er24 priority one - june 2016 q2

PRI RITYONE ISSUE 2 - JUNE 2016WWW.ER24.CO.ZAMake it yours

QUARTERLY MAGAZINE

Asaph a true hero

Off-duty medic revives a man who “died” of a heart attack

Farewell, Patrick Smith

The life of a medic

Clinical quality despite financial constraints

Puppy gets new hope

Dip EMC now offered

Rustenburg branch opens

PRI RITYONEMake it yours

CONTENTSFront page stories

ER24 staff

The life of a medic7Off-duty medic revives a man who “died” of a heart attack

6

21 Diploma in Emergency Medicine now offered

23 Realhelprealfast in Rustenburg

27 Puppy gets a second chance

5 Bundles of joy welcomed5

21

Clinical quality despite financial constraints

3 Farewell Patrick Smith

17

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All content must be submitted by no later than 9 August 2016. Content for consideration may be sent to the ER24 Communications Department by any staff member or client.

The next Priority One will be published on 9 September 2016.

Email: [email protected]: 0861084124Web: https://er24.co.zaEmergencies: 084124

Chitra Bodasing

Health and awareness

Community involvement

Events

Company interest

Is your home child-safe?911 Understanding PTSD

Dog attacks - protect yourself1315 Electrical injuries - don’t be a victim

13

1519 How well do you know your air

ambulance service provider?

33 Appropriate medical resources at an event is key

2928

ER24 still caring for wildK9 companion rescued

8 10 tips on how to protect your child

16 Take care of your eyes

Funders and medical schemes - customised service for clients

22Are we able to change?

Medical aid fraud a growing concern25

30 Dog rescued after being dragged by a car

31 Raising drowing prevention awareness

28

Patrick Smith

3 | Priority One | Issue 2, June 2016

ER24 staff

ER24 bid farewell this month to a man who dedicated several years of his life to helping those in their greatest time of need. Patrick Smith (65), from the ER24 Highway team, retired at the end of May. He is the first person at ER24 to have retired from operations officially. Smith, affectionately known to colleagues as Uncle Dan, started his career as a medic in 1986. He has been with ER24 since 2004. He had to start working soon after leaving school (Wentworth High School in 1970), to help support his family. He worked in the building industry and a few years

later, moved on to the metal industry where he trained to become a pipe fitter. Smith, a Newlands East

resident, soon realised his passion for helping people. “I loved helping and caring for those in need. There was a great need for paramedics. I decided to follow my passion and became a Basic Life Support (BLS) medic in 1986,” said Smith. He started his career at the government emergency services. He became an

Intermediate Life Support (ILS) medic in 1994 and moved to ER24 a number of years later. He worked at the

ER24 Central base and later moved to ER24 Highway. The job at hand was no easy task as he faced challenges. “When I first became a medic, I had to get used to the discipline and shift work. In time, and with patience and endurance, I was able to overcome these challenges,” he said.He described being a medic

as a noble career. “You try to help people in their greatest time of need. You must have a passion for the job. Then it becomes a career of joy and contentment,” he said.Smith has helped countless people following serious trauma and medical emergencies allowing them to return home to their families.One of the incidents he remembers is that of a woman who was struggling to breathe. “She had an illness that caused the narrowing of her throat. One day while having lunch she started choking. She was rushed to a nearby doctor’s surgery, however could not be helped. We were called out. When we got there she was struggling to breathe.

Farewell

“You must have a passion for the job. Then it becomes a career of

joy and contentment.”

Athish Mohun, Patrick Smith, Nash Appalsamy and Jonathan Kok.

Priority One | Issue 2, June 2016 | 4

ER24 staff“I applied the Heimlich Maneuver and after a few thrusts, to my joy, the piece of food stuck in her throat came out. The thanks I received from her and her family gave me great satisfaction,” he said.Every paramedic will know that with all great moments of saving a life, there is another where nothing can be done despite all efforts to save the person. “One of my worst or saddest cases was that of a six-month-old baby who stopped breathing in the early hours of the morning. On arrival, we found a number of people at the house. There was an air of

expectancy… a belief that we could do something to save the baby,” he said.Sadly, there was nothing that could be done for the child. “The despair and sadness made me feel so helpless,” said Smith. Although heartbroken, Smith knew that he had to stay focused and continue trying to make a positive difference where he could.Speaking about his retirement and in a message to his colleagues, Smith said, “Do not stop caring for the sick and injured. That friendly greeting, that smile, tells the patient that you have the best

interest at heart. Continue with the great job that you are doing. I would like to thank ER24 for the employment I had. May the company continue to prosper and grow. Thanks to my base manager, Derrick Banks, for the kindness and understanding in dealing with me. God bless you all.” Banks described Smith as the most caring and compassionate person he has met. In a message to Smith, Banks said, “Uncle Dan… how that name came about we never understood but thank you for being the person that you are and reminding us every now and then why we

chose this career. You have been a father figure to many of the staff. They have looked up to you for advice on many occasions. The crew, which is more of a family at the Highway team, and I are going to miss you. I hope you can now sit back and enjoy your retirement with your family and look back at all that you have achieved.” ER24 thanks Smith for his dedication and compassion for patients. We also thank his wife Hazel, children Angus, Allerise and Denielle as well as his grandchildren for sharing him with us.

Jonathan Kok, Lisa Gangabishun, Patrick Smith, Athish Mohun and Nash Appalsamy. Tracy Bederson with Patrick Smith.

Patrick Smith with Lisa Gangabishun.


ER24 staff


ER24 paramedics were on hand to help two women deliver their babies recently.Craig van Rensburg and Sekese Ramochela, from ER24 Kimberley, were dispatched in the early hours of the morning on 11 April to a farm between Riverton and Barkley West, in Stillwater, following a call from a woman stating that she was in labour. Upon arrival and assessment of the woman, paramedics found that she was experiencing contractions.They put her in the ambulance to be transported to hospital. However, the baby boy could not wait to see his mum. While continuing to check the woman’s vitals just after they left the house, Ramochela informed Van Rensburg that the baby was on its way. Van Rensburg had to stop immediately on a low water bridge to assist his partner and the woman.Despite his rush, by the time Van Rensburg got to the back of the ambulance, the baby

Bundles of joy

was already crying.The baby was born just two minutes away from his parent’s home. The umbilical cord was around the baby’s neck but they managed to remove it. The baby was warmed and placed in his mum’s hands. They were transported to Mediclinic Kimberley. The baby boy was born at a weight of 2.73kg. Ramochela was excited as it was his first delivery. He as well as Van Rensburg are happy that both mum and baby are doing well. In a separate case, a Sebokeng family welcomed a baby boy at their home on Freedom Day, 27 April. ER24 paramedics were contacted and upon arrival at the residence, found a woman on a bed. The baby was already on its way. Paramedics Magriet Eastes and Henry Horne, from ER24 Vaal, were on hand to deliver the baby.Both baby and the mother were assessed and found to be fine. They were transported to hospital for further care.

welcomed

Sekese Ramochela and Craig van Rensburg, from ER24 Kimberley.

Henry Horne, from ER24 Vaal.Magriet Eastes, from ER24 Vaal.

Henry Horne, from ER24 Vaal.


ER24 staff


Deon Hendricks was travelling in a Golden Arrow bus to his workplace in Woodstock on 3 May when he got severe chest pains. A few minutes later, the Strandfontein dad of two was “clinically dead”.

