Phil's Blog: EMS'ing it Joburg Style

What an adrenaline filled day I had today. Spent 12 hours with NetCare911, one of the private ambulance services in Johannesburg. So happy I was able to arrange this because it was a good way to see first hand the pre-hospital care system of Joburg and compare it from my experience from volunteering with EMS Cote St-Luc and our partners Urgences Sante. Definitely very different from what is going on in Quebec, I can tell you that from now.

Just a quick summary of how things work here. There is the provincial ambulance service that is run by the government and then you have two private companies; ER24 and NetCare911. Supposedly, the provincial service is run by "paramedics" with BLS training and is not the most reliable service. You can be waiting a very long time for them to come. ER24 and NetCare911 can be called when there is an emergency, however you need to call their respective numbers and of course there is a cost attached with the service. The problem that these two companies are running into is that people are figuring out that the provincial guys aren't too reliable and start calling them but not actually able to afford their services. The private companies are better equipped and have paramedics with several grades of training. They have their primary ambulances that get dispatched to calls and when higher care is required, there are advanced care paramedics driving around in modified, turbo charged cars to attend the call as well. Also, there isn't only 11 people trained in advanced care like some places I know. They usually get there faster because the blitz through the streets at very high speeds (sometimes reaching 180km/hr) and are able to provide the advanced care needed. Another interesting fact is that thye don't work under direct medical control from a doctor but they practice based on their scope of training and they are licensed to do what they are trained to do given the paramedic protocols. More accountability is on the paramedic. There's is also lots of political turmoil, just like any other service/company you can think of.

So my day started at 6:30am, where I met with Robbie at the NetCare911 base. As soon as I saw him, I knew we were going to have an awesome time. Very approachable, nice guy and loves to joke around. This was a big relief because you never know who you will be sitting beside in the car for 12hours. We hung around the base in the morning, he sent me all their protocols by email, showed me around, we did an equipment check, showed me all the drugs they carry! (close to 20 diff drugs) and off we were! The response car we were driving in was a supped (modified) volkswagen hatchback (reminded me of my car back home). Leather interior, manual transmission, lights and sirens and brand new brakes! Today, it was raining almost all day.

Supposedly when it rains, people in South Africa tend to stay in their homes and not cause too much trouble. We started off our slow morning with some coffee and then with a nice tour of Johannesburg while waiting for a call to come in. We visited a few hospitals. It was nice to see other hospitals and what their casualty (ER) area looks like compared to the hospital where I am at now. Bara and Joburg Hospitals are public, the others, you can tell right away are private - most owned by NetCare. We even drove into the rougher areas of Joburg to get a glimpse of what its like. I felt rather safe in an emergency vehicle but slightly stressed when even Robbie closed his window and made sure the doors were locked. We drove through the slums of Soweto and made it into the centre of Hillbrow. These are places where you wouldn't want to be seen in, especially during the night. It's fascinating to see how one point your in a rich area and all of a sudden it felt like I was in rural Ghana just a street away. We even had a chance to stop at Bara hospital. This is where the other trauma centre is located. We walked in and I got to see their huge trauma bay - the rain caused them to have a slow day as only 2 of their possible 20 bed resus bays were filled.

All of a sudden, we got our first call. A simple text message on his phone with location and patient information, along with a small screen in the car that has the same info. We plugged in the address to his Garmin GPS and off we were! WOW...they really know how to drive. He told me, I'm sure in Canada you guys go only 20km over speed when going lights in sirens but here we tend to ignore that. Zipping down the streets zigzagging through traffic - people are already bad drivers, when you put them with an emergency car, its even worse!!! I filmed a few runs to give you guys an idea of what it was like (check my facebook profile for that). It's amazing the force the car had and the acceleration. We were hitting speeds close to 160-180km/hr, however I felt safe. He was such a great driver, he had to, with 30 years of experience in Joburg and other places like Chad, he was good. We finally reached our call, which happened to be in the Italian Consulate filled with diplomates. An employee there happened to have chest pain and Robbie let me run the call while he helped me out with vitals, monitors, etc...Felt like I was just in Cote St-Luc! We assisted the ambulance once they got there and then freed ourselves to be ready for another call. After that, we went for lunch, drived around some more, lots of talking about Canada and snow and the french. Never a boring moment!

After lunch we both got a little tired, so we head back to base and took a nap. He woke me up saying we got a call where a crew arrived on scene and needed back up. Now it was raining hard and the driving was the same. We arrived to a very rough area in Joburg, can't remember the name of it. It was a building office and on the 5th floor. We got there and there was a man laying on the floor unconscious. He was complaining of some abdominal pain prior and when his boss went to get some help, he returned and found him laying unresponsive. The paramedics on scene were ventilating the patient, had an IV started and monitoring him. The patient was not breathing adequately and Robbie handed me the laryngoscope and endotracheal tube and asked me to intubate the patient. My first pre-hospital intubation was a success and got it in on my first shot. Wasn't too difficult, only Robbie made sure I was laying flat on the floor at the patients head to be able to get a good view of the cords. We packed him up and got him ready for transport. Only problem was, we couldn't fit in the elevator and we didn't have stairchair. So we carried him down 5 floors with the stretcher. We had to switch person every floor because it was too heavy and the stairwell was so narrow that it was very difficult to maneuver. We eventually made it down and got him into the ambulance. We assisted them with transport and I was bagging the patient all the way to Joburg Hospital, where I am doing my trauma elective. We rushed him in to the medicine casualty area and handed over to the docs. Very strange presentation and we didn't really know what was going on. Supposedly he may have taken some alternative medicinal stuff because he was sick the last few days.

We then got ready for the end of our shift and boom, another call came in. Unconscious 35 year old lady in Hillbrow (the bad area). Once on scene, there was an unconscious lady in the middle of the road and lots of people around her watching over. I was told that this looks like a very common presentation of FES (fluttering eye syndrome), you will see what this is from my explanation of the call. Once we assessed the lady, it seems like she may have had some sort of seizure, collapsed and bit her tongue. All her vitals were normal and we were basically observing her. Her eyes were fluttering around and she was responding to us. We talked to her more and coached her breathing, sat her up and eventually walked her to the ambulance. Within 2 mins in there, she was on her phone texting!! Supposedly this happens a lot. Some kind of stressor causes them to have a psychosomatic fit and they behave like they are having seizures but do it for the attention. It was very interesting to see!

That was our last call and we headed back to base. We then went over to visit his gf who is an ER physician at the Milpark hospital (attached to the base). We got coffees and hung out there for a bit. Then it was around 8pm and time to head back home. Got some chicken from Nandos and watched IronMan2 with Li.

What an awesome day. I really had a lot of fun with Robbie. He was an awesome tour guide, teacher and great paramedic. Tomorrow I will be spending a day on with the helicopter EMS with NetCare911. I hope we get to fly :) The weather might be a little yucky and they may cancel all helicopters. If that's the case, Robbie said I can meet up with him and spend the day on the response car again! Very excited for tomorrow, hope I will get to fly in the helicopter. So cool!!

Alright, it's bed time for me now. Here are some pics and check out the video.

Phil

Evie we have 7 days 17 hours and 1 minute 30 seconds until we see each other :)