The pending loss of advanced life support paramedics in South Africa

Abstract

Background In 2008 South Africa (SA) had 1631 registered advanced life support (ALS) paramedics to provide pre-hospital advanced life support care to a population of approximately 50 million. Compared to globally accepted ratios, the number of ALS paramedics in South Africa can be considered as grossly inadequate. This current shortage may be ascribed to migration. However, the extent and nature of this migration, the factors that have contributed to them leaving the country and the existence or effectiveness of implemented strategies that attempt to manage migration of SA ALS paramedic is not known for sure. Methods The study consisted of a two-phase mixed method descriptive survey. A subset of SA ALS paramedics made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N=97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n=10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were integrated to obtain an in-depth understanding of South African ALS paramedic migration. In addition, the study investigated whether strategies that attempted to manage migration of SA ALS paramedics existed, and if they did, how effective have they been. Result Fifty-one of 97 (53%) ALS paramedics responded to the questionnaire in Phase One. Of those, 24 (47.1%) were found to be working inside South Africa, while 27 (52.9%) were working outside South Africa. Working conditions, physical security, and economic considerations were ranked as the top three major factors contributing to the decision or intended decision to migrate. Initiatives to manage the shortage of ALS paramedics in the public sector EMS do exist; however, it appears to be inadequate at its current rate of progress. Conclusion This study suggests that ALS paramedics in SA are leaving to find work outside the country because of working conditions, physical security, and economic considerations. The current measures to manage migration appear to be ineffective, indicating that new or additional strategies to manage migration of ALS paramedics in SA may be required

Emergency care research priorities in South Africap

“…[12] SA has been losing significant numbers of prehospital practitioners with advanced training over the past decade. [13] Poor working conditions, physical security and economic considerations were identified as some of the main 'push' factors. [13] Govender et al [14] also hinted that current measures are inadequate to actively manage the shortages of prehospital practitioners with advanced training and their migration out of SA.…”

The variables perceived to be important during patient handover by South African prehospital care providers

“…There are proportionately lower numbers of registered prehospital emergency care personnel in these categories [ 20 ]. This is compounded by the numbers of advanced life support prehospital emergency care providers who leave the country to find work elsewhere [ 21 ]. There is usually a minimum clinical experience timeframe required for expatriate work, meaning that many higher qualified practitioners with experience have left the South African healthcare sector.…”

Students’ views on the need for hostile environment awareness training for South African emergency medical care students

“…One of the negative consequences is the loss of skilled staff when qualified EMS personnel leave SA to practise abroad, where working and living conditions are believed to be safer. [9] In response to the abovementioned concerns, certain law enforcement agencies and EMS providers offer hostile environment awareness training (HEAT) programmes for their staff. [10] These HEAT programmes focus on developing one's ability to assess situations, recognise specific risk factors, and where possible avoid these risks.…”

“…Exposure of paramedics to physical violence globally appears to vary considerably -from 2.9% to 79.5%. [3][4][5][6]9,14] Our literature review found few published studies that specifically dealt with the incidence of violence against EMS students. Of our 113 respondents, 78.76% reported being verbally abused (sworn at, ridiculed or threatened) either by a patient or bystander.…”