An off-duty medic saved the life of a fellow bus commuter who “died” after suffering a massive heart attack. ER24 medic Asaph Alexander from Mitchells Plain was on his way to work in Cape Town on 3 May when he noticed a male passenger in distress. Asaph, 39, who was standing in the middle aisle of the packed bus, said when they came onto Ottery Road, he saw the

Off-duty medic revives man who ‘died’ of heart attack

unknown man in his forties, getting up from his seat. He said, “I thought maybe he is giving someone a seat or getting off the bus but then he went and sat down again. He grabbed at his chest and said he had pains in his chest and arm.” Asaph said people started panicking and wanted to get off the bus, “probably because they didn’t want to see a dead body”.The medic, who was dressed in his red ER24 uniform, immediately sprang into action when he noticed the man fainting. He explained, “I checked his breathing pattern on his chest and saw no signs of life, including his pulse, which we

call clinically dead.”Asaph knew the man would be dead within minutes as the oxygen leaves the heart cavity, and started performing CPR. “I knew he was having a heart attack. I began doing chest compressions. After that there was what we call ‘ROCS’ which is the return of spontaneous circulation.”Asaph told the bus driver to head to Ottery Fire Station where paramedics were waiting for him and the patient. “The ECG machine showed he suffered a major heart attack,” said Asaph.The man was then transferred to Victoria Hospital. For Asaph, who has been a medic for 10 years, it was just

another day out in the field. “This is what we do every day, it’s about saving lives and seeing that person happy with their families.”Deon said he owes his life to the off-duty medic who saved him.Speaking from his home on 5 May, a weak Deon, 44, told Daily Voice he hoped to meet his hero soon to thank him.“I just want to say thank you for what he did. He saved my life and you rarely get people who do that. “He knew exactly what to do; he was so professional and worked quickly. If it wasn’t for him, I’d be six feet under, I really appreciate it. I owe him my life,” he said.

By Genevieve Serra Daily Voice

Lucky for Deon Hendricks, ER24 medic Asaph Alexander, 39, of Mitchells Plain was on the same bus and leapt into action. The medic was on his way to work at the Cape Town International Convention Centre. Asaph told Daily Voice that he could not detect breathing or a heartbeat, and realised Deon was clinically dead. He had “only a few minutes” – once

all the oxygen left the heart cavity, there would have been nothing he could do to save Deon. Photo: Bertram Malgas, Daily Voice.

ER24 staff

3 | Priority One | Issue 2, June 2016 Priority One | Issue 2, June 20167 |

As we put our ER24 uniform and boots on, we are reminded just how short life can be. As everyone else goes home to be with their families, we leave ours behind to start our shift. We do not say goodbye when we leave home, but a simple “see you later”. This, followed by a long-lasting hug, is what we leave our families with, not knowing if we will see or get to hold them in our arms again. While on shift, the phone rings and we begin the night by driving through traffic to get to a man who is seemingly not breathing. Several thoughts run through our minds as we arrive on scene to begin treatment. An hour and a half goes by and we have done everything we can to save the person. The family looks into our eyes with expectancy… only to find out that their loved one did not survive. It has only been a few minutes and our next call comes in. We put what has just happened behind us in order to be strong to help others in need. Standing strong, holding back on emotions and helping people in their greatest time of need is all part of our 12-hour shift. We go home tired and broken, take off our soiled uniform and thank God for keeping us safe so we can do it all over again. So many people tend to ask us how we do it, don’t we ever get scared or heartbroken. Yes, we do. But I am a medic and giving my life to save another is something that can never be taken away.

The life of amedicby Tyler Badenhorst, BLS Medic: ER24

Health and Awareness

Priority One | Issue 2, June 2016 | 4 Priority One | Issue 2, June 2016 | 8

Being a parent is no easy task considering the challenges faced by the youth of today. In light of Child Protection Week, ER24 offers the following tips on what a parent can do to protect their children.• Get to know your

children. A close relationship or bond with them will help you determine if anything is wrong. Let them know they can come to you should they need help.

• Educate your children about the dangers they face. Discuss topics like drug use, alcohol abuse, sex and peer pressure. Seek help from professionals if need be.

• Abuse, sexual assault,

10 tips on how to protect your child

abduction and violence are some of the challenges faced by youth today. Teach children not to go anywhere alone, never to go to secluded areas or anywhere with a stranger. Even if approached by someone they know, they should obtain your permission first before going anywhere with that person. Inform them that should they feel unsafe around someone, they should try to run away and scream to get the attention of other people who may be around them.

• A home is a place where a child should feel safe and loved. Ensure a healthy family environment.

Remember that children watch you. Set a good example.

• Never leave children unattended or in an unsafe environment. If your children are left in the care of someone else while you are at work for example, ensure the person can be trusted. If in doubt, find an alternative.

• Ensure your children know their names, your name and who to contact in case of an emergency when they are of age.

• Teach your children about responsibility. Put reasonable rules in place but also remember not to be overprotective.

• Pay attention to them,

listen to them, spend time with them and let them know that you care. Be involved in your child’s life. Find out what their interests are and support them where necessary. Remember that your child and their wellbeing is your number one priority.

• Pay attention to changes in personality or attitude. This could be a signal that something is wrong.

• Teach children about the use of social media, the internet and cellular phones. They should be made aware of the dangers and rules should be put in place to prevent them being exposed to predators.


3 | Priority One | Issue 2, June 20169 | Priority One | Issue 2, June 2016

child-safe?Is your homeParents worry endlessly about how to protect their children from abduction and violence but, generally overlook one of the biggest threats to their child’s safety - their own home. Children between the ages of one and four are more likely to be killed by fire, burns, drowning, choking, poisoning or falls than by a stranger’s violence.If home safety measures seem overwhelming, let our safety checks help you see at a glance what needs to be done before your baby arrives, crawls or starts toddling and climbing.

View your house as they would

The most effective way to ensure your child’s safety is to take the “babies eye view” of your home. Get down on your hands and knees to see what things look like from their level.

By asking yourself a few questions like what looks tempting, what is in my reach and where can I go, you will figure out which cupboards, drawers and other spaces pose a danger to your child. As your child starts walking and climbing, you’ll have to re-evaluate your home to determine what else could pose a danger to them. Using our comprehensive checklist, you will be better equipped to keep your child safe and prevent most injuries.

Is your homeHealth and Awareness

Priority One | Issue 2, June 2016 | 10 Priority One | Issue 2, June 2016

Bathroom

• Remember to keep the toilet lid down. Install a toilet lock to prevent your child from lifting the lid.

• Put razors, scissors, nail clippers, tweezers and other sharp objects in a locked cabinet or high up in a linen closet well out of your baby’s reach.

• Unplug all electrical appliances (hair dryer, curling iron etc.) and store them away in a high draw or cupboard.

• Store all medications and vitamins out of reach of children.

• Place a non-slip mat inside and outside the bath and shower.

• Never leave your child in a bath or shower unattended.

Around the house

• Cover all sharp furniture edges with padding or foam.

• Cover all plugs with safety covers.

• Hide electrical cords behind furniture or use cord-hiding devices.

• Use doorstops and door holders to stop them from slamming into your child.

• Cut looped window blinds to prevent your child from becoming entangled.

• If you have a fireplace, install a grid and never leave a child unattended while it is in use.

• Keep electronic equipment like decoders, DVD players and stereos out of reach or locked up.

• Secure furniture that can topple over (bookcases, chests of drawers for example).

Garden

• Make sure that all pools are covered with the correct covers at all times. You can also put a fence around your pool.

• Store and lock away all tools (hand, power and gardening tools for example).

• Ensure that your child does not gain access

General

• Taking a first aid course will enable you to deal with any incident more effectively. Parents as well as caregivers and domestic workers should be proficient in CPR and basic first aid.

• A comprehensive first aid kit should always be kept at home should any emergency arise.

• A detailed list of emergency numbers can be pinned on the fridge and be kept next to the phone.

• A fire extinguisher should be kept in the kitchen. Ensure that it is out of reach of children.

Kitchen

• Install safety locks on all your cabinets and doors to keep children away from household items which include cleaning products, cutlery and appliances.

• Never leave any hot pots or pans unattended on the stove. A child may try to reach for these, causing the hot contents to fall on them.

• Put latches on oven, microwave and refrigerator doors and install covers on all stove dials so your child can’t turn on the burners.

• Put a lid on your dustbin as a child may try to reach in and fall.

• If you have a dishwasher or washing machine, make sure it remains closed at all times.

to any fertilizers or pesticides.

• Maintain play equipment. Ensure they do not show signs of wear or rust. Make sure safety netting isn’t frayed or torn, bolts and screws are tightly fastened and “S” hooks are closed.

