ER24 Priority One Quarter 4 2016

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PRI Make it yours

RITY NE QUARTERLY MAGAZINE

ISSUE 4 - NOVEMBER 2016 WWW.ER24.CO.ZA

Making dreams a reality

EMS personnel under attack The difference we make

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PRI Make it yours

RITY NE

IN THIS ISSUE

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Front page stories

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15 EMS personnel under attack

19 The difference we make 25 Making dreams a reality

Company interest 3 4

Ben Johnson takes over the reins at ER24 ER24... the readers’ choice

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Clinical 5 7 8 9

Achieving clinical excellence

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At the forefront of critical care Why trauma patients are treated differently today Medical emergency or not?

ER24 Global Assist

11 Mediclinic SA and ER24 realign services 13 Africa... Rising to the challenge CONTACT:

Email: communications@er24.co.za Tel: 0861084124 Web: https://er24.co.za Emergencies: 084 124

DESIGN AND LAYOUT:

Chitra Bodasing Harduth

COPY COMPILED BY: Chitra Bodasing Harduth

NEXT EDITION:

The next edition of Priority One will be published at the end of the first quarter of 2017.

STOCK IMAGES:

Envato Australia TriggerFinger Photography

NEXT CONTENT DEADLINE: The next content deadline will be announced early next year. Content for consideration may be sent to the ER24 Communications Department by any staff member or client.

ER24 staff

16 17 18 23 24

How ER24 is trying to safeguard staff

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Patients lives at risk Crimes against staff

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Rebuild your life Pulling up our sleeves to save a life

Community involvement

27 Supporting seabird conservation 28 Santa Shoebox wraps up 29 Road safety discussed

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Awareness

30 31 32 33 35 36 36 37 38 38

Prepared for your holiday?

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Major cause of death and disability What to do at an accident scene Alcohol and driving do not mix Pool and beach safety Right information at the right time can save a life The importance of CPR

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Youngsters at parties - be responsible Holidays... festive or traumatic

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Celebrate with safety in mind

Health

39 40 41 42 43

Prevent dehydration

Stroke - Are you at risk?

Umdlavuza webele Keep your heart pumping Importance of bone and joint care

Events

44 Medical standby at your event 45 ER24 at the Sasol Solar Challenge

Training

46 Refresh your memory

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Ben Johnson takes over the reins at ER24 Company interest

“ER24 will continue to grow and will remain the leader of emergency medical care across the country.”

These were the words of Ben Johnson, the recently appointed Chief Executive Officer (CEO) of ER24.

Having taken over the reins from Andrew Boden, now the Executive: Related Business of Mediclinic Southern Africa, Johnson’s determination, passion and focus on the provision of quality care to patients is sure to keep ER24 at the forefront in terms of being the market leader in emergency medical care.

Johnson is well known for being a “man on the ground and hands-on” type of person.

That, coupled with his years of experience in the emergency medical services field, has earned him the respect of not only staff, but well-recognised role players in the industry.

For any emergency medical service company to be a success, the patient has to be the number one priority.

Johnson, the former ER24 COO, has always strongly believed in this. As CEO, this will remain his key focus.

“Through full commitment to ER24’s values which include

professionalism, integrity, compassion, innovation, balance and being a company that is performance driven, we are able to deliver high quality medical and contact centre services to the South African public, clients and funder market. At ER24, we put the patient above everything else. The patient is our number one priority.

Our focus on clinical quality, service delivery, patient care and employee engagement is what sets us apart from our competitors,” said Johnson.

When asked about his future plans for the company and what clients, public and staff can expect, Johnson said, “The next step in our evolution is to embrace the technological era.

“I think technology is going to bring about dramatic change in the healthcare landscape around how patients choose to engage with us and the services we offer. ER24 has to be at the forefront of this development and stay ahead of the competition. We are also embracing the Patient Experience concept and will strive to ensure that patients remain the centre of our focus at all times.”

The pre-hospital emergency

“At ER24, we put the patient above everything else. The patient is our number one priority,” - Johnson 3|

Ben Johnson was recently appointed CEO of ER24.

care industry is not an easy field within to operate but ER24 proves year on year that it is able to continue growing.

“Every year has been tough and that will never change.

Macro-economic factors, industry related issues, client retention, employee engagement, growth and sustainability are aspects that keep us “on our toes” so to speak. I think our success lies around the fact that we have

a great team all around and we are all working towards a common goal. Our staff, without a doubt, set us above any other emergency medical service company in the country. We have an amazing, diverse group of people working for us.

“Their client and patient focus, dedication to clinical excellence and the company’s values are second to none,” said Johnson.

Priority One | Issue 4, November 2016

Company interest

Getting to know the CEO Ben Johnson (40), was born in the United Kingdom. He moved to South Africa in 1984 and currently lives in Cape Town. Johnson completed a National Diploma in Ambulance and Emergency Medical Care, through the then Technikon Natal, in 1996.

He has since, completed various other courses and workshops and is now completing an Advanced Diploma in Management through Mediclinic.

He was a lecturer for the National Diploma Ambulance and Emergency Care Programme and a Rescue Coordinator. He also lectured CCA, AEA, BAA and various modules for the first, second and third year diploma programme.

In 2004, while Johnson was working for a medical services firm in Richards Bay, an opportunity to join ER24 in Durban presented itself.

Johnson jumped at the opportunity as it meant being closer to his friends and family who were still in Durban. Aged 26, he became the ER24 Durban Branch Manager. He never looked back and chose to remain at ER24 due to the company’s solid leadership and values as well as clear mission and vision.

He moved up the ranks becoming the Regional Manager for the Coastal Region followed by Acting National Operations Manager and later, ER24 COO before

taking over the reins as CEO. Below are answers Johnson provided to questions about his journey to becoming the CEO of the leading private emergency service company in the country.

Why emergency medicine?

I still do not know what drove me to become a paramedic although, I found it to be a very rewarding career.

In those days the private sector was non-existent with emergency medical services being provided by the Provincial Department of Health.

This was still early days for the Advanced Life Support qualification, especially for those with a Diploma in Ambulance and Emergency Care. I still remember, for the entire Durban metropolitan area, there were only four ALS paramedics on duty at any given time. We had to back up a large network of ambulances spread all over… from Durban to Hammarsdale (East to West) and Tongaat to Scottburgh (North to South).

We were pretty much it… four ALS paramedics for the entire metro.

You can just imagine the type of calls we attended to and how busy we were. I gained a huge amount of experience as a paramedic in the early days and have great memories.

Not many people know that I qualified as a paramedic at the age of 20 and since I was below 21 years of age, had to get someone older to sign out

“I think it is important that you are visible and accessible,” - Johnson Priority One | Issue 4, November 2016

my ALS drugs.

You continue to spend a lot of time with crews. Why do you consider being a CEO “on the ground” important?

I think it is important that you are visible and accessible, and that staff get to know you as a “normal person”. Spending time “on the ground” allows me to get a feel of how things are going, what staff are thinking, what their worries/ frustrations/concerns are and also, what good things are happening.

It also provides an opportunity for us to show staff what the company is doing, where we are going and how the team can pull together for us to achieve our goals.

The roadshows have definitely had a positive impact from what I hear and we will ensure they continue.

You are a family man… how do you cope with your hectic work schedule and personal

life?

That word balance… Easy to say, harder to do. But yes, it is something one has to continually focus on.

During the week work and family life tends to merge but, the weekends are 100% family time with my wife Coleen and daughter Anna.

Anna is six years old and is my “little buddy”.

What do you do in your spare time?

Camping, watching rugby or cricket, spending time with extended family… generally, getting out and about. Anything outdoors or in nature is game on.

The man behind the CEO title?

I am actually quite introverted and shy in large groups of people.

I am also just a normal person like everyone else, with my own fears, worries, sadness and joy, trying to figure out this mad thing called life.

ER24... the readers’ choice ER24 is the emergency medical service company of choice.

The company was recently announced as the winner of Pretoria News’ Readers’ Choice Awards in the Best Emergency Medical Care category. The company’s hard work and the high standards maintained did not go unnoticed and readers repaid their trust by nominating ER24 as the best.

The competition involved readers selecting their favourite business over

a period of four weeks, culminating in the finale, which is the publication of the Pretoria News’ Readers’ Choice supplement, in which the top two businesses in each category are named.

Pretoria News is distributed to a number of readers including most government departments and all embassies across Pretoria and is widely seen as a fair representation of the multiplicity of views and opinions across the societal spectrum. |4

Clinical

Achieving

clinical excellence

by Dr Robyn Holgate, Chief Medical Officer: ER24

At ER24, clinical excellence is non-negotiable. Some say this is a luxury in the pre-hospital emergency environment, we say it is a necessity despite other challenges such as security and safety, weather and shift work in our dynamic, uncontrolled environment.

We continue to put the patient and clinical care at the heart of our business and we are blessed to have an incredible team of specialist operational staff sharing our values.

Despite growing financial pressures, clinical quality remains our key focus.

Here is a look at what we are doing to ensure clinical excellence beyond that of our competitors, some of the clinical quality initiatives we have taken to ensure we are upholding our promise of clinical excellence despite the financial pressures and the additional cost of a clinical governance programme.

Patient safety Patient safety forms the basis of any clinical quality performance review. At ER24, 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. The very nature of 3|5|

our emergency business leads itself to adverse events, the human factor ever present.

Examples of recent adverse events include attacks on our paramedics and vehicle accidents. 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 change to avoid a recurrence of such events.

One such example is the instillation of in-vehicle panic devices and the rollout of Emergency Medical Support in Hostile Environments (EMSHE) training for our staff following the recent attacks on our crews. We have developed several retrospective indicators and trigger tools to further support our passion for patient safety.

These indicators are reported monthly. We are one of the first emergency medical service companies to report on pre-hospital trigger tools.

Examples include death during transport, same person response within 24 hours and intubation failure.

Clinical cost efficiency Clinical cost efficiency is critical to sustain our business however, we must provide the

best possible care in order to keep our exceptional clinical reputation.

Clinical indicators such as response times (average 12 minutes primary response time in urban areas), intubation (70% first pass intubation success) and intravenous insertion success (99% inserted in less than three 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. Our Critical Care Retrieval teams utilise the Hamilton T1ÂŽ ventilator.

We were the first emergency medical service company in the world to receive delivery of the upgraded model in 2014. Our standard adult transport ventilator is the DraegerÂŽOxylog 3000 plus and we have another 15 transport ventilators for our B Tech paramedics.

Electrocardiogram (ECG) monitoring is equally a critical skill and we are proud to have standardised on the Phillips MRX monitor since 2010. We not only monitor our patients, but can evaluate

chest pain by providing our Advanced Life Support (ALS) crews with 12 lead telemetry.

We can diagnose and transmit an ECG to a cardiologist and ensure they are ready for the patient in the Cath Lab if need be. This is what should be expected from a world class emergency medical service company.

Taking cost efficiency and value seriously Intensive Care Unit (ICU) and ventilated patient transports only account for 6% of our total advanced life support call volume at ER24. These patients require expensive equipment during transport.

They also require highly specialised ICU trained paramedic staff to care for them and special vehicle modifications to further avoid the risks of moving such a critical patient in a smaller everyday ambulance.

These services come at a cost, hence the decision to rationalise this resource and create speciality ICU Critical Care Retrieval transport vehicles for our critical patients. The South African infant mortality rate is 10 times that of Europe.

Locally, a lack of neonatal care services in non-urban areas necessitates transfer to tertiary centres. In our

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Clinical

service, neonatal transfers are undertaken by a Critical Care Retrieval Services (CCRS) team consisting of an emergency care practitioner (degree paramedic) with further training in neonatal intensive care, and an intermediate ambulance technician as assistant and driver. Review of the past 11 month’s data showed we transported 225 patients, around half being speciality neonatal calls. Our smallest baby transported during this time period weighed just 620g. 22% of these babies were on neonatal continuous positive airway pressure ventilation, half initiated by our dedicated retrieval team. We reintubated 6% of

our babies due to blocked or inappropriately sized tubes.

We managed to successfully begin weaning from high percentages of oxygen (which is toxic in premature neonates) in 6% of our babies transported during the time period reviewed.

So where to next for achieving clinical excellence at ER24?

Our goal is always to achieve and then maintain or exceed our standards. We have international accreditation via the National Accreditation Alliance of Medical Transport Applications (NAAMTA), an achievement we are proud of and will take significant effort to maintain. We have installed

Priority One | Issue 4, 2, November June 2016 2016

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 your emergency.

The foundation for reviewing quality clinical performance has been achieved at ER24.

Our next step is to automate our reports, research and present our findings internationally. The business model of the future successful emergency medical service will be different to what it is today. Ambulance transport for our basic life support patients (approximately 50% of call volume) will require development of a cost effective solution and

home-based intervention for our medical scheme partners.

The new clinical practice guidelines now out for industry comment are exciting and an enthusiastic attempt to further professionalise emergency medical services.

