include: General: •

• • • •

If you smell the gas, close the valve and ensure that the cylinder is connected properly or have it checked by a reputable dealer. Do not attempt to repair any leaking valves or systems yourself. Only utilise gas appliances for their intended use. Be aware of small children around gas appliances. Always leave a window or ventilation shaft open to ensure adequate ventilation in the room. Do not use gas appliances in confined spaces.

• • • • • •

Headaches Nausea and vomiting Dizziness Eye and throat irritation Fatigue Confusion

If you feel you have been exposed to a gas leak, evacuate the area and call emergency services. For medical emergencies, contact ER24 on 084 124. Alternatively, for more safety tips and enquiries visit the LPGas Safety Association website at www.lpgas.co.za.

Purchasing: • • •

Purchasing of a gas cylinder should take place from a reputable/authorised dealer. Ensure that the logo on the valve seal matches the logo on the cylinder. Filling or exchanging your gas cylinder should be done at a place of purchase or through a reputable dealer.

Maintenance: • • •

Service your gas cylinder regularly – approximately every two years or as stated by the manufacturer. If the cylinder has been disconnected and reconnected, make sure that the bullnose or O-ring is in place. Ensure that the hose is not perished, cracked or brittle.

Installation: •

For large or fixed appliances, ensure that the installation ISSUE 2 - JUNE 2018 | PRIORITY ONE |

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Priority One | Issue 2 | June 2018  
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