• Ensure you do not have any toxic plants in your house or garden.

post-traumatic stress disorder

Understanding



Although post-traumatic stress disorder (PTSD) has likely always existed, it has only been recognised as a formal diagnosis since 1980. PTSD can develop following a traumatic event that threatens your safety or makes you feel helpless. Any overwhelming life experience can trigger PTSD, especially if the event feels unpredictable and uncontrollable. PTSD can affect those who personally experience the catastrophe, those who witness it and those who pick up the pieces afterwards, including emergency workers. It can even occur in friends or family members of those who went through the actual trauma. PTSD develops differently from person to person. While the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear.When PTSD occurs soon after a traumatic experience, a person usually feels better after three months. However, some people can experience PTSD symptoms for many years. PTSD statistics in children and teens reveal that up to more than 40% have endured at least one traumatic event, resulting in the development of PTSD. Up to 100% of children who have seen a parent killed or endured sexual assault or abuse tend to develop PTSD,

and more than one-third of youths who are exposed to violence (for example a shooting, stabbing or other assault) will suffer from the disorder.

What causes PTSD?Virtually any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or being the victim of crimes such as rape, robbery or abuse. People may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment.

What are the effects of PTSD? Not all individuals who have been traumatised develop PTSD. There can be significant physical consequences of being traumatised. Traumatised people who go on to develop PTSD seem to be at risk for higher use of cigarettes, alcohol and other substance abuse problems. On the other hand, people whose PTSD is treated also tend to have better success at overcoming a substance-abuse problem.

Untreated PTSD can have devastating, far-reaching consequences for sufferers’ with effects on functioning and relationships, their families and for society. Individuals who suffer from this illness are at risk of having more medical problems. In children and teens, PTSD can have significantly negative effects on their social and emotional development, as well as on their ability to learn. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.

Why should I seek help for PTSD?According to the National Center for PTSD it is important to seek help for the following reasons:• Self – (Early treatment

is better). Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.

• Family – (PTSD symptoms can change family life). PTSD symptoms can get in the

way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.

• Physical health – (PTSD can be related to other health problems). PTSD symptoms can make physical health problems worse.

How can people cope with PTSD?Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example breathing exercises and positive imagery). Actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not), and minimising negative lifestyle practices like substance abuse, social isolation, working to excess and self-destructive or suicidal behaviours.

by At Grobler, Trauma Counsellor: ER24

Understanding Jim’s story

Jim* was in a collision four months ago. He was at a traffic light when another vehicle lost control and collided with his vehicle. He sustained minor injuries, but a friend who was a passenger in his car was killed. At first, the collision seemed like a bad dream. Then Jim started having nightmares about it. Now, he is haunted by what he saw and heard during the collision. Jim has trouble sleeping at night, and during the day he feels irritable and on edge. He gets a shock whenever he hears a siren or screeching tyres, and he avoids television programmes that might show a car chase or accident scene. Jim also avoids driving whenever possible, and refuses to go anywhere near the site of the crash.However, through counselling and coping mechanisms that were put in place, Jim’s health is improving. It is work in progress.



Do you think you have PTSD?Have you experienced and or witnessed an event which is in your mind was life-threatening and caused intense fear, helplessness or horror?Does the experience re-occur to you in some of the following ways?• Do you avoid

conversations, thoughts and feelings about the event?

• Do you avoid people, places and activities which remind you of the event?

• Do you experience repeated distressing memories and dreams

or both?• Do you have intense

physical and or emotional distress when exposed to things reminding of the event?

• Do you act or feel as if the event is repeating itself (flashback or re-living)?

• Do you blank or exclude parts of the detail?

• Do you feel detached from other people?

• Do you avoid reminders of the event and have a numb feeling compared to your feelings before the event?

• Do you feel you are losing interest in important activities in your life?

• Do you have the feeling

that your range of emotions is restricted?

• Do you feel that your future or life span is restricted including marriage and children?

Are you troubled by two or more of the following reactions?• Sleeplessness or problems

falling asleep.• The “on guard” feeling.• Anger, outbursts and or

irritability.• Exaggerated response.• Startled response.• Concentration problems.

Are you troubled by two or more of the following reactions?

• Is there a change in your sleep or eating habits?

• During more than one day, do you feel worthless, sad or depressed?

IndicatorIf your answer is yes to 60% of the above statements, you are at risk of developing PTSD. Please note: The above self-test is merely an indicator which allows the person to look at certain emotional indicators and be aware of possible negative emotions. The awareness thereof may assist in the process of learning how to regulate strong emotions.

* Name changed to protect identity

Additional sources: Psychiatric Times, Richard J McNally, Mitchell and Everly (1983, 1999, 2001), Randal Beaton, Society for Counselling Psychology



Protect yourself Dog attacksA dog may be a “man’s best friend” but do you know how to reduce your chances of being bitten by one?Having recently been called out to attend to patients who were attacked by dogs, ER24 is urging pet owners to take good care of their dogs by ensuring they are well socialised and trained from a young age, and kept safe in their property. ER24 is also urging people to avoid approaching unfamiliar dogs and to report stray dogs to the relevant authorities.Children should also be educated about how to act around and take care of their dogs. According to Samantha Walpole, the secretary of Animal Behavioural Consultants of South Africa, children are most at risk of being bitten by dogs. “Children are generally drawn to dogs. Wagging tails are attractive to children. Unfortunately, the public is ill informed that if a dog’s tail is wagging, it means that it is

happy and is safe to approach. This is far from the truth. “Children are also taught that hugging and kissing is an acceptable form of affection. To humans it is but to canines this is perceived as confrontational. “Fundamentally, humans and dogs speak a different language. When communication is misunderstood, people get bitten,” said Walpole, who is also a dog behaviourist and trainer.

Dogs turning on their ownersDogs could turn on their owners as a result of a number of reasons.Walpole said dog’s that bite their owners, or anyone else, could have an underlying medical condition. The dog could also be pushed to a point where it has no choice or could feel that its life is being threatened. Harsh and confrontational training methods could also

be a contributing factor with regard to human-related dog aggression. Walpole said that people should purchase dogs from reputable breeders to minimise the risk of being bitten. “If you want to purchase a puppy, do your homework to match the right breed with your lifestyle. Join a reputable positive reinforcement socialisation school. There should be continued training to build a good bond between you and your dog. You should seek assistance immediately if there are any early signs that make you uncomfortable,” said Walpole. Further tips provided by Walpole include the following:• Be respectful to your dog. • Research and learn

how to “speak dog”. There are a number of body signals that a dog displays to indicate that it is uncomfortable and needs space or that it likes what you are doing. By watching your dog’s

body language and understanding what your dog is saying, you are able to stop or change the reason for your dog feeling uncomfortable.

• Learn what your dog likes and dislikes and respect these needs.

• A dog should not be treated like a toy or tested to see how tolerant it is. Do not poke, push or sit on a dog or pull its tail.

• Stop what you are doing if a dog shows discomfort. Signs of discomfort include when the dog turns its head away from you, when the dog yawns, flicks his tongue out of his mouth or licks his nose, when the dog’s body freezes, when it moves away, lifts its lips or growls.

• Also stop what you are doing when the dog shows whale-eye (pronounced whites of the eye). This is often misunderstood as a



“guilty look” when it is actually an appeasement gesture in response to the stimulus.

• Never corner a dog.• Do not reprimand a dog

when it growls. This is a language prior to a bite. Growling means that a person should leave the dog alone.

• If your dog bites someone, do not place the dog in a similar situation. If necessary, temporarily confine the dog in a safe area with water and shelter. Immediately seek the assistance of a qualified trained professional. Ensure the behaviourist has the correct credentials and is affiliated with a reputable organisation. Organisations such as Animal Behavioural Consultants of South Africa or COAPE SA can be contacted.