It is so exciting to be part of a dynamic, changing profession. We will keep you updated of the clinical changes in the industry as they are made available and continue to put our patients first at ER24 by delivering the best possible clinical care no matter what your emergency. •

With special thanks to Dr Ronnie van der Merwe for his clinical leadership and guidance. | 64

Clinical

At the forefront of

critical care

The most critical time for any patient is during transfer and transport. In order to improve patient safety, one of ER24’s key areas for development is in the realm of Critical Care Retrieval. Critical Care Retrieval is required when a patient is particularly sick or injured and therefore requires paramedics with specialist skills and training to transport the patient from one hospital to another. These paramedics also have access to specialised equipment and the latest technology. Currently, ER24 has a team of seven Critical Care Paramedics (CCP) and four intermediate life support medics who are dedicated to transporting these patients on a variety of different transport platforms. Recognised as leaders in this field, these members of the Critical Care Retrieval Service (CCRS)

have recently made further strides in developing Critical Care Retrieval in South Africa and ER24.

Louis Jordaan was invited by the Emergency Care Society of South Africa to develop a workshop on Critical Care Transport for their pre-hospital conference held in Cape Town. Jordaan and CCP from Johannesburg, Willem Stassen, lectured on topics such as mechanical ventilation and neonatal critical care during this workshop.

Stassen and Jordaan also presented on specific aspects of neonatal care at this conference. Maryna Venter, also a CCP from Johannesburg, presented research from ER24 at the second conference on the Transport of High Risk Neonates in Copenhagen,

Denmark. Venter said, “Sometimes in South Africa we believe that our medicine is not as developed as the rest of the world. I was encouraged to see that ER24 practices exactly the same as those in Europe with the same equipment.”

Further to this, the knowledge and experience of ER24’s CCRS team members is recognised across the world.

Three times a year, Stassen and Venter visit Malta to lecture delegates from all over the world, including America and Britain, on the concepts and practice of Critical Care Retrieval.

Stassen also recently confirmed that a research article that he is a co-author on will be published in the South African Journal of Critical Care. The paper discusses the need for

upskilling paramedics who are doing these retrievals in areas that do not have a CCRS available.

“This is something that ER24 already identified. We have already started processes to train and upskill our paramedics to ensure that they can manage a variety of different complicated cases,” he said. These courses will start soon.

The CCRS team at ER24 is not only passionate about transporting their critical and complicated patients safely, but also about the development of CCRS within the country. By sharing knowledge and experience, the hope is to develop CCRS as a specialised field within South Africa.

This will eventually translate to safer critical care retrieval for all patients.

Above: Willem Stassen, ER24 Critical Care Paramedic, is committed to clinical excellence.

Right: Maryna Venter, Critical Care Paramedic, lectures at a recent workshop.

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Priority Priority One | Issue One | 4, Issue November 2, June 2016

Clinical

Why trauma patients

are treated differently today Have you just witnessed a patient being treated differently to what you witnessed previously? Having doubts? Wondering why a cervical collar or spine board was not used even though you are aware it is common practice?

ER24 sometimes receives complaints from the public regarding the treatment of patients on the scene of an accident not being consistent.

On investigation, it is found that the complaints do not relate to alleged negligence by the crew but, are due to people not being familiar with the latest best practice within the pre-hospital emergency medical care arena.

The most critical moment is immediately after the trauma.

Hence the importance of immediate, best practice prehospital care.

Below are some facts provided by ER24’s Dr Vernon Wessels that will help you establish if your loved one is being provided with the best care: • Not applying a cervical collar in some cases or even removing one in certain patients is often required due to latest research showing adverse effects being caused to these specific patients.

• Paramedics are taught and allowed to do spinal clearance on some patients on accident scenes. They are able to follow a well researched protocol to

identify patients who do not need to be immobilised. This optimises the use of limited resources and prevents patients with uninjured spines from developing pain in their back as a result of being immobilised for prolonged periods.

• For decades, the use of tourniquets (a constricting band to stop blood flow to a limb) were banned in the pre-hospital field as they were considered dangerous and unacceptable.

Recent research showed how many lives were saved among people with uncontrollable bleeding due to injuries sustained in combat situations (especially in the Middle East).

Within the civilian emergency medical service, there are a number of cases that have demonstrated the effectiveness of this device in stopping uncontrollable bleeding from limbs. Majority of the patients did not only have their lives saved but also, did not loose their limb.

Those who did have to undergo amputations were due to the extent of the injury sustained and not due to the effects of the tourniquet.

• More focus is being placed on moving patients with life-threatening, operable injuries urgently to hospital instead of spending too much time on the accident scene.

Some techniques considered standard practice in the past,

Priority One | Issue 4, 2, November June 2016 2016

Dr Vernon Wessels.

like putting up an intravenous drip, will often not be done on scene but rather en route to hospital or not at all in some instances as this is no longer considered as high a priority as it used to be.

“Pre-hospital emergency care has evolved from simply following preset protocols that were developed based on what was thought at the time to make the most sense, to a fully fledged profession where research drives evidence-based best practice

techniques. Paramedics are able to apply their knowledge and skill to determine the best course of action for a specific patient based on that patient’s need at the time,” said Dr Wessels.

So next time you see paramedics treating a patient differently, keep in mind that the patient may be receiving the latest and best treatment science has to offer.

If you are unsure and would like peace of mind, check with a medical professional. | 84

Clinical

by Margie Saunders, Manager of Funders & Medical Schemes: ER24 and Jocelyn Eales, Fund Manager: ER24

Medical emergency or not?

We are all feeling the pressure of the current tough financial challenges and those of us who have medical aid and have seen what the increases in contributions are for 2017, are wondering how we are going to afford to retain our medical cover. However, when we see what the actual cost of medical care is, we realise that we cannot afford not to have medical cover.

Our medical schemes are also under huge financial pressure due to an aging population, many young and healthy members leaving, an increase in chronically ill members and more expensive treatments being developed and prescribed.

Medical schemes are thus faced with the option of either increasing contributions or decreasing benefits, neither of which is well accepted by members.

Although we have little control over when we fall ill or what disease or injury affects us, we can all play an important part

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in containing medical costs.

The cumulative effect of this is affordable, sustainable medical cover in the long term. Below are some examples of where we can make a difference.

Pharmacy, GP or emergency department?

We need to seriously consider what we do when we are ill.

Many members go straight to the emergency (casualty) department of their closest hospital for minor ailments, where a visit to a pharmacist or primary healthcare nurse could suffice. In the case of a more severe injury or illness, the next option should be your local General Practitioner (GP).

Most GP’s are able to diagnose and treat these conditions very effectively at a fraction of the cost of a hospital emergency room, making your out-ofhospital medical aid benefits last longer.

Most people think that emergency departments are much quicker than consulting

a GP and, as the treatment is provided in a hospital, would not be paid from your day-to-day benefits. This is not the case. All emergency departments triage or “sort” patients according to their specific medical conditions and not according to when they arrived at the department. Thus, if more seriously ill or injured patients arrive after you, they will be seen before you and your wait could be many hours. Emergency departments also generally charge much more than GP’s for the same treatment.

Ambulance, car or taxi?

Ambulances are certainly required for critically ill or injured patients and are staffed by appropriately qualified staff. This means that ambulances are a very expensive means of transport and if ambulances are being used to transport minor/inappropriate cases, an ambulance may not be available to transport you when you are in a critical condition.

Ambulances should thus only

be used in the case of a dire emergency.

ER24 is focused on ensuring the fair and consistent application of our process for managing non-medically justifiable cases for all our contracted medical schemes. All ambulance claims for our contracted medical schemes are audited, and if it is determined that you have called an ambulance when you could have used a car or a taxi to get to hospital, you may well become liable for the cost of the ambulance. One of ER24’s key roles is to help you to make the correct decision as to whether you need to see a pharmacist, primary healthcare nurse, GP or go to an emergency department.

ER24 offers an “Ask the Nurse” service to all our clients. This service is available 24 hours a day, seven days a week. Our friendly ambulance staff may also inform you that, should you choose to be transported by an ambulance, you may become liable for the account.

Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 Global Assist

Mediclinic SA and ER24 realign services to meet industry demands Mediclinic Southern Africa is constantly investigating opportunities to improve the level of care our patients are receiving and how our business can align itself to better meet these demands.

ER24 has now been integrated into Mediclinic’s operations.

Andrew Boden, Executive: Related Business of Mediclinic Southern Africa says, “We are excited about this change that will allow us to streamline our operations and improve the decision making processes to ensure we remain agile within the constantly changing environment.”

Ben Johnson has been appointed to the role of Chief Executive Officer (CEO) of ER24 from August 2016 with the ER24 business reporting into the newly created Related Business division.

Koert Pretorius, CEO of Mediclinic Southern Africa says, “ER24 is a vital part

of our patient experience, and this realignment will ensure that all elements of the business are working towards a common goal of putting the patient at the core of every action.”

Mediclinic Southern Africa is one of three platforms under Mediclinic International. The LSE listed company owns and manages approximately 22% of the Southern African private healthcare industry through its network of 52 hospitals and two day clinics, offering over 8 000 licensed beds across South Africa and Namibia. The remaining platforms represent the largest healthcare providers in Switzerland (16 hospitals and four clinics) and the United Arab Emirates (five hospitals and 39 clinics).

ER24 is a first party provider of emergency medical services, accredited with the National Accreditation Alliance of Medical Transport

ER24 Global Assist’s integrated service offering includes: • • • • • • • • •

Access to our international hospital group Aeromedical services Medical concierge services Medical case management Cost containment International patient management Hospital in-patient referrals Repatriation of mortal remains Comprehensive network of service providers

This positions ER24 Global Assist as the medical services solution of choice on the African continent. Together Mediclinic International and ER24 Global Assist are uniquely positioned to provide realhelprealfast.

Applications (NAAMTA), specialising in on-site medical management, ensuring the health and safety of national and expatriate workforces

in the mining, oil, energy and infrastructure sectors of industry throughout Africa, especially in high risk remote locations.

Ben Johnson on ER24 Global Assist During the expansion of ER24’s services, we decided to pursue a more direct approach with regard to our assistance offering to the industry. As a result, the ER24 Global Assist brand was created. We are proud to note that the brand has grown immensely and consequently, we are able to support our clients and their members with a complete integrated healthcare solution.

Furthermore, at ER24 Global Assist, we provide clients 3 11 | |

access to our international hospital group, Mediclinic, where clinical care is of the highest quality.

Our Medical Concierge Services provide for daily patient management, including arrangement of appointments with identified healthcare providers, arrangement of hospital admissions, as well as transportation and accommodation for the patient and/or accompanying family members.

The Global Assist portfolio gives clients access to Aeromedical Evacuation Services. ER24’s aircraft are all fully configured with critical care equipment and use state-of-the-art technology to ensure the most effective patient care at all times.

ER24’s Global Assist clients have access to the deployment of the following pressurised aircraft: • Dassault Falcon 50EX Jet • Dassault Falcon 20 Jet • Cessna Citation V Jet

• British Aerospace Hawker 700 Jet All aircraft are staffed by ER24 paramedics, doctors and nurses with extensive training and experience in all forms of emergency medicine.

Further to this, ER24 Global Assist is connected to an expansive network of emergency service bodies in an integrated scene management system. This allows us to draw on a variety of related services when emergencies arise.

Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 Global Assist

Africa...

Rising to the challenge

by Dr Robyn Holgate, Chief Medical Officer: ER24 Africa… a deep, dark continent or dream holiday destination? Either way, this beautiful continent is full of contrasts. The second largest and second most populous in the world, with around 1.2 billion inhabitants, Africa is also the world’s poorest continent, where the effects of poverty include hunger, disease and lack of access to basic necessities such as healthcare.

So how does the nonAfrican evaluate healthcare facilities in Africa? Many review models and attempts at improving healthcare have failed due to a lack of understanding by those trying to impress their views on Africa. The patient should always remain first priority, and with this in mind, it is often prudent to work with a reliable local medical assistance partner when choosing a healthcare facility.

Africa is a continent where more than one million people die every year from malaria, most of them being children.

This accounts for a large percentage of malaria deaths worldwide. Despite knowing that access to clean water will reduce infection transmission by 50%, Africa is a continent where water is a luxury in some healthcare facilities.

Frequently, healthcare crises place the continent in the news; one cannot forget the devastating effects of Ebola in West Africa and the world’s 3 13 | |

response to assist in the outbreak.

With millions of people dying from infections and healthcare error, the emphasis regarding healthcare selection should be on accurate risk review and cost containment to ensure affordability. In a largely unregulated industry, however, word-of-mouth referrals to private facilities belonging to doctors are apparent, thanks to some of these facilities often ambitious marketing efforts.

Such facilities rely on insurance and international clients to sustain their business and they make use of the ever powerful dollar to ensure that their infrastructure is maintained, but they have been known to hold on to patients that exceed their treatment abilities.

For those who can afford it, the best possible clinical care is available in Africa, provided you know where to find it. There are various key questions that need to be considered when assessing a medical facility for use: How was information on the facility attained? When was the facility last visited or audited? Is the hospital truly internationally accredited or are marketing and online search engines driving referrals to an inappropriate facility? When was a physical survey of the hospital last completed?

A reliable assistance partner

with an African base and the ability to travel and review facilities is ideal when seeking to access medical care in the continent. Even before considering this, though, making a corporate decision around patient priority triage as well as putting in place policies and procedures for evacuation will assist in guiding assistance teams to make the right decision.

