Pasco Risk Management are often asked about the risks associated with medical and related emergency services in the emerging markets of Africa and elsewhere. In light of this we opted to begin offering some advice and additional information on emergency health services which will be available to visitors during the FIFA World Cup which can be extended to other operations across the continent.  The first of these features will look at the primary health care services or first responders available to visitors in the form of helicopter evacuation and air ambulances for repatriation of critical patients.

Medical emergencies will often dictate specialist attention is required immediately to save the life of a patient. Doctors and paramedics refer to this as the golden hour when critical primary patient care is needed within the first 15 minutes of any major trauma while specialist attention will be needed in a further 30 minutes.

Helicopter evacuation

In South Africa the helicopter emergency services are operated by Netcare 911, operating from Grand Central in Johannesburg as well as Virginia airport in Durban with Red Cross helicopter services covering the Western Cape region. Emergency medical services of ER24 are currently in the process of gaining accreditation for their helicopter emergency service which is expected to be operational in time for the FIFA World Cup. ER 24 will be operating fro their base at Grand Central in Johannesburg.plan

The Netcare Facility at Grand Central operates two helicopters the BO-15 Messerschmidt for day and night operations and another single engine aircraft as a back up.  The helicopter emergency services will operate in a general arc of roughly one and a half hours flying time.  Implying that places such as Mafikeng and Nelspruit will fall under the coverage of the Johannesburg based services.

The process to activate the helicopter services will be dependent on the medical insurance.  Often the first responder will arrive on the scene ans asses the situation d the patient according to set criteria.  If the patient matches the criteria then the request for a helicopter evacuation will be elevated to the medical officer of either the local government or the respective medical aid or medical insurance company.  At that point the medical officer will give the go ahead implying that the costs will be covered by either the government or the medical aid.  The helicopter is then able to be airborne in the space of 8 minutes.

Each flight is fully equipped for any emergency such as cardio, pediatric or advanced life support systems. The flights are crewed by a single pilot as well as a doctor and a paramedic on day time operations while night time operations will see the crew supplemented by and additional pilot for safety reasons.

The crew and pilots of the helicopter services are regarded as the elite of their respective services.  Pilots need to be able to negotiation concrete canyons and land at road intersections as well as being able to extract patients in rough rural terrain and will transport the patients to the respective helipad of the appropriate hospital. While the doctors and paramedics on the flights are also regarded as being highly trained and skilled in their disciplines.

Wayne Thompson regional general manager aeromedical operations at Netcare911 says that often the issue is getting the patient  appropriate care. “Often the helicopter emergency services or HEMS will be deployed for primary care for incidents such as road accidents or burn victims and we need to transport them quickly to the best facility.”

In addition helicopter services can also be deployed in situations where time is of essence and the delays experienced in traffic could be a life threatening issue.

Evacuation from further afield

Emergency evacuation in other parts of Africa is becoming increasingly important due to business seeking to engage in the economic growth of the continent.

There are a variety of air ambulance services operating from South Africa, such the SOS International service and the Netcare 991 services.  The SOS International operates from Grand Central while the Netcare 911 service operates from Lanseria.  Both services are able to be airborne and en route to the patient within an hour of the “go a head” by medical insurance companies.

Air ambulance services based in South Africa are able to evacuate patients in a single day from as far as Abuja in Nigeria and Addis Abba in Ethiopia.  Any further north, regulations will require that the plane must stay over night and the pilot and crew rested.

Other services offered by the air ambulances are the wing-to-wing transfers where the patient is  being repatriated to the country of origin from South Africa.  The patient can be transfered to an air ambulance service via Tunis or Luxor for European destinations, Tenerif for North American destinations and Dubai for Far East destinations.

A major challenge for air ambulances is the required clearances before take off.  Often the air services will be required to pay a fee for the use of the airspace that they travel over as well as a landing fee and then a refuel costs which can be punitive especially if the fuel has had a long transport line.

Depending on the needs of the patients each flight will carry two pilots a doctor and a paramedic. Similar to the helicopter operations each will carry cardio, pediatric and advance life support systems.

Jacques Pienaar aeromedical operations centre manager at Netcare911 says that the most likely scenario that will emerge in terms of the FIFA world Cup will be that the injured fans or foreign visitors will receive primary care in South Africa and then be stablised at the respective hospitals or clinics and then repatriated either via an international carrier or if required the air ambulance service

Air ambulances have often been used by corporates seeking to repatriate employees. An example cited by the Netcare 911 was the explosion at a refinery in an unnamed Africa sate.  The company was able to re-act quickly and evacuate employees to the best medical facilities.

Next week

First responders and crisis call centres in South Africa