Unfamiliar dogsWhat should you do and not do when you see an unfamiliar dog close by? Walpole said that an unfamiliar dog should be ignored. “Do not encourage an unfamiliar dog to approach you. Quietly and calmly walk away. Do not turn your back on the dog but rather try to have your body facing sideways toward the dog,” said Walpole. If the dog approaches to attack you, do not scream, run away or turn your back on the

dog. Do not make eye contact as this is often perceived as confrontational. Keep your hands close to your body and stand still until the dog has backed away or is preferably out of sight. “If you have food on you, break it up into small pieces and underarm toss the food toward the dog’s head. If the dog eats, continue to toss the food while slowly backing away to a safe place,” said Walpole. You can also place something such as a chair or backpack if available between you and the dog. If you are unable to escape an attacking dog, place yourself in a foetal position with your head tucked toward your chest. Cover your head with your hands. If a person is bitten by a dog, the incident should be reported to the police. If the dog is being ill-treated or neglected, the SPCA can be contacted. ER24’s Doctor Kumeshan Moodley, who has treated numerous people for dog bites, said that anyone bitten, even with minor injuries, should visit a medical practitioner. He said that one of the main reasons for this is the possibility of a person developing infections or rabies. Rabies, which is a viral and almost always fatal disease, is mainly transmitted by the bite of an infected animal. The virus exists in the saliva of a rabid animal.

People who develop rabies could experience anything from headache, fever, vomiting, muscle pain, difficulty swallowing, anxiety, profuse salivation, paralysis, restlessness, fear of water and seizures. Dr Moodley said that a person will not necessarily develop symptoms immediately. It is possible to only experience symptoms later in life. There is no effective treatment for people (and animals) once they develop rabies symptoms. Hence it is important to seek medical attention immediately after being bitten. “Treatment of bites depends on the severity of the injury as well as whether the dog was a stray, a pet that was immunised or not immunised. Where it is unknown if the dog was immunised, as a precaution, the patient would be treated based on assumption that the dog was not immunised,” said Dr Moodley. He stressed that proof would have to be provided that the dog was immunised. Otherwise treatment will be administered as if not immunised. Dr Moodley explained further that treatment is broken up into three categories:

Category one Scratches that are on the surface of the skin. If the dog is immunised the patient is given a tetanus vaccination and the wound is cleaned and dressed with dry dressings

(simple bandage or gauze. Plasters should not be used as this would close the wound completely and as a result, could lead to infection). If the dog is not immunised or if it is unknown, a tetanus and dose of the anti-rabies vaccine is administered.

Category 2 Minor injuries or puncture wounds. The wound should be washed with tap water and dressed with dry dressing. A medical practitioner will give the patient a tetanus vaccine and antibiotics to prevent infection. In cases where the dog was not immunised or where it is unknown, a full set of the anti-rabies vaccine will be given as well.

Category 3 Deep wounds. The same treatment as category 2 but depending on the depth of the wound and the location, a patient can be admitted to hospital for further treatment.

He added that whether or not a person received the rabies vaccination while still a child, they should be immunised again as a precaution. He urged people to take care of their dogs, to feed and love them. “Also remember, as you would take your children for their vaccinations, you should also take your dogs for their vaccinations. Remember to supervise your children when they are around animals,” he said.

The importance of hand hygieneDaily, people touch surfaces, equipment and a number of other items without thinking twice. While people cannot be paranoid about everything they touch, washing their hands prior or following certain activities is vital. ER24 is urging people to practise proper hand washing. Proper hand washing is one of the easiest things people can do to reduce the spread of infection and disease. Regular hand washing especially at the following

times should be practised:• Before eating.• Before preparing food.

It is also important to wash your hands after handling any meat products to prevent the spread of bacteria that can result in food poisoning.

• After coughing or sneezing into your hands or tissue. After blowing your nose.

• Before and after attending to a person who is sick.

• After going to the toilet.

• When using any chemicals or household cleaners.

• After touching animals.• Touching garbage or

garbage bins. • When your hands are

visibly soiled.Washing your hands regularly only takes a few minutes of your day. This does not mean a simple quick rinse with just water is adequate. An effective and inexpensive way to remove germs is by washing your hands with soap. You should wet your hands with

water, apply enough soap to cover the surface of your hands, lather well and wash the surface of both hands. This includes your palms, the back of your hands, wrists, every and between each finger as well as under your fingernails. You should then rinse and dry your hands thoroughly. Alcohol-based hand rubs are also recommended.It is important to teach your children the importance of washing their hands as well. Remember to set the example.



Connecting to electricity illegally, cable theft, undertaking electrical work without fully understanding what to do, being negligent and not ensuring that exposed live wires for example are attended to. These are some of the ways in which people are putting their lives in danger. ER24 is urging people to be careful as well as to refrain from activities such as connecting to electricity illegally or stealing cables.ER24 paramedics have attended to incidents where people sadly died due to electrical injuries sustained.Where victims survived, many were left in a serious or critical condition. Be it at home, work or outdoors, everyone should exercise safety when dealing

Electrical injuriesdo not be a victimwith electricity. Below are some safety tips for people: • Always be alert

when using electrical appliances.

• Never undertake any electrical work unless you understand what to do. If you do know what to do, you should still be careful as mistakes can happen. You should never work on anything that still has current. The current should be shut off prior to work beginning. Remember to turn off the switch or main power supply when working on something like a light bulb for example.

• Treat all electrical cables and outlets as live, even

during load shedding or general power failures.

• Never work in wet areas or with anything electrical and wet. Mowing the lawn or using power tools in wet weather for example is dangerous.

• Do not overload sockets as they may become hot and burn away insulation. You may be electrocuted if you touch it. It can also start a fire.

• Ensure extension cords are in good working order. Inspect extension cords for damages before using it. Ensure cables and cords are kept out of reach of children. Secure all plug points or electrical outlets with

covers. • Beware of exposed live or

damaged wires at home or when anywhere else. Ensure you get these fixed if at home or report those found in public areas for example, to the relevant authorities.

• If someone decides to help a person who has been electrocuted, they should ensure their own safety first. They will be of no use to the victim if they become a victim as well.

Willem Stassen, Senior Flight Paramedic at ER24, added that people should also be attentive at their place of work. A number of incidents he has attended to, occurred at the workplace. “This is


Health and Awarenessoften related to someone inadvertently switching on the mains while another works on the electricity. In addition, I have also had incidents where individuals tried to connect to electricity illegally or steal cables. These are all unsafe practices and must be avoided,” he said.

LightningNot many people are aware of the dangers of lighting. A person who is electrocuted could be affected in a number of ways. The greater the voltage and longer the exposure, the greater the injury. Injuries commonly caused by lightning include burns and damage to the nervous system, heart, muscles or soft tissue. Explaining further, Stassen

said, “The heartbeat is regulated by electrical impulses (small electricity currents) that run through the heart that allows it to pump in a regulated and ordered manner. “When a person is electrocuted, normal electrical impulses of the heart may be disrupted, causing disorganised currents. “Further to this, electrocution and lightning strikes may cause mild to severe burns depending on the voltage and the length of exposure. It may also cause breakdown of the muscle cells in the body, releasing potassium and other chemicals. These electrolytes and chemical surges may further interfere with the heartbeat and lead to renal failure.”

Tips:• If you are outside,

seek shelter indoors immediately if you sense a storm approaching.

• You should avoid high ground, standing under a tree for shelter, open structures and spaces as well as tall isolated objects such as street light poles.

• Get to safety as soon as possible. Get into a building or a hard topped vehicle however, remember not to touch anything metal as a precaution. Remember to keep windows closed.

• If you are at home or in a building, you may still be at risk. Avoid water, electronic equipment and windows.

• If you see someone who has been struck by lighting and they are unresponsive, immediately call for help. Move them to a safer area if possible.

• If they are unresponsive and you are trained in CPR, immediately start chest compressions. Do not delay the use of an Automated External Defibrillator (AED) if available.

Stassen said, “CPR and defibrillation have consistently been linked to outcome. The sooner CPR is started and the sooner the patient is defibrillated (if indicated) the better the chance of survival.”