Let us consider a few cases experienced by ER24’s medical staff that depict the real challenges faced within the African healthcare system.

Case 1: Misdiagnosis No-one ever dreams of falling ill on their dream holiday, but this is what happened to one of our clients.

His family stayed with him day and night, putting their holiday on hold while he recovered from gastroenteritis, a clinical condition that usually improves within a couple of

days. As the days turned into weeks, however, his family became sceptical about the diagnosis he was given by local doctors. These doctors were liaising with the client’s insurer and providing medical information that portrayed a rosier picture than that which the family were witnessing.

The client’s family refused to sign documentation or accounts and desperately tried to get the insurer and the doctors to realise the severity of the patient’s condition.

When an evacuation was finally arranged with ER24, the patient was suffering fulminant liver failure and was critically ill. A local doctor who acted outside of his specialty to manage a patient had resulted in the client’s life hanging in the balance.

Case 2: Unfit to fly Air ambulance operators – especially those with Intensive Care Unit (ICU)

Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 Global Assist capabilities – can find it very frustrating to be informed that a patient is “too sick to move”, placing an evacuation on hold. Is there generally too much trust placed on a referring doctor regarding whether a patient should be moved to a better equipped facility? The majority of the time, the answer is yes.

Serious requests for evacuation should not be hindered by referring specialists dictating that a patient is too sick to be moved; rather such decisions should be made in consultation with the air ambulance medical director and, where appropriate, the assistance company medical director. There is only a small subset of patients for whom air ambulance evacuation will only change the place of death. Those patients have a clinical condition where mortality is expected, and a careful decision should be made regarding whether it is necessary to evacuate the patient, especially if their family support structure is in-country. But with the regulated air ambulance industry in South Africa, and the exceptional standards imposed by accredited providers, all other critical patients should be afforded the opportunity to be moved to a centre of excellence. The overriding guiding principle should be whether the patient’s best interests have been considered. A tragic example with a fortunate ending follows.

Fifteen days after a motor vehicle accident, a polytrauma patient was lying on a gurney in a passage at the ICU of a facility in Africa. When the flight medical team arrived to fetch her for transport, they found her covered in faeces and urine. The patient had no monitoring devices

attached and had been given medication for a seizure. An endotracheal tube had been inserted, but the patient had been left unattended. Her funders had been informed that the patient was too sick to move to definitive care, which had delayed a potential air ambulance transfer.

The ER24 repatriation team quickly moved to reintubate her, commence ventilation and insert catheters to monitor urinary output. They transfused emergency blood and started definitive care at her bedside, potentially changing the patient’s outcome through good clinical management of her injuries. This care was continued from bed to bed by her dedicated specialist retrieval team.

Case 3: The tragedy of malaria, too little too late The clinical presentations of malaria can vary by extremes. One patient, an expatriate healthcare worker, was evacuated at significant cost following a diagnosis of malaria. On arrival in South Africa following air ambulance evacuation, he was declared well enough to be managed as an outpatient, and only three doses of anti-malarial medication were prescribed before he was declared medically fit to return to work.

A second patient died within 24 hours of being presented to us. The history given to the retrieval team was that he was not improving after his last consultation a week before, where he had been treated for malaria. It is not certain whether this patient was correctly treated at the initial consultation, but when he presented at the second consultation a week later, he was critically ill.

He was jaundiced, suffering

Priority One | Issue 4, November 2016

liver and kidney failure, and was managed at a small suburban hospital for several days before the request for evacuation was made. He required intubation and ventilation by the flight crew, as well as blood and platelet transfusions. Despite their intensive resuscitation and care, the patient died.

Deciding whether a patient should be evacuated is a difficult but important decision. The two cases above illustrate the challenges when making the call about whether a patient with malaria requires evacuation to definitive care.

It is the exception that a patient cannot be managed in Africa, where so many are treated and recover. When platelet levels start dropping and patients start fitting, or they are too sick to walk, this tragic, mosquito-borne disease requires urgent intervention. When the patient presents with multiorgan failure, it may be too late to intervene. These are the patients that should be referred in haste to specialist healthcare facilities with intensivists, pulmonologists and nephrologists available as a team if any improvement is to be expected.

Case 4: The smoke and mirrors scenario There have been cases where patients have perceived a facility to be capable of meeting their medical needs due to its perfect location or designer layout. However, some such facilities might not even have a doctor available 24 hours a day. The aforementioned assessment questions need to be asked of any medical facility; plus, doctors’ credentials need to be checked thoroughly before a patient is handed over for care. Imagine a specialist doctor with no formal medical

training afforded the title because their family is royalty in the country, or a radiology department that may be a review network entirely dependent on radiologists stationed in another country.

These are the realities we may be faced with. Consider an unventilated patient on the computed tomography (CT) scan table with a bradycardia – death would be imminent if there is no-one qualified to watch over the patient.

ICUs may not have a qualified nurse or ICU nurse specialist in their employ. ICUs may also not have oxygen available, or a defibrillator to immediately manage a dying heart. Although the exception, these are the harsh realities of some instances of medical care that we have been exposed to.

Successes Despite a picture of a ravaged healthcare system depicted through the real-life scenarios above, there are many stories of joy and success – outcomes that make dedicated teams of professionals remain devoted to their patients and the countries in which they work. As funders, it is the need for consistently excellent care that drives us to find a facility capable of reliably managing our patients. That reliability includes honesty regarding a patient’s clinical condition and the hospital’s ability to manage a patient.

Local knowledge of African facilities and specialities, as well as accurate assessment of the patient’s needs, are critical to ensure that patients who require extended hospital care are afforded access to adequately equipped facilities.

Where adequate care is not available locally, an air ambulance evacuation may need to be considered sooner rather than later. | 14

ER24 staff

EMS personnel

under attack

Emergency personnel are called upon to help people in their greatest time of need.

In many instances, they could be the difference between life and death.

Despite their dedication to helping strangers and aiming to save as many lives as possible, the risk of finding themselves in lifethreatening situations when trying to assist people in need of medical attention is increasing.

Attacks on EMS crews have been going on for a long time.

Crimes committed against them started increasing a few years ago.

At ER24, just one of various emergency medical service companies in the country, there has been about 18 incidents over the past two years.

Some of these incidents resulted in crews sustaining serious injuries.

Fortunately, there has not been any fatalities at ER24 to date.

Crimes against EMS personnel vary.

Below is a list of situations that EMS crews in general have found themselves in: • EMS personnel have been attacked, robbed, hijacked, stabbed and assaulted. These incidents either occurred while staff were responding to an incident, at a scene while attending to a patient or while on their way to or at the hospital for example.

• There have been incidents 315 | |

ER24 staff at a march held in Cape Town recently to highlight violence against EMS personnel.

where criminals have posed as fake patients in order to attack and rob staff.

• Items have been taken/stolen from the ambulance while paramedics were attending to a patient on a scene.

• EMS personnel attend to a number of medical-related calls in crime hotspots.

There were instances where paramedics were targeted in these areas.

• EMS personnel have also

been seen as the “enemy” at protests and other hostile situations.

They have been attacked while trying to attend to patients at some of these incidents.

Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 staff

How ER24 is trying to safeguard staff

ER24 staff at the recent EMSHE training in the Western Cape.

ER24 launched its Emergency Medical Support in Hostile Environments (EMSHE) course in 2011. This course is directly targeted at addressing concerns relating to violent crimes committed against EMS personnel.

Peter van der Spuy, General Manager of Quality Assurance and Support Services at ER24, said, “The aim of the course, which entails various training exercises, is to teach our staff various skills, such as identifying hostile environments, how to deal with these situations and, if the need arises, how to defend themselves and the patient.

We have found that this course has better equipped staff to deal with crimes committed against them (opportunistic crimes while attending to patients or while responding, during protests and other hostile incidents for example). In 2014 we introduced EMSHE 2, a more

advanced course. We have seen a number of successes due to the implementation of EMSHE. In addition, ER24 also has continued education courses and workshops to better equip staff. We pride ourselves in protecting our staff.” ER24 also works closely with the SAPS to ensure that it keeps up to date with trends and hotspots to further improve the safety of staff. “We monitor situations and have a network which helps in identifying potential threats. ER24 works well with various local authorities and we have utilised their services numerous times. We continue to do so,” said Van der Spuy.

Dealing with various incidents and scenarios can have a severe and negative impact on EMS personnel.

ER24 ensures that staff members have access to trauma support specialists when required. Debriefing takes place as well.

In training... Staff taught skills to help them in hostile situations.

Priority One | Issue 4, November 2016

| 16

ER24 staff

Patients lives By attacking EMS crews, not only are their lives in danger, but also the lives of those who are in need of medical attention.

Vandalising or stealing emergency vehicles means fewer vehicles are available in case of an emergency in the area.

This ultimately increases the risk to patients.

“There are instances, such as during protests for example,

at risk

where EMS personnel are either instructed not to enter a hostile area until it is cleared by authorities or are escorted by authorities to gain access to patients.

“There are also cases where the patient has to be brought out to EMS personnel.

“With this said, we also have processes in place to determine which crews, based on their experience and training, will go into these

areas should the need arise,” said Peter van der Spuy, General Manager of Quality Assurance and Support Services at ER24. By keeping quiet about crimes committed against EMS staff, it will eventually affect you and your loved ones. “Community members and leaders as well as other role players have a vital role to play in protecting the very same people who are there to take care of them.

“Criminals are putting your lives in danger and comprising your health. We urge the public to report criminals to the police,” said Van der Spuy. In addition, people are urged not to purchase any medical equipment or medical stock sold at second-hand shops or from medical companies, pharmacies or people who are not registered to provide such services.

We are here to provide medical assistance to those in need. Report those who commit crimes against EMS personnel to the authorities.

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Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 staff

Crimes against staff

A number of crimes have been committed against EMS personnel. Below are two recent incidents involving ER24 staff. You can make a difference by reporting criminals to the police.

An ER24 medic was stabbed and assaulted on 24 September.

Medics were on their way to a nearby hospital to hand over patients on board from a motor vehicle collision that they attended.

They came across another motor vehicle collision on Ohrtmann Road in Pietermaritzburg.

According to the paramedics they pulled over to assess the incident and confirm if further resources were required on scene.

Moments later four occupants from one of the vehicles involved in the collision verbally assaulted the paramedics.

The situation later escalated and one of the occupants presented a knife and attacked one of the paramedics.

The paramedic sustained wounds to his face and hands before a member of the public stepped in and disarmed the knife-wielding man.

The paramedics called for police assistance and further ER24 resources shortly after the verbal assault began.

When another ER24 emergency vehicle arrived on the scene the suspect ran across the road and returned with a brick and attempted to further assault the ER24 crew on scene.

One of the paramedics managed to disarm the suspect.

Police arrived on the scene and the suspect apparently proceeded to verbally assault the police officers and attempted once again to assault the medical crew.

It is understood that the suspect also assaulted the driver of the other vehicle that was involved in the collision.

Four suspects were detained by the police on the scene and taken to Mountain Rise Police Station. A case was opened.

The injured paramedic received several stitches to his face and hand at a nearby Mediclinic.

He also sustained several bruises.

The patients that were originally being transported in the ambulance were later transported privately to a nearby hospital.

Robbery A second incident involved two ER24 paramedics who were robbed of their cellular phones and cash at Howick Falls on 18 October.

At approximately 9.50am a distress call alerted ER24’s Emergency Contact Centre that the two paramedics on the specialised Paramedic Ambulance were held at knife point and robbed.

Priority One | Issue 4, November 2016

ER24’s paramedics often stand by at the well-known tourist attraction spot near the Howick Falls.

Some of the curio shop owners were still busy setting up when the incident took place.

There were no tourists or visitors at the spot at the time of the incident.

The two paramedics were inside their vehicle when they were approached by a young male holding a large knife.

According to the two female paramedics, aged 35 and 27, the man ordered them to look down and give him their cellular phones and all the cash in their wallets.

He also asked them to remove the SIM cards and memory cards from their phones before giving it to him.

The two paramedics said that the man threatened to cause severe harm to them if they did not comply.

Curio shop owners stated that they saw the man running from the ambulance towards the river and up the embankment towards a nearby informal settlement.

Police were informed of the incident along with ER24’s area management.

SAPS dog units as well as patrol units conducted a search for the suspect.

The two paramedics were

transported to a nearby Mediclinic where they were assessed.

The suspect fled with two Samsung cellular phones and R110 in cash.

A case was opened and the suspect was arrested in the early hours of the following morning.

Police officers raided a property in the Shiyabazali Informal Settlement located close to where the robbery occurred.

The cellular phones belonging to the paramedics were recovered.

The knife used by the suspect to threaten the paramedics was also recovered.

The suspect was later positively identified by the paramedics. ER24 commends all Howick SAPS police officers involved in the speedy arrest of the suspect.

Thank you to Sergeant Kunene, Sergeant Buthelezi, Constable Kunene and Constable Makaye who went the extra mile.

ER24 also thanks Knight Security Solutions, the SAPS K9 Unit (Pietermaritzburg), Flying Squad (Pietermaritzburg), Search and Rescue (Pietermaritzburg) and officers who were in the Howick SAPS patrol van for their assistance following the incident. | 18

ER24 staff

The difference A 17-year-old off-road biker was injured while riding in the Shongweni Dam area recently.

It is believed that the bike landed on top of the biker when he lost control of it.

Other bikers who were riding past the area saw the patient

we make

and took the bike off the man.

One of them had to ride to an area where there was cellular phone signal to call for help.

ER24 paramedics attended to the incident. It was no easy task to get to the patient as he was deep in an area covered by dense bush. Paramedics drove the ambulance as far

as they could. They were then assisted by Rescue Tech crews. They travelled for about a kilometre in a Landrover however, could go no further. The paramedics and Rescue Tech crews decided to hike, about three kilometres, to the patient.

Upon arrival at the scene, the

crews found the patient lying close to a pathway.

Upon assessment, it was found that the youngster sustained moderate injuries.

He was treated and crews as well as bikers, hiked out of the area with him. He was transported to hospital for further medical care.

Off-road biker rescued 3 19 | |

Priority Priority One | Issue One | 4, Issue November 2, June 2016

The difference

ER24 staff

we make A dog that lost a lot of blood after he was stabbed in the chest survived the ordeal thanks to all who worked together to save his life.

Spider was stabbed by an apparent intruder at a property in Allens Nek recently.

ER24 paramedics were called to the property after guards from a security company found that Spider, believed to be five months old at the time, had been stabbed.

The guards tried to help the dog.

Paramedics took over treatment upon arrival at the scene and rushed the

dog in an ambulance to a veterinarian in Randpark Ridge.

While in theatre, it was found that Spider sustained a massive laceration believed to be the size of a panga-type knife.

The object used to stab the dog lacerated many major organs, such as the lungs and liver, and also penetrated the diaphragm.

It missed the heart but caught the major vessels off the aorta. He received two units of blood.

Fortunately, Spider recovered.

ER24 thanks all involved for saving Spider.

Beach visit after 35 years Wish granted… Mr Dirk Gunther (84), had not seen the beach in 35 years.

While being transferred from a Newcastle to Durban hospital by ER24 on 9 October, Mr Gunther mentioned that he wished he could see the ocean as he had not in so many years.

Margery Meijerink, from ER24 Newcastle, said she would do her best to grant his wish. However, on the day,

weather conditions did not permit. She spoke to ER24 Durban Branch Manager, Jannes Prinsloo, who gladly assisted her in granting Mr Gunther’s wish.

During the transfer back to Newcastle on 11 October, Lucas Nzimande and Shaun Naidoo, from ER24 Durban, stopped at the beach, allowing Mr Gunther to experience what he had not in so many years.

Priority One | Issue 4, November 2016

Spider survives | 20

ER24 staff

The difference

we make

ER24 Cape Town South Metro delivered these much needed teddies, from ER24 Southern Cape, to the Red Cross Burns Unit to lift the spirits of little patients.

ER24 paramedics and Midvaal Fire and Rescue recovered the body of a man believed to have been in a river for some time in Meyerton.

ER24 Southern Cape supporting the Rhino Run.

ER24 Nelspruit crews visited Jungle Zone Nursery School.

ER24 Joburg South conducting free blood pressure checks at the Johannesburg South Community Day event.

ER24 Joburg North did a safety and awareness talk at Heron Bridge School.

3 21 | |

Priority Priority One | Issue One | 4, Issue November 2, June 2016

The difference

ER24 staff

we make

Day made for young boy from Sonlandpark, in Vereeniging, who wanted to see an ambulance. He is pictured with ER24’s Dayne Olsen, Cecil Parsons and Jacob Mafale.

ER24 participated in the 2016 Fire Fighter Challenge recently.

Teresa van Gool was the overall female winner of the Fire Fighter Challenge.

ER24 at the Vangate Mall where youngsters learnt CPR during a demonstration.

ER24 Ladybrand crew hosting an awareness talk at Ladybrand Academy.

ER24 Cape Town North Metro received an award from the National Institute for the Deaf. Pictured are Thembinkosi Mrubata, Grant Bruinders and Righardt Steyn with Henry Carelse (seated).

ER24’s Ziyaad Warasally delivered a healthy baby girl in Ladysmith recently.

Priority One | Issue 4, November 2016

ER24 Cape Town South Metro showing their support for Pug Rescue at the Pug Olympics.

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ER24 staff

Rebuildyour life

by Marvin Mukwevho, Quality Assessor: ILS at ER24

The front page headline of the local newspaper reads, “House burns down – family left desperate and stranded”.

The caption below the picture showing the rubble said, “Only the garage and outside room remained after a fire raged through this home in Brackendowns”.

It was 18 August 2008 when the Mukwevho family lost everything.

We had no clothes except that which we were wearing on that night. We had lost everything. But we did not lose hope and faith that we would prevail triumphant in this trial.

I remember how, after reading about us in newspapers and hearing my interview on Radio 702, people came in large numbers to help where they could.

Clothing stores donated boxes of brand new clothes for the entire family. The community came in numbers and offered a helping hand. It was a painful moment and time. I for one, had academic and sports awards on the shelf at home. I watched all these precious things burning right in front of my eyes.

As I looked around, there were people there who were watching the house burning.

To some of them, it was a fascination.

They had their phones out, recording videos of this house in flames, probably to share with their friends at school or at work.

I asked myself how 3 23 | |

somebody’s pain and loss could be such a great spectacle to another. I took great offence at what I was seeing.

A neighbour ran to my mother and tried to comfort her.

Then I heard her saying that she was praying that the flames do not come to her house.

I think at this time she took a moment to assess her words and tried retreating. She then said that she was praying for our house too.

Now, not only was I offended by what I was seeing but also by what I was hearing.

When the firefighters arrived, they had come to our house straight after having to service several calls.

When they opened their hoses to extinguish the flames, they found out that they had run out of water. This made me really angry.

I asked myself how our only relevant help was not able to assist us.

It was another 30-minute wait before another fire engine arrived. By then it was too late.

The whole house was down.

They managed to save the garage and the outside room.

It took us approximately eight months to finally move into what was our home. And from that experience, I learned that out of every bad experience, one should strive to get out of that only the wisdom therein and leave the bitterness and anger aside.

As you read this article you

may think to yourself that you do not need to rebuild a house that got ravaged by flames.

You may however, need to rebuild an aspect of your life that may have been destroyed.

Allow me to share a few things with you: Are you alive?

If we had died in that fire, then that would have been an acceptable reason to fail in rebuilding the house.

But because there was still breath in us, we were able to draw some determination and strength from deep within and start the rebuilding process.

If there is still breath in you, then you are the perfect candidate for a person who wants to rebuild their life.

If you are still alive then you meet the criteria.

If you are reading this, then yes, I am talking to you.

I know they raped you. I know they infected you with HIV. I know you wanted that person to love and encourage you but all they ever did was to hurt you and make you feel worthless.

But what you went through did not kill you. Since you are alive, you have what it takes to rebuild your life. There is absolutely no need to take your own life.

All you should do is rebuild it “brick by brick”, day by day.

Learn to forgive those who have hurt you As I had mentioned, I took great offence to what I was

Marvin Mukwevho is an aspiring ambassador of health and wellness and a motivational and inspirational speaker as well.

hearing and seeing. It felt as though people were rejoicing in my pain.

But I came to a realisation that holding on to anger and bitterness was not the answer to my challenge. In fact, if anything, anger makes everything worse. It is an unnecessary burden. There is nothing wrong with being wronged.

But there is something wrong with constantly remembering that you were wronged.

I read a quote which says, “Holding on to anger is like grasping a hot coal with the intent of harming another; you will end up getting burned”.

Another profound quote which describes the effects of unforgiveness says, “Holding on to anger is like drinking poison and expecting the other person to die”.

Being unable to forgive others will harm the bearer of the unforgiveness. Anger and bitterness are toxic. Let

Priority Priority One | Issue One | 4, Issue November 2, June 2016

ER24 staff them go.

Build a life that is pure and full of love for all people. It does not matter what they did to you. It does not matter how much they tried to destroy you. Move on. Forgive them.

Let it all go.

Choose to build carefully When you are building your life, try to avoid including that who caused your life to “collapse”.

My previous point speaks about forgiveness but, forgiveness does not mean reconciliation. You do not have to include people who hurt you into your future plans.

TD Jakes once said, “If people can walk away from you, let them go”. Do not try to water plants out of concrete.

It is a waste of your time.

Some people are in your life to serve as scaffolding. They are there to hold you up to a certain point. When their time has come, let them go. You are stronger than you know. I dare you to try standing up on your own.

If you can choose your “building material” wisely, you will build a beautiful life.

What used to be an eightroomed house was renovated and built into a beautiful 13-roomed house.

Likewise, your situation did not destroy you. It could not destroy you. The fact that you are reading this right now tells me that you made it.

Choose your friends carefully and choose what you listen to carefully.

Check where you are spending your time. If it is

not beneficial, let it go.

If it does not develop you, move away from it. Choose carefully. Build a beautiful life.

Do not be pessimistic When one of our neighbours visited a few days later, she saw the rubble and came to the conclusion that the situation was hopeless. She proposed that we sell the property and buy a new one.

This neighbour of ours was so enthusiastic such that she even had a house for us to purchase.

President Barack Obama once delivered an address and after the talk, he was accused for giving the Americans “false hope”. He replied in a short phrase but it really got me thinking. He said that “there is nothing false about hope”.

There is nothing false or wrong with hoping for the very best for your life. You can still build something amazing.

Do not trade your dreams in for what looks easier. Do not give up on what you want and settle for that which others say suits you better.

Do not settle for anything that is not the very best.

You know what you want out of your life. You know what you are building. You know which direction your life is taking and how you are forming it.

Do not be moved by external opinions. Stand your ground and you will win.

Rebuild your life. You will win if you do not quit. No matter how tainted a person’s past is; their future remains spotless and without blemish.

Pulling up our sleeves to save a life

by Russel Meiring, Communications Officer: ER24 With the shortage of the necessary red liquid that flows through us all, ER24 decided to make a difference.

ER24 decided to invite the South Africa National Blood Service (SANBS) to its Head Office so that we could donate blood yet again.

ER24 Head Office staff were greeted by a large white tent set up in the parking lot on 8 September with a team of phlebotomists waiting to “bleed us dry”. With a few nervous faces, staff began to fill out the necessary paperwork.

Now, lying in the chair, armed with a biscuit and juice, comes the thought that

a mere one pint of blood can save up to three lives.

As the life force begins to flow through the tubes, a smile spreads across the face of the donors. We are making a difference.

Vanessa Raju, spokesperson for the SANBS, says that up to 3 000 units of blood are needed every day hence, every donation can make a difference.

With so many units being needed every day, ER24 heeded the call and did their part.

With so much need for blood, do you not think rolling up your sleeve is a small price to pay?

Priority One | Issue 4, November 2016

| 24

Community involvement

Little Aidan all dressed up and ready to go. He is pictured with ER24 Joburg North Branch Manager, Saul Behrmann, and Russel Meiring, ER24 Communications Officer.

Making dreams A young boy’s dream came true just before going into theatre for a surgery on 21 October.

Little Aidan (7), became the youngest “member” of “Team Red”. Aidan, dressed in his red ER24 superhero flight suit, took his first official ride in an ambulance.

With the help of the sirens blaring and the lights flashing, Aidan, in the company of his ER24 “colleagues” and family, bravely reported for duty at Mediclinic Morningside.

Aidan, who lives in Bryanston, was diagnosed 3 25 | |

a reality

with a rare genetic disorder called Costello Syndrome when he was 18 months old.

The syndrome is so rare that he is only the second diagnosis in South Africa. He is one of only a few hundred people worldwide who has been diagnosed.

Costello Syndrome affects various parts of the body.

In Aidan’s case, he has to undergo abdominal scans every three months to screen for cancerous tumours. He also has to undergo heart scans as he has a thickened left ventricle wall.

In addition, Aidan has

Culcaneo Vulgus Feet as well as a number of other challenges as a result of the syndrome.

Aidan recently developed growths under his lower eyelids. The surgery on 21 October was to remove these growths as well as adenoids as a result of them affecting him.

Aidan has been for numerous operations. To lighten his mood in the run up to the operation he underwent on 21 October, Aidan’s mum, Melissa Botha, requested a visit from any emergency service.

“Aidan loves emergency services… firefighters, police officers, paramedics, ambulances… he gets so excited. With the run up to this operation and Aidan having so many bad experiences, I thought about having a fireman, police officer or paramedic visit him to take the edge off. I put a message on Facebook stating that Aidan was not dealing well with the idea of another hospital visit. I requested a visit from any emergency service. ER24 contacted me wanting to assist. ER24 blew my request out of the water,”

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Community involvement she said.

ER24 paramedics visited Aidan a day before the operation with a goodie bag and a flight suit.

He put the flight suit on immediately and did not take it off until it was time for his bath that night. “The first thing he did the morning after was put the flight suit on again,” said Botha.

On the day of Aidan’s operation, ER24 Joburg North paramedics, including branch manager Saul Behrmann, picked Aidan up and took him to hospital.