Our eyes are needed in most tasks we undertake daily, yet we take them for granted.While the eyes are equipped with various defence mechanisms to prevent damage, we need to be cautious at all times. Some of the defence mechanisms that keep these highly sensitive organs safe from harm include tears and eyelids. Tears are produced continuously at just the right volume (except when we cry), and viscosity to ensure good lubrication of the eye, clear vision and to wash away dust. Eyelids blink regularly and close within milliseconds when we sense an approaching threat. The pupil adjusts according to the incoming light to allow just enough for good vision. Despite these natural defences, injuries and damage still occur, often due to our own negligence. ER24 staff is often approached at events by patients who have a foreign object in their eye, most commonly dust and dirt.

Rinsing the eye with normal saline usually dislodges the objects and clears the eye, but often the patient complains of still feeling the object despite it not being visible at all. In most cases the object is no longer present and this sensation is caused by damage that has occurred to the top layer of the cornea which can best be seen by colouring the eye with a special fluorescein dye that sticks to the damaged tissue. Other damage that is fairly common is metal grinder dust that burns into the cornea when people use angle or bench grinders without safety goggles. These objects are often more difficult to

remove and may require a visit to an emergency centre or even an ophthalmologist. Arc eyes is a painful condition caused by burns sustained to the cornea due to the UV radiation emitted by arc welding where a protective visor was not used. Patients often treat themselves with local anaesthetic eye drops which help to relieve the pain but this exposes the eye to permanent damage and even blindness due to the protective mechanisms also being suppressed by the drops.More serious injuries can occur when objects enter the eyeball and often these cannot be identified on examination

in the pre-hospital environment. An example of this is tiny shards of metal or stone that are produced when hammering metal items or concrete. The speed of these items is sufficient to penetrate through the sclera and into the eyeball and often the entry point is not obvious. Without a detailed examination by a doctor this injury could lead to permanent loss of the eye.Safety glasses are essential when you are exposing your eyes to potential damage like when cycling, grinding, hammering or using electric saws – use them and give your eyes a greater chance of remaining healthy.

Take care of your eyes

Examples of eye damage found at events serviced by ER24. In both cases the eyes were treated with eye ointment and covered, resulting in full recovery.

by Dr Wessels, Site Based Medical Services: ER24


Clinical

Clinical qualitydespite financial constraints

Growing financial pressures are forcing us to do what we do best for less in pre-hospital Emergency Medical Services (EMS). These trends of more affordable EMS service delivery are becoming the new norm. As a result, we’ve had to undertake operational improvement programmes and lean transformations, but none at the expense of clinical quality.At ER24, clinical excellence is non-negotiable. We’re grateful to have an incredible team of specialist staff sharing our values starting with our operational teams. We continue to put the patient and clinical care at the heart of our business. We’ve already demonstrated this by achieving our international NAAMTA accreditation. Here’s a look at what ER24 is doing to ensure clinical excellence beyond that of our competitors, some of the clinical quality initiatives we’ve taken to ensure we’re upholding our promise of clinical excellence, despite the financial pressures and an additional cost of a clinical governance programme. Our clinical claims team is responsible for ensuring clinical quality through retrospective chart reviews. This includes patient report form audits and trend/indicator analyses. Clinical indicators such as:• Response times (average

12 minutes primary response time in urban areas).

• Intubation (70% first pass intubation success).

• Intravenous insertion success (99% inserted in less than three attempts) are proudly equivocal to the best in the world.

We’re proud to say every adverse event incident is investigated and where necessary a solution implemented to ensure meaningful change for our business.Road traffic accidents and safety in an ambulance are a real fear. We’ve gone the extra mile to ensure our patients’ comfort and safety by utilising state-of-the-art Stryker® stretchers in our custom-made ambulances. These stretchers have the thickest mattresses and are used by the best in the world - expensive, but our patient’s comfort is our priority, especially since the majority of our patients are

awake and their wellbeing is critical.We’ve researched and acknowledged that mechanical ventilation is the gold standard for all our intubated and ventilated patients, hence we’ve invested in the best equipment to empower our team to do their best clinically. Our Critical Care Retrieval teams utilise the Hamilton T1® ventilator. We were the first EMS service in the world to receive delivery of their upgraded model in 2014, and now have 4 T1’s in use. Our standard adult transport ventilator is the Draeger®Oxylog 3000 of which, we have 22 nationally. In addition to this we have another 15 transport ventilators for our B Tech paramedics.ECG monitoring is equally a

critical skill and we’re 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 ALS crews with 12 lead telemetry. We can diagnose and transmit an ECG to a cardiologist and ensure they’re ready for the patient in the Cath Lab if need be. We currently have 46 Advanced Life Support Phillips MRX Cardiac monitors on our vehicles. We have so many examples of ER24’s investment into the best clinical environment and care for your relative, friend or client and there’s no doubt all the initiatives translate to an ultimate saving for our schemes, and a life saved. With this in mind, shouldn’t you choose ER24 as your preferred service provider?

by Dr Holgate, Chief Medical Officer: ER24

despite financial constraints


Advertorial

Article prepared by Flow Communications on behalf of the National Home Security Month.

The concept of home security goes beyond the electric fence, secure gate and alarm system – often it’s the smaller things inside the home that need just as much attention. Are hazardous materials out of your child’s reach? Do you know what to do in the event of an emergency? No one should ever take safety for granted, so we’ve put together a list of things to consider in turning your home into a safe haven.

Top tips from ER24

Avoid fires and smoke inhalation

“It is not uncommon for emergency services to attend to residential fires. It actually occurs more often than one may think,” said ER24 spokesman Werner Vermaak. “In most cases, someone is injured or even killed as a result of smoke inhalation or severe burns.“A smoke detector can make a difference, as it sounds an alarm or alerts a response

Turn your home into acompany as soon as it detects smoke. You will also be able to act quicker and evacuate should the need arise.” Vermaak adds that it’s important to limit the fuel sources you have in your home. For instance, do not store large quantities of flammable liquids or items in your house. If you have to store them, do so in a well-ventilated area outside and ensure they are away from other chemicals or sources that may cause a reaction when combined. “Hazardous materials should be clearly marked and stored away, preferably in a separate well-ventilated area. Keep a small fire extinguisher in your kitchen, braai area or living area. Also make sure that you know how to use it and it is inspected regularly,” he said.

Learn basic first aidBasic first aid can save a life, and it is vitally important to know what to do should an emergency occur at home. ER24 offers first aid courses of differing levels. Visit www.er24.co.za for further information. “Should someone be injured, the first thing to remember is

to stay calm,” said Vermaak. “Assess the nature of the injury and quickly determine your next steps. If you are trained in first aid you can start assisting the injured person. “You can also contact ER24 on 084 124 to obtain telephonic first aid. From here the call taker will determine if an ambulance should be dispatched. If you are unsure, call for an ambulance.”

The NHSM home security auditAs well as considering the advice above, National Home Security Month has put together a home safety checklist you can follow:

First aid: • Is there a well-stocked

first aid kit in the house? • Do you, your domestic

worker and/or au pair have basic first aid skills?

Pool:• Is the pool area enclosed,

and does the gate have an effective lock so kids can’t get in?

• Is a pool net in place? Fire: • Are there smoke or heat

detectors in the kitchen, garage and bedrooms?

• Have you tested your smoke detector’s batteries lately?

• Do you have a gas detector if you have gas elements installed?

• Do you have fire extinguishers around the house?

• Do you have a fire blanket?

• Were your gas installations installed by a certified professional? Note: only installations post 2009 need to be certified.

Poisons/chemicals• Are these clearly marked,

locked away and out of reach of children?

Emergency protocol• Is there a family

emergency protocol in place?

Emergency numbers • Do your kids have these

saved on their phones? Are they easily accessible in your home?

Home security is everyone’s responsibility. Don’t get caught out! And remember, we’re here to help with any questions you may have – our security experts are ready to give you the advice you need.

safe haven


Company interest

Over eight years ago, I was asked to present a talk at the International Travel and Health Insurance Conference (ITIC) in Venice entitled Buying a Good Air Ambulance. That very title inferred that if you could buy a good air ambulance you must be able to buy a bad one. Well, at the ITIC in Athens last year I presented a session entitled How Well Do You Know Your Air Ambulance Provider which, when analysed, is pretty much the same topic. So, why are we still talking about the same issue? Because we are hoping to understand the complexities and potential

wrongdoings that continue to exist in this expensive and risk-laden industry. At the ITIC in Athens, I presented to a room full of delegates, but many of these were air ambulance providers or representatives of accreditation bodies. What is needed to raise standards in the industry is for insurers and their designated assistance providers – the fund holders and payers that are responsible for selecting and paying for these medical flights – to be more involved with understanding what it is exactly that they’re getting for their money. Preaching to the converted is all well

and good, as hopefully these colleagues will help to spread the message: that we need to commit more attention to who is being engaged to fly these missions.

Audits and accreditation Is accreditation the answer to raising industry standards across the board? Is accreditation indeed even considered by many as being worthwhile? These are discussions that I have had with prominent industry people in recent times – some of whom are not really aware of what European Aero-Medical Institute (EURAMI), the National Accreditation

Alliance of Medical Transport Applications (NAAMTA) and Commission on Accreditation of Medical Transport Systems (CAMTS) provide. Other insurers have made the decision to only use accredited operators, but many are confused by the choice. So, is the marketing by these organisations misdirected, as it targets operators and doesn’t more actively try to engage and promote its benefits to payers? I’m not going to make judgements on who is the best credentialing organisation – all three provide valuable services in the different areas of air ambulance provision

How well do you know yourair ambulance provider?

by Andrew Lee, International Business Executive: ER24 Global Assist

air ambulance provider?


Company interest

that culminate in the total service. Aviation, medical, maintenance, personnel, management and the financial stability are some areas that combine to complete an audit. Having all these components comprehensively covered by one international accrediting body that sets the standard for the industry norm would be the ideal to my mind, however. Then, there is the scenario where a patient case presents in a difficult area that has no accredited operators, but does have options of air ambulance suppliers that the insurer knows nothing about. When this happens it’s difficult to know if a supplier’s website is that of a genuine operator or a broker, or a combination of the two. In such situations, how should the insurer and its designated assistance company deal with the selection of a provider to mitigate risks as much as is possible?

Go for broke? First, the broker issue is a difficult one. Brokers often have impressive websites, as that’s where they invest a good deal of their money. They don’t usually carry any liability for insurance or medical malpractice - and some don’t even look for this in the operators from whom they receive quotes. Brokers often have no control over the end provider, and this glosses over matters of importance such as the airworthiness of the aircraft being used, the legality of the operator and the mission, the qualifications of the medical staff, the standard of equipment carried and whether the pilots are licensed for the aircraft being used. There are some brokers available that do add value to the process by supplying additional services, as well as air ambulances, but these are few and far between. Secondly, there is the operator-broker, who owns an aircraft and advertises as being a worldwide operator. In some ways, the operator-broker is less transparent than the broker, as it has the ability to provide some documentation relating to

its own aircraft. Problems can arise when the payer doesn’t check beyond these documents, however. The typical problematic scenario here is an operator who has a turboprop aircraft, which is operated in a perfectly acceptable manner, yet the company’s marketing leads you to believe it has a global capacity and it will quote on any flight requested of it by the client. It will even quote on and accept jet flights, which it will broker out, while allowing the client to assume the flight is under the control of the operator-broker, who may very well be an accredited provider. Any accreditation will, however, be null and void in this instance as it was only gained for turboprop usage and all the associated elements – medical, insurances, equipment, and so forth. Putting medical teams on other people’s aircraft will also likely be in breach of the accreditation, with some broker-operators not always being transparent or forthcoming about such information. Unfortunately, these issues are not widely tackled by accreditation bodies. It would be prudent for insurers, therefore, to make their own investigations into the providers they are choosing to partner with to ensure they are fit for purpose and operating in line with legal and other expectations.

Check and double check Part of my remit in working for ER24 Global Assist is to develop and grow its network of air ambulance partners. I do this by trying to use known, accredited partners and, even then, double-check the potential new partner is appropriately qualified. Some would say that three years between audits is too long, and aircraft and staff can change, equipment that is borrowed or hired to complete an audit is returned and indemnity levels of cover can be reduced. When ER24 is unsatisfied with the accreditation, it sends out an audit document for completion, prior to a

follow-up location visit. Unfortunately, only about one in four potential partners are willing to participate in such a process. This is a frightening number as it doesn’t mean these operations aren’t flying, just possibly not correctly. Once they receive the documentation I usually get a reply stating they are collating all the information, but then nothing comes back. The reason in my opinion is they don’t have the ability to provide correct, current and identifying information. One reply from a supposed operator, “forgive my lack of knowledge but what is an Air Operator Certificate (AOC)?” And yes they are being used by payers.

Breach of regulations I still find it difficult to understand why payers are not showing more attention to who they are using when it comes to sourcing air ambulance provision. In Africa, there are several examples of operators providing services in a dubious fashion. In South Africa, for example, there are companies providing aircraft that are not Part 138-registered - which is required under the South African Civil Aviation Authority’s air ambulance regulations. Each aircraft flying medevac in the country must be licensed for purpose, along with all flight and medical crew, who must complete Part 138 training and be certificated on completion. The Chief Medical Officer (CMO) or medical director must be registered with the Department of Transport, and takes total responsibility for all medical related matters, from staff to equipment. However, there are air ambulance operations that are providing services that are clearly in breach of Part 138 - either aircraft are not compliant or pilots are not type-rated for the aircraft being used. But unless payers are aware of such issues, how do they know what questions to ask? Aside from attending relevant sessions at the ITIC,

there are a few key questions that those contracting with air ambulance providers can ask potential partners to ascertain whether they are a genuine operator. Air ambulance costs are one of the most expensive items on a travel claim, and they really do need to receive more due diligence attention.

These are some of the questions that can be asked to ascertain a genuine operator:• Is documentation

current? (ask for copies of the air operator’s certificate and insurances).

• Is your medical director a current practicing clinician? (ask for a résumé).

• What medical equipment do you carry?

• What aircraft do your fleet comprise? (ask for tail numbers).

• What medication do you carry?

• Do you supply a ground ambulance?

• Do you keep medical records and how?

• Do you have flight protocols?

• Where are you licensed to operate/fly?

• Can you supply medical oxygen?

The following aspects need to be considered when auditing a provider:• Management• Operations• Maintenance• Safety record• Ground ambulance• Pilot experience • Medical staff• Medical equipment

To progress, we must look carefully at the selection process and delivery of air ambulance services. We have to achieve change, and to do that we have to make bold decisions. Payers need to become part of the due diligence process by listening to those that are trying to make a difference, but most of all sharing what they expect from the provider. It is in all our interests to be working together for the betterment of the industry.


Company interest

ER24 and Mediclinic are proud to be offering a Diploma in Emergency Medical Care (Dip EMC), providing applicants with an entry point into a career in Emergency Care Services. The qualification provides a holistic development of the individual and ensures the basic competencies to operate as an Emergency Care Technician. The programme was initially developed following requests by ER24. Mediclinic is the first higher education institution to obtain accreditation for the Dip EMC. The programme is accredited by the Health Professions Council of South Africa (HPCSA) and Council on Higher Education (CHE) and is registered with the Department of Higher Education and Training. Mediclinic’s main objective is to produce graduate learners who are equipped with skills to render lifesaving emergency care to critically ill patients. Graduates will be qualified with an Advanced Life Support (ALS) qualification and professional registration with the HPCSA as an Emergency Care Technician. The curriculum is outcomes-based and follows a learner-centred approach. It is a two-year programme which consists of theoretical and clinical components. Teaching is contact-based, using problem solving and self-study and training is accompanied by professional personnel in simulated and real life settings. For more information visit www.mediclinic.co.zaThe qualification is currently only available from our learning centre based in Bellville, Western Cape, but it is intended that the application for the Gauteng based facility will be granted in the near future.