“There were a number of vehicles (response vehicles, an ambulance and rescue vehicle) at our door. ER24 made such an impact. Aidan got to ride to hospital in the ambulance. He was the paramedic and I had to play the patient. I cannot thank ER24 enough. Aidan was so excited and had a blast before his operation. The paramedics literally changed his whole experience with hospitals,” said Botha.

Aidan has become a household name in many homes with various people wanting to help.

As a single mum trying to do the best for her child, Botha has had to find ways of helping Aidan cope with the challenges he faces. She has also had to find ways of raising funds to cope with monthly expenses.

Challenges “As a result of the Culcaneo Vulgus Feet, Aidan was walking almost with the insides of his ankles. We tried

various non-invasive ways to treat the condition. However, last year he had to undergo an operation. It was one of the most difficult operations we went through. He was in Plaster of Paris for more than six weeks and if you know Aidan, you will know that he is busy all the time. His mobility is his expression of communication. I had to keep him busy. He was a bit depressed that he could not move around. As a single mum it is a challenge. Aidan also gets uncomfortable with food and clothes and even getting him ready for school is a challenge. The biggest thing that works fort him is imagination. I cannot be an adult all the time. I have to be a child with him… to entertain him, get him to school and be on schedule.

“Finance is another challenge. Aidan has to go for occupational therapy and needs medication and specialised equipment. There are costs that are not covered by medical aid. The average cost of raising Aidan is about R35 000 a month,” said Botha.

To raise funds, Botha created a website called Raising Aidan.

She raises funds by selling cupcakes catering for everyone’s taste including those who are diabetic or require gluten free.

You can help raise Aidan by buying these cupcakes. To find out more about how you can help Aidan, visit www. raisingaidan.co.za or visit the Raising Aidan Facebook page.

“I cannot thank ER24 enough.

Aidan was so excited and had a blast before his operation,” - Botha Priority One | Issue 4, November 2016

| 26

Supporting seabird conservation Community involvement

SANCCOB, a registered nonprofit organisation, recently thanked ER24 for its generous donation of emergency services (two paramedics and an ambulance) during the Penguin Festival.

SANCCOB’s primary objective is to reverse the decline of seabird populations through the rescue, rehabilitation and release of ill, injured, abandoned and oiled seabirds – especially endangered species like the African penguin.

In a letter to ER24, Executive Director Dr Stephen van der Spuy and the SANCCOB team said, “Your support has contributed greatly to our seabird conservation work with African penguins and other seabirds. Thank you…

3 27 | |

together with the help from our conservation partners and volunteers, you are ensuring SANCCOB continues to rescue ill, injured, abandoned and oiled penguins and other seabirds – and successfully rehabilitate them for release back into the wild.

In a non-spill year, SANCCOB treats close to 2 500 seabirbs, of which approximately 1 500 are African penguins, at both its strategically placed centres in Cape Town (Western Cape) and Cape St Francis (Eastern Cape). SANCCOB also contributes to research which benefits seabirbs, trains people to care for birds and educates the public to appreciate this unique heritage.

While it is commonly assumed that most African penguins remain in the wild, according to SANCCOB, this is not the case.

Less than 2% of the African penguin population remains in the wild. The African penguin (Spheniscus demersus), the only penguin species to occur naturally on the African continent, is endangered.

The species has consistently declined from an estimated 1 million breeding pairs in the 1930’s to a point where only 17 263 African penguin breeding pairs remain in the wild in South Africa today (latest figures released by the Department of Environmental Affairs).

Since 1968, SANCCOB has been at the forefront of saving

the African penguin and has treated more than 90 000 African penguins and other seabirbs.

Research according to SANCCOB confirms that the African penguin population is 19% higher as a direct result of their oil spill response efforts alone.

According to SANCCOB, currently, the biggest threats to the species include habitat destruction, commercial overfishing which has depleted fish stocks, oil and marine pollution and predation by seals, sharks and land-based animals.

Penguin’s cannot protect themselves against these threats. “Only people who care – like you – can help them,” said Dr Van der Spuy.

PriorityPriority One | Issue One |4,Issue November 2, June 2016

Community Company involvement interest

Santa Shoebox

wraps up

by Tiisetso Mashego, Acting Marketing Manager: ER24 ER24 once again pledged a number of boxes towards the Santa Shoebox Project.

ER24 has been pledging boxes to the project annually since 2013. The initiative is planned and coordinated by the Marketing Department with the help of some ER24 staff members.

This year, ER24 pledged 100 boxes for boys and girls, aged between one and four, based at the Little Stars Facility in the Diepsloot area. ER24 staff came out in their numbers to help wrap boxes, pack items, label boxes and double check contents of the boxes.

There is truly nothing better than the feeling of knowing that you are making a difference in someone’s life, someone who ultimately can never repay you.

Most of the children are either orphans or from disadvantaged backgrounds.

It is good to know that what we did as ER24 staff will make 100 children smile this Christmas.

I thank all ER24 staff who took the time to volunteer and make a difference in a child’s life.

The gifts were handed to the children on 18 November.

Sonja Hood, Santa Shoebox Project Coordinator for JHB North, thanked ER24 for the amazing boxes. She said it was wonderful to have ER24 on board once again.

How the Santa Shoebox Project works: The Santa Shoebox Project, which originated in Cape Town in 2006, has grown tremendously.

The project is supported by extensive volunteers, is represented in all provinces and is distributed throughout South Africa and Namibia annually.

Donors pledge gifts to children in the form of a wrapped shoebox.

Inside each box are toiletries, an item of clothing, toys, stationery and sweets.

The donor is given the name, age and gender of the child to which they are donating to in the form a label with the child’s details on it.

All the boxes are then collected, either from individual donors or from giant corporations, as part of their Corporate Social Investment (CSI) initiatives.

The donors are then given a drop-off date and zone for when the complete boxes need to be dropped off.

The items are then checked by the Santa Shoebox volunteers to ensure that all the required items are included in the box for that particular child.

The coordinators then allocate a school or orphanage to the donors, with a date for which they can come and celebrate with the kids when they receive their gifts.

Priority One | Issue 4, November 2016

Didi Lengoabala enjoys packing a Santa Shoebox.

Beaula Poonin with one of the boxes she filled for a child.

Above: Chandre Bruce, Michelle Conradie and Justice Tshabalala volunteer their time to pack some boxes.

Left: Spreading the joy. Tiisetso Mashego completes yet another successful Santa Shoebox Project operation.

| 28

Road safety discussed

Community involvement

ER24 Bloemfontein and the ER24 Training Department visited Grey College recently to talk to learners about road safety, the importance of wearing a seat belt and being appropriately restrained in a vehicle.

ER24 staff provided the children with various safety tips including what they should do when crossing the street to ensure their safety.

At ER24, we believe that educating children about safety is of utmost importance.

Child car seat Parents play a vital role in ensuring their children are safe while in a vehicle. We urge parents to take note of the new regulation, in the

National Road Traffic Act, that aims to protect children by the use of the child car seat.

The use of a child car seat for all children under the age of three was made compulsory from 1 May, 2015.

While it is law to use child car seats for children under the age of three, this does not mean that adults should ignore the need to restrain older children. Make sure they are restrained appropriately.

What is the appropriate restraint for your child?

ER24 offers the following advice: • Infants should ride rearfacing at least until they are a year old.

• Once they exceed the weight or height limit set by the manufacturer of the infant safety seat, they should continue to ride rear-facing in a convertible safety seat. It is best to keep toddlers rearfacing as long as possible.

• When they have outgrown this seat, they should use a forward-facing safety seat with a full harness. This should be used until they exceed the weight and/ or height limit set by the manufacturer of the seat.

• Children who have outgrown a convertible safety seat should use a booster seat until they are at least four feet.

• Children who are tall enough to wear an adult seat belt should still ride in the

back seat until they are 13 years old. Adjust the seat belt so the lap belt crosses the child’s upper thighs and the diagonal belt crosses the upper chest at a point between the neck and shoulder.

Also remember, it is vital that you make use of a seat belt as well.

Failure to do so could result in you being fined or, in the case of a collision, you possibly sustaining critical or fatal injuries.

Thanks We would like to take this opportunity to thank Grey College for allowing us to talk to their learners. We also thank Van Rensburg Patoloë for sponsoring party packs for the children.

At the back: Thys van Niekerk (BLS at ER24 Bloemfontein), Petro Jonker (ER24 Training Academy), Lucas Bezuidenhout (ER24 Bloemfontein Branch Manager), Wayne Jooste (ALS at ER24 Bloemfontein), Lonika Janse van Rensburg (representative from Van Rensburg Patoloë) and Mario Stevens (BLS at ER24 Bloemfontein). At the front: Zuan Jonker and Keegan Janse van Rensburg.

3 29 | |

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Prepared for

Awareness

your holiday?

by Russel Meiring, Communications Officer: ER24 The festive season is almost upon us and you have probably been planning for some time.

But how ready will you be should an emergency arise during you vacation?

During the 2015 festive season, 1 755 people lost their lives as reported by Transport Minister Dipou Peters.

This was an increase of 14% from the previous year.

The Western Cape recorded the highest increase (33%) in deaths, from 122 the previous season to 162, followed by the North West which increased by 26% from 108 to 136 fatalities.

Other provinces that also showed large increases in fatalities included Gauteng (10%), Eastern Cape (22%), Free State (20%),

Mpumalanga (16%), Limpopo (12%) and the Northern Cape (19%).

The only province to show a decline in road fatalities was KwaZulu-Natal (-2%).

By reading our guidelines below, you will be able to prepare for an emergency that may arise while you are on you holiday.

checking your vehicle, you can minimise the risk of it breaking down.

The Automobile Association of South Africa (AA) recommends that a 52-piont check-up be done before going on a long trip.

These inspections can be done at any reputable vehicle service centre.

Plan for the worst No-one wishes to be involved in an emergency, but statistally, it will happen.

Properly preparing your holiday can decrease the odds and, should the need arise, you will be equipped for your emergency.

Your destination How well do you know your destination? An emergency can happen at any time.

Knowing the few tips below can mean the difference between life and death: • Know where your closest hospital or general practitioners are located.

• Have a list of the emergency services in the area.

• Make sure that each family

Vehicle Make sure that your vehicle is roadworthy. Also, by

member carries around a card with all their emergency medical information.

• Remember, by adhering to the rules of the road and following our guidelines, you can have a safe and wellrested holiday.

On your journey By following these few tips, you can make sure that your journey is a pleasant one: • Know your route and the rest stops along the way.

• Stop every 200km or two hours.

• Drink plenty of cool liquids to stay hydrated.

• Listen to some music while driving to ensure you do not become drowsy.

• Should you become drowsy, pull over in a safe area, have a good stretch and a brisk walk.

What you should pack A number of necessities should also be packed in your vehicle. These include: • Power bank – Should you be stranded and your cellular phone needs an emergency charge • First aid kit • Fire extinguisher • Reflective warning triangles • Tire gauge

• Foam tyre sealant • Jumper cables • Flashlight and batteries • Workers gloves • Duct tape • Tow rope • Multipurpose utility tool • Rain Poncho.

• Drinking water • Nonperishable snacks • Warm blanket

Priority One | Issue 4, November 2016

| 30

Awareness

Major cause of death and disability Trauma is said to be a major cause of death and disability across the world.

In South Africa, one of the common causes of death and disability is road-related incidents.

Daily, ER24 attends to collisions that result in people sustaining severe or fatal injuries.

Sadly, despite all efforts by highly qualified expert paramedics, there is nothing that can be done for some patients as a result of the severity of injuries sustained.

For survivors, assessment, treatment and transportation to the closest appropriate 3 31 | |

hospital by paramedics is the key focus.

Time is of the essence.

Injuries sustained during these incidents include those to the head, severe impact to internal organs, broken bones… the list is endless.

For some, even with expert treatment, severity of the injuries sustained leaves little if any room for recovery.

Thousands of people die or suffer injuries that lead to life-long problems as a result of collisions on South African roads every year… in many instances, due to causes that could have been prevented.

Speeding, driving while under

the influence of liquor, driving un-roadworthy vehicles, unrestrained children in vehicles, not using child car seats where necessary, texting and driving… these are choices that motorists make, choices that not only pose a risk to them, but innocent people around them.

The festive season is almost upon us.

That means that there will be more long distance drives, people rushing to get to their destinations, more parties, more alcohol and reckless behaviour.

We urge people to take their safety as well as that of others

seriously.

How do you prevent being a road fatality statistic? Below are some tips: • Be patient and alert while driving.

• Speeding must be avoided.

• Keep a safe following distance.

• Ensure children are buckled up or appropriately restrained.

• Avoid road rage.

• Do not drive while under the influence or liquor or drugs.

• Ensure you get enough rest prior to leaving as well as take breaks while driving.

• Make use of a hands-free kit and refrain from texting and driving.

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Awareness

What to do at an accident scene Do you know what to do if you are involved in a collision?

You could be involved in a collision at any time and its best to know what you should and should not be doing.

Rather be prepared.

Below are some tips to help you should you encounter a road-related incident.

• If you are involved in a collision, stop the vehicle (in cases where you are uninjured or have sustained minor injuries and assuming that the vehicle is still in working order in cases of bumper bashings etc).

• Do not leave/flee the scene.

Get your vehicle to a safe area on the side of the road if possible to avoid further possible incidents.