Diploma in Emergency Medicine now offered

by Michael Emery, GM of Sales and Marketing: ER24

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

Company interest

| 22

ER24 provides customised services, risk mitigation and case management solutions to various medical schemes and their appointed administrators, as well as other funders in the healthcare industry. Over the years, we have gained a solid reputation of work efficiency, effectiveness, dedication and utmost professionalism, which is the commitment made to all our contracted medical aids.

New clientsWe would like to take this opportunity to welcome COMMED, RUMed, Suremed Health and Xelus – MyHealth as our new clients. We are very excited that they have chosen to partner with ER24

as their Emergency Medical Service provider.

Clinical governanceClinical excellence is a non-negotiable at ER24. We actively embrace patient safety which we achieve through sound clinical governance principles, including but not limited to: implementation of best practice clinical protocols and guidelines; education of ER24 clinical staff to ensure that they comply with best practice guidelines; assisting with concurrent case management of high risk cases; interaction with referring and/or receiving specialists and hospitals as and when required to ensure optimal clinical outcomes and

Funders and Medical Schemes

by Margie Saunders, Manager of Funders and Medical Schemes: ER24

Customised services for clients

most appropriate facility; clinical review of all patient report forms; medical review of all query cases which do not comply 100% with documented EMS protocols; and the prompt and thorough review of any complaints. Our own operational staff are all encouraged to log any adverse events as this affords us the opportunity to constantly review and improve our services. Research is a very important part of clinical governance and patient safety and we are constantly initiating quality improvement projects. We also play an active role in assisting students to complete their tertiary research projects. Most of these initiatives are headed up by

our Chief Medical Officer (CMO) and her research team. Network Provider Manager In additional to ER24’s focus on monitoring and maintaining the quality of care provided by our own resources, we have a dedicated Network Provider Manager who interacts directly with our contracted service providers. The key objective is to establish and maintain a credible and quality managed pool of Emergency Medical Services providers to augment ER24 in times of high demand or geographical unavailability and thus ensure country-wide access to quality-controlled EMS providers for our contracted medical schemes 24/7.

Are we able to Contrary to popular belief, it is not that easy to accept change and in our world that is the one constant we all face, in addition, given the rate of change in the world today, it easy to be swallowed by circumstance. Having read inspiring books by Alvin Toffler and Ricardo Semler that recount cases where people have managed to make both organisational and societal changes, I often tend to contemplate the learnings from these modern day masterpieces. The simple truth is that change is all around us, and driving change can take a lot of work. So are we able to predict the changes ahead

of time in order to “ride” the wave to success or is it this an unmanageable force that we just have to accept and make the best of, come what may? Having recently just watched the movie “The Impossible” which is a movie that tells a dramatic and catastrophic story about the tsunami that took place in December 2004 on the coast of Japan, for me it had an undertone or second track that demonstrates how a catastrophic event can change the world. Imagine being a horse breeder at the turn of the 20th century. A seemingly good business to be in as horses were the main transportation method and

by Michael Emery, GM of Sales and Marketing: ER24

it would certainly appear that if you were planning the forecast of the future of your business you would be on solid ground. Then suddenly, rail and combustion engines come onto the scene and the changes in the horse breeding industry becomes catastrophic to your business. If you were prepared for it, you would have been looking for the alternatives and adapting your business in order to accommodate this change. So here is my view, embrace change and enjoy it, or face the possibility of being swept aside by circumstances that you are not prepared for. At ER24, our business has

continued to grow and evolve due to being able to metamorphosize and adapt to change. Our industry faces many challenges. If you listen to the world view on the increasing ageing population and the burden of disease for example, globally we could be facing a ‘tsunami’ or catastrophic event. What I can say after nearly 30 years of working experience is, accept change when it does come along. Suddenly the mountains will look like little molehills. And it is really as simple as that. Oh yes and enjoy it… Because it is great to be alive. Until next time…

change?


Company interest

in Rustenburg

Meet Lourens Smit, an Advanced Life Support paramedic, who is part of the ER24 Rustenburg team.

in Rustenburg

Priority One | Issue 2, June 2016 Priority One | Issue 2, June 2016 | 24

Company interest

Realhelprealfast has arrived in Rustenburg. ER24 is proud to announce that it has opened a branch in the city. With an experienced regional manager, acting branch manager and highly qualified staff, clients can rest assured that they will be in good hands. The newly established ER24 Rustenburg branch promises quality pre-hospital care to patients. Marius Koekemoer, the ER24 Northern Regional Manager, said, “It is an honour to open this new branch. The people of Rustenburg can expect well organised, highly skilled staff that will render the best care possible to all clients. “The public of Rustenburg can rest assured that their lives are in safe hands. I would like to welcome the new staff to the ER24 family. Without a

dedicated and well-oiled team ER24 would not operate as efficiently. We will support staff in their efforts to make ER24 Rustenburg a success.” Johann McDermott, the Acting Branch Manager, has years of experience in the Emergency Medical Services (EMS) industry.He started his career in 1999. He joined the Fire Department as a rookie fire fighter when ambulance services and fire stations were combined. Shortly thereafter, he moved to ambulance services. He had his sights set on becoming an Advanced Life Support (ALS) paramedic. He reached his goal at the age of 26. In 2006, he was given an opportunity to do a Critical Care Assistant course and he grabbed it with both hands. McDermott has been

involved in the successful establishment of several ER24 branches and plans no different for ER24 Rustenburg.“We are out and about. We aim to be visible everywhere and be the first port of call for any emergency in the community. Thus, rendering appropriate emergency care in a realhelprealfast way. You never know when a medical emergency could occur. It could involve you, loved ones or a total stranger. Save the number 084 124 on your phone. Call this number immediately in case of a medical emergency. The time saved may just be what is needed to save a life. Feel free to have a chat to us when you see us as well,” he said.In his message to staff at the branch, McDermott said, “We have all chosen this career for similar reasons. We all

have a passion for people and we should never lose that. Patients always come first. As a team we can always keep that motto a reality.” Also part of the ER24 Rustenburg team is Lourens Smit, an Advanced Life Support paramedic. Smit said he is excited to have joined the team at the new branch. “Next to creating a life, saving one is the highest calling. I am excited to be part of this initiative. It’s a privilege to be part of the team. We have been busy. We have a really motivated team. We spend a lot of time on the road and at stationary points. I certainly think we have been noticed. We want to be part of the community and I think we are getting there,” he said.Remember, ER24 can be contacted on 084 124 in case of any medical emergency.

Charne Language, based at ER24 Rustenburg, with two of the vehicles you can expect to see on the road.


Company interest

Medical aid fraud is one of the fastest growing challenges facing the medical aid industry. It provides a different challenge to other types of fraud as a result of member perception, as well as the fact that both members and service providers often work together in committing the fraud as both parties benefit from this. Members often say “I pay contributions so I am entitled to use all my benefits” or “I pay contributions and can use my benefits in any way I want”. Members, however, do not realise the impact of this, not only on the medical aid industry as a whole, but also the direct implications to the members themselves as this contributes to the overall cost of healthcare costs, which in turn translates to above-average increases in contributions. At the 16th

Annual Board of Healthcare Funders of Southern Africa (BHF) Conference held in 2015, Dr Hleli Nhlapo, deputy chair of the Healthcare Forensic Management Unit (HFMU) of the BHF, advised that it is estimated that at least 7% of medical aid claims are fraudulent and that the figure might be as high as 15%. According to him this implied that the cost of fraud is approximately R13 billion per year (calculated on 10% of the approximately R130 billion per year spent in the private healthcare sector in South Africa).