• Give your name and address, the name and address of the owner of the vehicle where necessary as well as the registration number and your driver’s licence details where required to do so. Report the incident at a police station within 24 hours.

• While on the scene of a collision, try to stay calm.

Assess the situation to determine the best way to handle it. Make use of hazard lights and an emergency triangle to alert passing motorists. There are instances where secondary collisions occur. Hence, you should ensure scene safety. Assess traffic flow and determine if it poses a danger to anyone including those involved in the collision or others around.

• Ascertain the nature or extent of the incident - Is everyone who was travelling

in your vehicle accounted for (people could have been ejected from the vehicle for example)? Are people who were travelling in the vehicle you were in injured?

Are people in other vehicles involved in the collision injured? Are people trapped in vehicles? Is there a fire? Are patients lying on the road?

• Call emergency services immediately or instruct someone to do so immediately. You should always have important contact details, such as emergency services and the SAPS, stored on your phone. ER24 has a dedicated, 24/7 Emergency Contact Centre that enables you to request an emergency vehicle telephonically.

Call 084 124 in case of an emergency. Remember that the information you are requested to provide and the information you supply is often the first point where a life can be saved.

• Where first aid is needed, start immediately if you are able to do so. You should always carry a first aid kit in your vehicle. If a patient you are with is unconscious, open

Priority One | Issue 4, November 2016

their mouth to check if there is something inside that is causing an obstruction.

Check if the person is breathing. If the patient is breathing, leave them in the position you found them in and monitor them. If the patient is not breathing and you have been trained to do so, initiate CPR. • If a wounded person is bleeding heavily, take gauze or sterile dressings from the first aid kit and place it on the wound. If gauze or sterile dressings are not available, use a towel, t-shirt or blanket for example. Press the gauze or other material tightly, applying direct pressure to the wound. Maintain that pressure until emergency services arrive. Do not stop pressing to check if there is continued bleeding or to look at the wound.

• Never move an injured person unless for their own safety (for example, if the vehicle is on fire or if there are other threats). Remember that moving a person could make their condition worse, hence it is not advisable unless vital to do so.

• If there is a fire, use a fire extinguisher. You should always carry a fire extinguisher in your vehicle and also know how to use it.

• Remember that while it is important to assist a patient, you should also ensure your safety. Do not attempt anything that may jeopardise your own safety. You are of no use to anyone if you are injured while attempting to help others. Also remember, never touch a person’s blood or try to assist them without proper protection such as gloves.

• Remember to guard children or ensure that they are safe or supervised on an accident scene.

Other important information: If you are a passing motorist, pay attention to the road ahead, slow down and drive cautiously. If you stop to assist patients, ensure that you stop your vehicle in a safe area where you do not pose further danger or an obstruction. Everyone should go for first aid and CPR courses. | 32

Awareness

Alcohol and driving You insisted on driving because you only had a few drinks.

Days later you wake up in a hospital. Suddenly you remember a crash scene. You were trapped in your vehicle

3 33 | |

do not mix and your family was scattered around the area. You later find out that your child died in the collision.

This is one of several ways your future could change for the worse… it could also

end with you killing more innocent people, you facing jail time or even you losing your life in a crash as well. So just few drinks… is it worth it?

You can try and debate it now,

you can explain how well you handle your alcohol and you can also say you know what you are doing… none of this will matter when either you or someone else dies.

Dr Robyn Holgate, the Chief

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Awareness Medical Officer of ER24 said, “In South Africa, the legal limit is a breath alcohol content of 0.24mg per 1,000ml, or a blood alcohol limit of 0.05g per 100ml.

The general rule of thumb is a maximum of one unit of alcohol per hour. However, to be safer, if you are going to be driving, rather refrain from drinking any alcohol. Alcohol distorts a person’s judgement and perceptions as well as slows down reaction times.”

She added, “Society needs to have zero tolerance for people who drive while under the influence of alcohol. My mother was driving home with my little boy from school in the middle of the day recently.

They were nearly killed by an intoxicated motorist. Imagine having on your conscience that you almost or did kill somebody as a result of being intoxicated.”

She added that mild to moderate intoxication can impact on a person in a number of ways. It could lead to mild incoordination, nystagmus (fast involuntary movements of the eyes), ataxia (loss of full control of body movements) and slurred speech. A higher level of intoxication may lead to coma, respiratory depression and a drop in blood pressure.

Loud aggressive behaviour with the loss of inhibition may also occur as a result of alcohol consumption.

“If you are ever in doubt about the serious consequences of driving while under the influence, volunteer for a shift at your local EMS or police service,” said Dr Holgate.

Apart from witnessing how lives are torn apart, you will witness the difficulty paramedics experience when attending to an intoxicated patient. You will also experience the problems

encountered by paramedics who try to attend to a patient in the company of an intoxicated uninjured person on scene.

Saul Behrmann, ER24 Joburg North Branch Manager, said gaining correct information from an intoxicated patient, such as how the incident happened, what they remember and contact details for family members who need to be informed of the patient’s injuries, is challenging.

It is also difficult to gain information from an intoxicated patient on their medical conditions as well as medication they are on.

“Assessing them is difficult as they repeat questions and comments. Some intoxicated patients want you to assist them and then they change their mind. Being intoxicated makes general assessment and treatment difficult.

“If an intoxicated person (uninjured) is on a scene and knows the patient, they hamper paramedics’ treatment to the patient. They want to get involved in what is going on. They sometimes threaten and push paramedics around as they ‘want the best treatment for the patient’.

While they do not understand what treatment is being provided to the patient by the paramedic, they do not believe that it is the best treatment. Paramedics obtain assistance from authorities to keep the area around the patient/s safe and to keep the intoxicated person away from the scene. Paramedics encounter intoxicated people who become aggressive towards them even though they see them, paramedics, trying to provide treatment,” said Behrmann.

Dr Holgate said people who consume alcohol should note that the rate at which a person becomes intoxicated

Priority One | Issue 4, November 2016

Unit calculation How do you calculate how many units of alcohol you have consumed?

Multiply the volume of the drink (in millilitres) by its percentage alcohol by volume and divide by 1 000 to determine the number of units of alcohol in the drink you had.

For example: • 350 millilitres of beer at five percent volume would be calculated 350 x 5/1000 = 1.75 units.

• 750 millilitres of wine at 12 percent volume would be calculated 750 x 12/1000 = 9.0 units.

Think before you drink. ER24 can be contacted on 084 124 in case of any medical emergency.

varies. “On average, it takes about one hour for the body to metabolise one unit of alcohol. However, this can vary based on body weight, sex, age, personal metabolic rate, recent food intake, the type and strength of the alcohol and medication taken,” said Dr Holgate.

She provided the following explanation: • If a man and woman of the same weight were to drink the same amount of alcohol at the same rate, the woman would be more intoxicated than the man.

This is due to gastric alcohol dehydrogenase concentration being significantly higher in men than in women. Gastric alcohol dehydrogenase is the enzyme that begins the breakdown process of alcohol in the stomach. More alcohol makes its way to a woman’s small intestine for absorption.

A woman’s blood alcohol concentration increases by about seven percent more that a man. Women have a naturally higher percentage of body fat than men. This results in them having a higher blood alcohol level than men.

• An older person often has a higher fat-to-muscle ratio and less body water. As a result, when compared to a younger person with the same weight who has had the same amount to drink, they may have a higher amount of alcohol in their blood.

• The use of illicit drugs and medication such as antihistamines, pain relievers and antidepressants in conjunction with alcohol can increase the effect of the alcohol consumed. Drinking alcohol while on illicit, overthe-counter and prescription drugs can lead to illness or death.

• Drinking alcohol on an empty stomach can affect a person more than if they were to eat before drinking liquor.

The rate of alcohol absorption depends on how fast the stomach empties its contents into the intestines. Foods high in fat for example take longer to exit the stomach. If you eat before you consume alcohol, the alcohol will be absorbed slower than if you were to drink on an empty stomach.

• Alcohol may be metabolised more slowly if your liver function is impaired. | 34

Pool and Awareness

beach safety Plan on spending your time at the pool or at the beach?

While this is exactly how many people plan on spending their time over the next few weeks, ER24 is urging the public to be responsible.

Drowning, especially during the warmer months, is a common occurrence.

Below are some tips to keep in mind to prevent drowning: • Remember that anyone, including people who can swim, are at risk of drowning.

Avoid taking risks and being overconfident.

• Refrain from drinking alcohol if you plan on swimming or if you are supervising others who are swimming. Remember that alcohol impairs movement and thinking.

• Children must always be supervised while around water or if swimming.

Never allow a child to swim without adult supervision.

• Keep your pool covered with an approved safety/ pool net when not in use. It is a good idea to put a fence around your pool if it is not fenced.

• Never dive into or act recklessly around a pool.

Remember that you could easily fall or slip into the water and get injured.

• Do not swim far out into the ocean. You may struggle due to fatigue or get swept away.

Swim in designated areas.

• Wear a life jacket especially when participating in water sports.

• Never swim alone.

Someone drowning?

• If you are at the coast and you see a person drowning, alert a lifeguard immediately. If you can swim and decide to save the person yourself, ensure you wear a floatation device.

• If you find a person drowning and are able to get them out of the water be it at a pool or at the beach, initiate CPR if there is no pulse and breathing.

• Do not stop CPR unless the person starts to breathe on his/her own.

• Call for an ambulance as soon as possible and tell them what you are doing so they can send the correct level of care.

• Do not put the person in the car and drive to hospital. You may be involved in an accident due to panic or the victim may suffer brain damage while en route to hospital.

3 35 | |

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Awareness

Right information at the right time can save a life

by Santi van Heerden, Contact Centre Coordinator: ER24

ER24 has a dedicated, 24/7/365 Emergency Contact Centre that enables you to request an emergency vehicle telephonically.

Over the years we have found that the initial call is often the reason for delays as the information received from callers is vague and sometimes incorrect.

While we completely understand that making a

call in the event of a dire emergency can be daunting, we would like to emphasise that the information supplied is often the first point where a life can be saved.

The following guidelines can be applied when placing an emergency call: • Dial 084 124.

• Where possible, stay with the patient and remain calm.

• During the call, you will

be asked for your name, your telephone number, an alternative contact number if you have one and what appears to be wrong with the patient.

• The Emergency Resource Officer will ask you a series of questions to determine what type of vehicle and clinical practitioner to send to you.

• You will also be asked for

the incident address, the complex name/office park/ street address, area, town and province.

The town and province are very important as there are duplicate suburbs in multiple provinces (for example Rosebank in Johannesburg and Rosebank in Cape Town.

Remember, providing the right information at the right time can save a life.

The importance of learning CPR November highlights the importance of people having the ability to perform Cardiopulmonary Resuscitation (CPR).

At ER24, we constantly urge people to learn CPR. Why… Simply put, it is a skill that could save a person’s life. The thing about an emergency is that you never know when one may arise? Anyone including family, friends and colleagues could suffer cardiac arrest for example.

You may just be the only one around who could possibly save them. Hence the importance of learning CPR. Below are some facts and tips about CPR provided

by Willem Stassen, ER24 Critical Care Paramedic.

What is CPR? CPR is the artificial means of ensuring that there is still blood flow to the brain and vital organs in the absence of a heartbeat (when someone goes into cardiac arrest).

When exactly should CPR be performed?

Any patient who is unconscious, not breathing and without a pulse should have CPR started. Research has shown that it is often difficult to definitively feel a pulse on these patients. For this reason it is suggested that any patient who is not breathing or who is breathing abnormally (gasping) should have CPR started immediately.

What does CPR do?

CPR provides blood and oxygen to the heart muscle during compressions in order for the heart to have energy to restart. In addition, while the heart attempts to restart (if possible), CPR provides blood to vital organs. CPR and defibrillation (shocking patients in certain heart rhythms) have shown to be the only interventions that improve survival in cardiac arrest. The chances

Priority One | Issue 4, November 2016

of survival without brain damage diminishes every minute that no CPR is done.

This means that waiting for an ambulance and paramedic to arrive before starting CPR will most certainly lead to a decreased chance of survival or an increase in the chances of catastrophic brain damage.

See why it is important to learn CPR? How do you initiate CPR? This is done by applying external pressure to the chest by means of compressions.

By applying this external pressure, blood is squeezed from the heart and chest cavity and circulated through the rest of the body, thus allowing for blood flow.

Start CPR by interlocking your fingers and placing both hands on the breast bone of the chest. This is right in the centre of the chest. Push down onto the breast bone, keeping your arms straight.

Release the compression and

repeat at a rate of at least 100 compressions per minute.

CPR should only be stopped if your life is in danger, if you are physically exhausted to the point where you cannot continue or until help arrives.

Should CPR be combined with mouth-to-mouth?

We have watched movies and know that mouth-to-mouth is a requirement, right? Wrong.

It is no longer required to do mouth-to-mouth during CPR. Why? Because it discourages people from starting CPR, delays the start of chest compressions (the most important element of CPR), and there is passive breathing between each chest compression. Research has shown that there is no difference in mortality (survival) when patients are given compression-only CPR or where mouth-to-mouth is performed intermittently.

Remember, you could save a person’s life. Learn CPR. | 36

Awareness

Youngsters at parties

be responsible

Parties will continue following matriculants completing their final examinations and while it is great to celebrate, they should do so responsibly.

Incidents, especially among matriculants, increase at this time of year. Incidents include motor vehicle accidents, assault and drowning.

Contributing factors include reckless driving and the abuse of drugs and alcohol.

Klaus Milbert, the Skills Development Facilitator at ER24, said alcohol intake increases among matriculants who are 18 years of age as they are allowed to drink by law.

In addition to the increasing tendency to have alcohol at parties attended by matriculants, concerns have also been raised about the availability of liquor to their underage partners.

Accidents The question every teenager should ask themselves is, can their conscience handle someone’s death as a result of their driving?

In addition to speeding, people should never drive while under the influence of alcohol or drugs. People should keep in mind their reaction time to any danger posed on the road is slower

while under the influence of drugs or alcohol. Most vehicle accidents, in which teenagers were the drivers, resulted in major trauma, disability or death.

The reality is if anyone dies while you are behind the wheel, you could face criminal charges. “You may survive but others may not.

There were accidents in which drivers, who were drunk or on drugs at the time, did not sustain injuries. However, others involved were killed or disabled,” said Milbert.

Remember that as exciting as driving while underage may seem, you have not been taught how to handle the vehicle in certain situations.

That comes with experience and age. In addition to criminal charges, your recklessness could also affect your job opportunities in the future.

“Killing someone is a terrible feeling to live with. Underage driving can also result in a licence denial when you reach the age for application,” said Milbert.

Drowning Drowning increases among matric party groups. “There is alcohol and drug usage at these parties. Then a youngster decides to go for a swim. Either they cannot

“For that short-term high, the possibility could be a longterm disability,” - Milbert 37 |

Klaus Milbert, the Skills Development Facilitator at ER24.

swim or play rough in the pool and drown,” said Milbert.

Drugs Youngsters should keep in mind that the danger of taking drugs includes overdose and medical conditions such as psychoses as well as heart and kidney failure. “For that short-term high the possibility could be a longterm disability or a criminal record. It is not worth it,” said Milbert.

If you go to a party or club, remember not to accept drinks from strangers, especially open drinks or drinks in a glass.

Do not leave your drinks unattended. Girls should also

travel in two’s while in a club, including the toilets.

Emergency Although you want to go out and have fun, think about the possibility of something going wrong. Youngsters should ensure their parents are aware of where they are going in case of an emergency.

“You need to have a good relationship with your parents.

“Something could go wrong and parents need to know where to find you. If you are missing they will know where you last were.

“Also, if there is an emergency at home, parents will know how to get hold of you,” said Milbert.

Priority One | Issue 4, November 2016

Holidays... festive or traumatic The festive season for most people is a time of holiday, happiness and fun.

Most people get ready to go on holiday or spend time with their families and do fun things they never have time for. The shops are full of gifts to buy and happy festive music plays all around. It is a happy time for a number of people.

However, not everyone feels this way.

For some people, the festive season is one of the most difficult and sad times of the year. Because the festive season is a time where families spend time together, the people who have lost family or loved ones struggle to cope without them. For some people, it is a time where they are confronted

with the loss of a loved one.

We have had people who fear the festive season nearing because they “have to face their pain”. People who loose loved ones find that the festive season is the time when they miss them the most.

During the festive season, there is an increase in motor vehicle collisions, suicides and deaths in general. It is most probably the time of the year where the most deaths occur.

Unfortunately, people become reckless during the festive season. A number of people drink too much and this results in a higher number of collisions and deaths during this time.

Therefore, there are a number

Awareness

by Henning Jacobs, Trauma Support Coordinator: ER24

of people who have lost loved ones during the festive season.

Therefore, the festive season is just a reminder of the loss they suffered. We urge people to be careful and responsible during the upcoming festive season. Always remember that your actions could put your loved ones or other people’s loved ones at risk. Do not be responsible for turning your own or someone else’s festive season into a nightmare.

We urge people who fear a sad or depressing festive season to put skills in place to help yourself cope. Some skills that will help include spending time with friends or family.

Do not take on this time alone as this could make it worse.

Surround yourself with good

friends or family. Another skill that will come in handy is to make sure you try to have fun.

Remember that it will help you cope with the trauma. Fun is one of the best ways to cope with trauma.

Exercise is another great coping skill. People need to exercise as it helps to cope with the physical and mental effects of trauma. There are a number of different types of exercise and people must embrace whatever works for them. Focusing on religion is also another way to cope.

Many people find their peace and joy in religion.

Should you need assistance in dealing with trauma, phone 084 124. The ER24 team is standing by to help.

Celebrate with safety in mind Whatever your intentions over the festive season, be it going away on holiday, visiting local attractions or staying at home, ER24 is urging everyone to keep safety in mind.

Outdoors If you plan on going camping or sightseeing, do some research about the area if you have never been there and plan accordingly. Be aware of your surroundings at all times especially when hiking, sightseeing or approaching areas that include cliffs. You could be stepping on loose stones or boulders or venture too close to the edge of a cliff.

If there are children with you,

ensure you know where they are at all times. This should be something you ensure at all times.

Braai If you plan to have a braai while away on holiday, ensure you are allowed to do so at the location you have chosen.

If you are allowed to, be careful. When having a braai at home or while away on holiday, keep a fire extinguisher close by. The braai stand should not be placed in or close to the only escape.

The braai stand should be sturdy. Never abandon the fire. Do not start fires close to

Priority One | Issue 4, November 2016

dry brush and grass. Children should be a safe distance away from the braai area.

Teach them about the dangers of playing with matches and lighters.

Home safety If you are going to be away from home, remember to cancel newspaper deliveries and have a friend or family member remove letters or pamphlets that may be put in your post box, at your fence or gate.

It is a great idea to have a security system installed if you do not have one. If you do have a security system, ensure that your alarm,

electrical fence, beams, cameras or any other security measures that you have in place, are working.

When leaving home, ensure that windows are closed and that doors, garages and burglar gates are locked.

If you are going all out with Christmas trees, lights or other decorations, avoid overloading electrical outlets.

Ensure potentially dangerous items, such as those that pose a choking hazard or breakable items such as those made of glass, are out of a child’s reach.

Turn off decorative lights when you go to sleep or leave home. | 38

Health

Prevent dehydration While ER24 urges people to put their safety first over the festive season and to drive cautiously, we are also urging people to pay attention to their health.

Enjoying the summer weather by spending time outdoors could negatively effect your health if you are not cautious.

Remember not to spend too much time in the blazing sun as you could suffer from dehydration.

Dehydration is a condition that occurs when the loss of body fluids, mostly water, exceeds the amount that is taken in.

With dehydration, more water is moving out of our cells and body than what we take in through drinking.

Dehydration can lead to confusion, fainting, seizures and eventually, may lead to 3 39 | |

death.

Hence the importance of taking this condition seriously.

How to prevent dehydration Dehydration can be prevented by: • Making sure that an adequate amount of water is consumed during the day.

• Planning ahead and taking extra water to all outdoor events and work where increased sweating, activity and heat stress will increase fluid loss.

• Avoiding exercise and prolonged time outside in the sun during high peak temperature, especially during the middle of the day.

• Ensuring that older people and children have adequate drinking water or fluids available and assisting them

as necessary.

• Avoiding alcohol consumption, especially when it is very warm.

Symptoms Symptoms of dehydration range from minor to severe and include: • Increased thirst • Dry mouth and swollen tongue • Weakness • Dizziness • Palpitations (feeling that the heart is jumping or pounding) • Confusion • Sluggishness • Fainting • Inability to sweat • Decreased urination Treatment One of the first steps in treating dehydration is to gradually cool the patient.

This can be done by cooling through spray mists and fans or cooling blankets and baths.

If the patient is conscious, electrolyte/carbohydratecontaining fluids, along with water, should be given to them.

When is the time to seek medical attention?

Medical attention should be sought if the patient experiences any of the following: • Increased or constant vomiting for more than a day • Fever over 38°C • Diarrhoea for more than two days • Decreased urination • Confusion • Weakness • Sluggishness • Headache • Seizures

Priority Priority One | Issue One | 4, Issue November 2, June 2016

Health

Stroke are you at risk?

ER24 is urging people to educate themselves about stroke, a common and serious condition affecting millions of people around the globe.

A stroke, which could lead to death or disability, occurs when blood flow to parts of the brain is cut off.

There are two types of stroke.

The most common is the ischemic stroke.

An ischemic stroke occurs when a blood vessel supplying blood to part of the brain becomes blocked by a blood clot.

The blood clot could either form in an artery in the brain or travel to the brain through a blood vessel from another part of the body.

The second less common but more likely fatal type of stroke is the hemorrhagic stroke which occurs when a blood vessel in the brain leaks or bursts/ruptures causing bleeding.

Recognising the signs of a stroke early and seeking urgent medical assistance are of utmost importance as it increases the person’s chances of survival and recovery.

If you suspect you or someone else is having a stroke, conduct the FAST test. The FAST test entails the following: • Face – Is one side of the person’s face drooping?

The person should smile or show their teeth. If one side is drooping, they could be having a stroke.

• Arm – The person should keep their arms raised for a few seconds. If one arm drifts

down or is weak, they could be having a stroke.

• Speech – The person should try to speak. If there is slurring or if the person struggles to understand or repeat any sentence, they could be having a stroke.

• Time – If the person experiences any of the above, call emergency services immediately.

Immediate and appropriate care can improve a patient’s outcome. Strokes can be

Priority One | Issue 4, November 2016

reversed if treated before the affected brain tissue dies.

Risk factors There are a number of risk factors that increase a person’s chance of having a stroke.

Hypertension, or high blood pressure, is the leading cause of strokes (and heart attacks) in South Africa.

Hence, it is vital that you get your blood pressure measured regularly.

Risk factors for stroke

also include diabetes, high cholesterol, smoking, excessive alcohol intake, heart disease and stress.

It is vital that people live a healthier lifestyle to reduce chances of having a stroke.

Quitting smoking, reducing alcohol intake, making the right food choices (such as reducing salt and sugar intake), and including moderate exercise into your daily routine, can make a positive difference. | 40

Health

Umdlavuza webele Breast cancer is not an illness that affects only those who speak English and live in the city Nelisa Sipamia was diagnosed with breast cancer in October 2007. Since her ordeal she has become a voice for women who have suffered from breast cancer, bringing education and awareness into rural areas and helping people make informed choices about their health. Her journey inspired her to help change the stigma of cancer by talking about it in a language which people could understand.

Sipamia’s journey started after she felt a strange pain in her breast. There was no lump, just pain. The doctor sent her for a mammogram and she embarked on a journey which started in a haze of denial and misunderstanding and changed the course of her life forever. “They said that there was something in there and I needed to see a surgeon and have an operation,” says Sipamia. “It was such a shock to me when they told me it was cancer. You ask yourself - is this right? Is it me? When I saw the surgeon I told him it was a cyst, not cancer, but the surgery was scheduled, the diagnosis made. I remember asking him to please, let me keep my breasts, and he explained that it would depend on how far the cancer had spread. I woke up, and my breast was gone.”

For Sipamia, it was an experience which could have been made far less terrifying if she had felt more informed and understood more about what her options were.

She was in shock, not only because of her diagnosis, but 41 |

because how quickly her life had changed. She did not feel as if she had control.

“I was given all sorts of advice by people saying I should not have done this or done that or that I should have seen a sangoma,” says Sipamia. “I think what I did need was education. People need far more clarity about the possibilities before they go into theatre and about their diagnosis. In rural communities, people are not being informed and even charities are not getting their message to the people. That is because advice is not being given in the right language.”

Rural communities face inordinate difficulties when it comes to education. Children walk for miles before they get to school, often on an empty stomach, and they share textbooks and stationary. In this situation, learning English is hardly a priority, especially when it is not spoken at home.

As a result, many people do not understand the impact of cancer or know how to detect it because awareness is primarily in English.

“Nobody told me about reconstruction for my breast, I was not given the choice,” says Sipamia. “I am not saying it is something I would do, but I should have been told about it so I could make an informed decision. I knew a lady diagnosed with breast cancer who visited a sangoma - they opened the breast with a blade and put medicine into it. It became septic and she died. If she

by Tamsin Oxford

Nelisa Sipamia at the Cancercare Survivors’ Summit sharing her experience and life after cancer.

had understood more about her cancer, this could have changed the course of her life.” For Sipamia, it is not about forcing people to stop seeing a sangoma, but to rather encourage them to see a doctor first. She believes that by educating people about cancer in their own language and in a way which respects their culture, it is more likely to encourage them to see a professional. “My radiologists asked me to talk to people about breast cancer, to help them recognise the signs and give them advice – they find it difficult to reach people in the right way,” says Sipamia.

“I realised how important it was to explain cancer to people in a way they would understand. Recently my oncologist asked me to talk to a Xhosa lady who wanted to speak to someone who had been through this ordeal. I sat with her and reminded her that this is just a phase in her life. She went ahead with the

treatment.”

There remains a stigma around cancer in African society, but through education and open dialogue this can be overcome. If women understand more about it, they will be more likely to check their breasts, take their concerns to a doctor, and potentially save their own lives. If breast cancer is caught early, the survival rate is high. “I brought candles to our church and I asked people who had lost someone to cancer to come forward and light a candle,” says Sipamia.

“People just cried as they came up. The whole church was alight. I wish I had brought my camera. Every person there had been touched by cancer and nobody talks about it. It is scary. But if we can speak about cancer in our language we can help remove the fear and the stigma.”

• Information obtained from Red Ribbon Communications.

Priority One | Issue 4, November 2016

Health

Keep your heart pumping ER24 is urging people to live a healthier lifestyle to reduce their chances of developing heart disease.

Heart disease refers to any disease or condition that affects the heart and limits its ability to function properly.

Speaking about how the heart functions and the possible conditions that people could develop, Dr Vernon Wessels, from ER24, said, “The heart functions as a pump that circulates the blood through the lungs to receive oxygen and then, on return to the heart, this oxygen enriched blood is pumped to the rest of the body. The heart muscle itself receives blood through the coronary arteries.

“One condition that most people are aware of is narrowing of the coronary arteries that supply the heart muscle with oxygen rich blood. Should this narrowing completely close off, the patient will suffer a heart attack (myocardial infarction). A patient suffering a heart attack often goes into cardiac arrest which requires Cardiopulmonary Resuscitation (CPR) to be performed to keep the person alive until hospital treatment can be provided. There are however, a multitude of other diseases that affect the heart.

Most of them will eventually

lead to the heart becoming ineffective and the patient suffering heart failure.”

He added that some of these conditions are present at birth and may be due to an abnormality in the development of the fetus however, the majority of conditions that eventually lead to heart failure are often unnoticeable to the patient.

“Many of these conditions can be prevented or limited.

An example of this is hypertension which is a condition where the blood pressure is constantly raised above the normal limits.

Most people will not have any symptoms until such time as the organs that are exposed to this high pressure start to fail. The heart is one such organ and continuous pumping against a high pressure gradient causes the heart muscle to thicken and eventually start to fail.

“Other conditions that can cause heart disease are infections that affect the internal lining of the heart (endocarditis) and often the valves, for example with rheumatic fever, as well as the outer lining of the heart (pericarditis),” said Dr Wessels.

According to The Heart and Stroke Foundation South Africa (HSFSA), every

Priority One | Issue 4, November 2016

minute, 33 people around the world die from heart disease.

Nuraan Cader, the Public Relations and Communications Officer of the HSFSA, said, “Non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), are estimated to account for 43% of total adult deaths in South Africa.

“Every hour, at least five South Africans have a heart attack. The reasons for this?

First of all, many people are unaware of their risk for heart disease. 50% of South Africans do not know that they have high blood pressure, which is the main cause for strokes in South Africa. One in two people do not know that they have diabetes. Often, risk factors that have been present are only discovered once the individual has a heart attack or a stroke,” she said.

What signs to look out for Dr Wessels said that depending on the underlying cause, heart disease will often present with tiredness, shortness of breath (especially when climbing stairs or participating in other exercise), and chest pain (which may be absent). There are also other signs that develop with heart failure that

may not be attributed to the heart by the patient. These include swelling of the ankles and tenderness of the liver due to congestion.

Risk factors Bad lifestyle habits like smoking, obesity, lack in exercise and excessive salt intake all contribute to heart disease. “Hypertension is often not identified by the person as being present until their blood pressure is taken.

Therefore, it is advised that people have regular medical check-ups, especially if they also have some of the other risk factors. Hypertension is treatable but if left unmanaged, can cause severe debilitating complications, amongst others heart failure and stroke. Healthy lifestyle is critical. Stop smoking and reduce alcohol intake.

Maintain a healthy weight and get regular exercise (even regular walking is better than nothing).

“Eat healthy food and avoid excessive salt intake.

Moderate exercise is good however, excessive exercise in someone who is not used to it can overload the heart and potentially lead to a heart attack or heart failure.

If unsure, seek advice from a healthcare professional,” said Dr Wessels. | 42

Health

Importance of bone and joint care

Bones are living tissue that continuously modify themselves according to the activity a person undertakes.

With little activity to stimulate the bone cells, the bones will progressively become weaker.

Joints are designed to move and therefore, healthy activity is required to keep them functional.

By not taking care of your bones and joints, you risk developing conditions that can significantly hinder your quality of life.

ER24 is urging people to live healthier lifestyles.

Obesity, poor diet, smoking and lack of exercise are some risk factors that contribute to the development of joint and bone problems.

Besides injuries (such as sprains, dislocations and fractures), the most common bone and joint condition affecting people is arthritis.

Explaining further, Dr Vernon Wessels, from ER24, said, “Osteoarthritis develops as a result of damage to cartilage of the joint due to abnormal loading causing wear and tear (usually taking years to develop), whereas rheumatoid arthritis is a condition where a person’s own immune system causes damage to the cartilage.

Septic arthritis is a condition where a person develops an infection in a joint, usually arising from another infective focus somewhere in the body.

This is not too uncommon in young children and requires urgent attention.”

Another common inflammatory condition of 43 |

the joints that affects adults is gout, where increased uric acid causes crystals to be deposited in the joints causing damage and pain. “This is often precipitated through certain foods and drinks like alcohol (especially beer), red meat (especially liver and kidneys) and certain seafood (like anchovies, herring, mackerel and mussels).

“Cancers of the bone do occur. Fortunately, these conditions are not as common as the others mentioned.

However, any abnormal growth or pain in bones, especially in children, should be seen to by a doctor,” said Dr Wessels.

The most common symptoms associated with the majority of conditions is usually pain and stiffness or limited movement of the joint.

“However, there are specific symptoms that would point to a specific cause. For example, a warm, swollen painful joint is likely to be inflamed either through an infection as with septic arthritis or through another joint inflammatory condition like gout,” said Dr Wessels.

Due to the various causes of joint and bone pain and many being easily treatable but having devastating consequences if left unchecked, it is preferable that people seek medical assistance with any new onset pain or stiffness in a joint that does not resolve fully within a short period of time (a day or two). “The doctor may refer you for x-rays and possibly blood tests depending on

the clinical finding during examination. For the majority of conditions, treatment is effective in the early stages,” said Dr Wessels.

For most of the conditions mentioned above, if untreated, the patient will progressively loose more function of the particular joint, which in some cases can lead to other joints of the body receiving abnormal load and eventually also suffering damage. “Many of the causes are treatable and for those that cannot be fully treated or prevented (as is often the case with rheumatoid arthritis), assistance devices are available to assist patients in still being able to function with day to day activities. In severe cases, joint replacement is an option for certain joints like the hip and knees or permanently stiffening a joint to limit pain (arthrodesis) which is often done for the ankles,” said Dr Wessels.

Healthy lifestyle Dr Wessels said it is essential to have an active lifestyle with healthy exercise in

moderation to ensure that bones remain strong and healthy. “Along with that is a healthy balanced diet to ensure that enough calcium, minerals and vitamins are taken in. Some modern food and drinks can be harmful to bone formation, in particular fizzy drinks that contain phosphoric acid as this removes calcium from the body,” he said.

While healthy activity is required to keep joints functional, Dr Wessels said care must be taken not to overstrain joints as this can lead to damage to the cartilage surfaces and eventually to osteoarthritis.

“One way in which strain to specifically the knee joints is caused, is through obesity.

Therefore, weight loss for those who are overweight will assist greatly in preventing the development of osteoarthritis of the knees. Another contributor to joint damage is abnormal load on the joints due to poor posture or poorly designed footwear. Maintain good posture and wear good quality, comfortable footwear,” he said.

Priority One | Issue 4, November 2016

Events

Medical standby ER24 consistently monitors international and local legislation thereby ensuring world class service delivery, compliance, safety and security at events.

Staff ensure that adequate analysis and preparation takes place prior to any client’s event.

A full risk assessment is conducted and an operations

at your event

plan unique to the event being held is drafted. All risk assessments and operational plans follow processes and standards as set out in the Mass Gatherings Act

SANS10366 as well as the Emergency Medical Services Act. Our clients can therefore be assured of efficient medical care and standby.

Medical standby by ER24 in recent weeks

ER24 provided medical support to riders at the Route 99 Mountain Bike Race held at the Cradle of Humankind.

ER24 providing realhelprealfast at the SA Rugby Gold Cup semifinals.

ER24 on standby at the PetroSA Half Marathon.

ER24 Vaal staff doing the Cancer Walk.

Priority One | Issue 4, November 2016

44 || 42

Events

ER24 providing medical support to swimmers at the Dischem Sun City Swim.

ER24 looking after canoeists at the Umpetha Challenge.

ER24 Rustenburg standing by at the Ala Neon Fun Run at Waterfall Mall.

ER24 on standby at the Nedbank Golf Challenge.

ER24 at the Sasol Solar Challenge ER24 was proud to be on standby at this year’s Sasol Solar Challenge that was held from 24 September to 1 October.

Emphasising engineering and innovation, the competition gives South African and international university students in the disciplines of science, engineering and technology an opportunity to showcase their ingenuity by designing worldclass solar-powered vehicles.

Participating teams design, build and manage their solar-powered vehicles as they race across the South African terrain, covering a distance of 2 000km of varying road conditions.

The Sasol Solar Challenge helps to improve the South African industry’s knowledge of

technologies like photovoltaic cells, electric motors, battery systems and vehicle aerodynamics. It drives local

One | Issue 4, November 2016 3Priority 45 | |

research and development of technologies that go into building a successful, competitive solar car.

The event commenced in Pretoria at the CSIR and concluded in Cape Town at the V&A Waterfront.

| 44 Priority Priority One | Issue One | 4, Issue November 2, June 2016

Training

Refresh your

memory

by Yvonne Dalgety, Training Supervisor: ER24 Multiple choice

Crossword 1

The space between the pleura and the lungs and extends from the sternum to the spine is called a) cranium b) hypogastric region c) mediastinum d) epigastric region Where are the inspiratory and expiratory centres located? In the a) lungs b) cerebellum c) intercostals muscles d) medulla Name the cartilaginous structure that contains the vocal folds a) pharynx b) epiglottis c) bronchus d) larynx The reflex preventing the lungs from overexpansion is the a) Hering-Breuer b) Cheyne-Stokes c) Kussmaul’s d) Reflex arc

H Q G H E T Y C O R H T Y R E W

O W F P E R I C A R D I U M S L

R H D J M I T R A L Z Q E X Z A

D I S K Y A T D F C X D B N H I

A T R I O V E N T R I C U L A R

E E A L C R E S G A V E Y A E T

T S P Z A E Y N S X B T P D M A

E R E X R W U T T B J A L E O U

N W I M D Q I A I R K L A P G N

D E O C I N I C H A I U T S L I

I S I C U L U P J N W C E Q O S

N L U M M S U O K C A R L K B V

A L Y V I M P N L H S I E E I W

E E E D I S N I A Z Y C T J N X

8

3 I U M I T R A L 13 P A R D P I L L 23 R T A E 25 R T

14 H I S

P10 11 U T L U M O N 18 A R R Y

21 M E D I C U A

28 M Y O C A R D I U M

E 30 A L V E V S

A 31 O C R O N A R

Priority One | Issue 4, November 2016

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9

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12 13

14 15

16 17

18

19 20 21

22

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24

25

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27 28 29

30 31 32

33

34 35

R C T B N M U I D R A C I P E Z

Crossword Crossword answers: September 2016 1 2 P E R I C A R D V U 6 L D 8 9 Y S T O L I C S E F A S 12 T T 15 N D O C E 16 L V E I N D I 17 T A R I A C N 22 A S A V E A 24 C S A O F27 R R I U D B

3

7

Word search answers: September 2016 C O R O N A R Y P A P I L L A E

2

4P 5 V 7 B U N D L E N R K T N I C S R N I J C E L E 19 A O R T A S 20 D V E 26 S P I D N T U I M P T I 29 I N T I M A Y

Across

Down

1. Gatekeeper to the respiratory system 5. Where the bronchi enter the lungs 8. Clears the upper respiratory passages 10. The act of breathing and the exchange of gases 12. Membranous covering of the lungs 13. Ventilates all alveoli 15. Carbon dioxide decreases the …..level of blood 16. See 25 dn 19. Inspiration 20. Collection of all the alveoli 24. Back of the throat 27. Carrier of oxygen 28. Partial pressure of oxygen (ab) 29. Air filled cavities in the skull 32. Chords producing sound 34. Air sacs 35. Cells sensitive to PO2 Levels

2. One of the respiratory control centres (2) 3. Detergent lipoprotein 4. See 6 dn 6. Muscles increasing width of chest 7. Smallest of the air passages 9. Reflex clearing the lower airways 11. Most important of the respiratory gases 14. Centre in the pons varolii controlling inspiration 17. Area housing the vocal chords 18. Sends inhibitory impulses to the medulla 21. Chemoreceptors found in the carotid 22. See 27 dn 23. Carbon …..waste gas of respiration 25. & 16. acr. Resting respiratory volume 26. Amount of air left after normal breathing is ……volume 27. & 22. Reflex preventing overexpansion of the lungs.

30. Gatekeeper to the nasal passages 31. Pharynx at the back of the nose 33. Pharynx at the back of the mouth

Answers in the next issue of Priority One.

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