Defining healthcare fraud In an article titled, Ethics in healthcare: healthcare fraud by G.A. Ogunbanjo, healthcare fraud is a type of white-collar crime involving the filing of dishonest healthcare claims in order

to achieve a profit. The Association of Certified Fraud Examiners furthermore defines healthcare fraud as a deception or misrepresentation that a person or entity makes, knowing that the misrepresentation could result in some unauthorised benefit to the individual or entity or another party. The most prevalent fraud involves a false statement, a misrepresentation or a deliberate omission which results in benefits being granted, which would otherwise be denied.Fraud is committed for personal gain or to damage another person and the most common purpose is to defraud people or entities of money. It is important to remember that fraud, including medical aid fraud, is still a crime and a civil law

violation.

The perpetratorsMedical aid fraud is mostly committed by members, service providers, brokers, medical scheme administrators and other parties.

Examples of fraud include: • Claiming for services not

rendered• Code manipulation

(charging for a more expensive procedure by billing for tariff codes with a higher monetary value, or charging for codes in respect of services not provided)

• Service providers giving cash to members and then submitting a claim to the medical scheme

• Supplying groceries or merchandise to patients and claiming for medical

Medical aid fraud a growing concern

by Michelle Conradie, Fund Manager: ER24

Medical aid fraud


Company interest

services from the medical scheme: For example, a member obtaining nappies and deodorant from the pharmacy who then claims for medication from the medical scheme

• Provider syndicates obtaining member information and submitting claims for members who never consulted them

• Billing for ethical medication (brand name medication) whilst dispensing cheaper generic medication

• Providing sunglasses but claiming for contact lenses or glasses

• Using invalid tariff codes• Medical scheme card

fraudulently used, for example member lends his medical scheme card to family members or friends who are not registered to use the benefits of the medical scheme

• Fraudulent foreign claims• Enrolling ineligible

people for coverage• Dual membership,

for example member belonging to two medical aid schemes at the same time

• Non-disclosure of prior ailments (pre-existing conditions) on an application form

KPMG’s Medical Schemes Anti Fraud Survey indicates that the largest percentage of service provider fraud was through code manipulation (40%) and services not rendered (25%). The most prevalent fraud by members are not disclosing pre-existing conditions (92%). According to an article published by Medimed, being found guilty of fraudulent behaviour can have the following direct implications on the member: • Scheme membership can

be terminated • Fraudulent claims can be

reversed and the member will be liable for payment to the service provider or the scheme can recover losses incurred from the member

• The member can be reported to their employer where the medical aid contribution is subsidised by the employer

• The medical scheme can open a criminal case

Responses to service provider fraud includes reporting the service provider to the relevant governing body, blacklisting the service provider, stopping direct payment to the service provider by refunding the member and instituting civil action for recovery.

Direct consequences of healthcare fraud Medical aid fraud has a direct financial impact on a medical scheme. According to the Healthcare Forensic Management Unit of the Board of Healthcare Funders of Southern Africa (BHF), impact includes direct financial losses to the members of the scheme as a result of additional costs for investigations, management time and legal costs as well as

non-financial costs such as reputational damage. This all ultimately leads to increased contributions, which affects all members of the scheme. The unit states it is estimated that the current cost of healthcare fraud adds an additional R192 to R410 per month to every principal member’s medical aid contributions.

How can you as a member of a medical scheme prevent fraud? • Analyse your claims

statements carefully. Check that you have received the services claimed for by the service provider.

• Keep your medical aid number and medical aid card in a safe place.

• Refrain from accepting money in exchange for a claim from your medical aid.

• Report suspicious behaviour. Most medical schemes have dedicated fraud departments where suspicious behaviour can be reported to.



Puppy gets a second chance

Doctors from Mediclinic and paramedics from ER24 saved a puppy following a bizarre incident recently where a man tried to sell it on the streets of Cape Town. Dr Janne Killops and her colleague Geoff Bettison we conducting a route inspection for an event being held in the city. While they were patrolling the route, they came across a man who tried to sell the puppy to them. He offered the puppy to Dr Killops for R10. She immediately noticed that the puppy appeared to be extremely weak and dehydrated. She decided to intervene and help the puppy. The police were also called to the scene.

Dr Killops and Bettison returned to the clinic station at the event where paramedics from ER24 assisted her in rehydrating the puppy. Among those who assisted in caring for the puppy was Maxine Hall-Dickson, an Advanced Life Support paramedic.Event organisers soon heard about the ordeal and offered to sponsor the puppy for a full vet check-up as well as food, toys and a bed. Once they returned to the clinic station from the vet, the puppy was bathed and cared for until he started showing positive signs of rehydration. Speaking about the incident and the way people gathered

to help the puppy, Dr Killops said, “I was inspired. What is great about working with Mediclinic, ER24, the City of Cape Town and the various services at events is the resounding message that everybody and everything matters. I think that this story is all about that. “Cape Town is a very special place. It is only in Cape Town where you will get six or seven police officers rushing to the plight of a little dehydrated puppy. “It was like a relay of care. The police officers, traffic officials, Mediclinic, ER24… everyone worked together to look after the puppy.” She said she was amazed at the number of

community members that visited the puppy as well. The puppy made such an impression on a member of the race organisation that they decided to adopt the puppy and give him his own race t-shirt. “I am so humbled to be surrounded by such amazing and caring people. In this country there are times when people lose hope when it seems that no one cares to make a difference. There is so much difference that we can make in our country. Don’t turn away. Do not make it someone else’s problem. We can be the solution. That was the lesson learnt,” said Dr Killops.

Ma’or Margo, BLS medic from ER24 Specialised Medical Services with Dr Janne Killops assess the puppy.

A puppy that a man tried to sell for R10 is now in good hands.



A local law enforcement officer and his K9 sustained minor injuries on 17 May after the vehicle they were travelling in overturned on the N7 outbound in Milnerton, Western Cape.Upon arrival, ER24 West Metro Branch Manager Shane Fascio and paramedics Craig Wylie, Sakeenah Abrahams and JP Smith, found the police officer walking around on the scene, attempting to extricate his canine companion from the overturned vehicle which lay on the side of the road.The paramedics assessed the scene and found the canine, a Border Collie named Molly, lying trapped inside the vehicle. Fortunately, Molly had sustained only a minor laceration under her one eye.ER24 paramedics, along with Cape Road Assist, used a winch from the towing vehicle to break the middle partition to free Molly.After a short time, Molly was freed from the vehicle and handed to her anxious handler. They were both assessed and treated.The officer was transported to Mediclinic Milnerton for further treatment. Molly was handed over to the K9 unit, waiting at the hospital, for further treatment.The cause of the incident is not yet known.

K9 companion rescued

Above: Craig Wylie and JP Smith load Molly into the ambulance. Right: Shane Fascio with Molly after her rescue.



ER24 still caring for wild

Petronel Nieuwoudt, founder of Care for Wild, and Dr Ferreira du Plessis, a veterinarian, try to help an injured rhino calf.

ER24 still caring


Community involvementRescued orphaned, abandoned, injured and displaced animals continue to thrive at Care for Wild Africa.Among the animals taken care of at Care for Wild, based in Mpumalanga, are a number of baby rhinos that would have been left with little or no chance of survival if there was no intervention by those committed to wildlife preservation. ER24 is among the number of organisations that have come on board to help Care for Wild in its aim to save and rehabilitate rescued baby rhinos. Apart from having assisted Care for Wild with much needed equipment in the past, ER24 continues to supply them with medical supplies.Among the supplies donated recently were rhino rescue bags and two much needed first aid kits. Petronel Nieuwoudt, the founder of Care for Wild, said, “I would like to thank Andrew Boden, ER24 Chief Executive Officer, and the ER24 team, for donating the much needed medical rhino rescue bags which are used for emergency rescues of injured and orphaned rhinos. My guys always use those bags. ER24 has done brilliantly with these bags without even knowing it. These wound dressings and other supplies

Dog rescued after being dragged by carA dog is lucky to be alive after having been dragged about 50 metres under a car in Napoleon Street in Bloemfontein. ER24 Bloemfontein branch manager, Lucas Bezuidenhout, was contacted on 12 May by the owner of the car for help. Bezuidenhout as well as Sector 4 Neighbourhood Watch, from Uitsig Bloemfontein, member Wimpie Geyer and his son Wynand attended to the scene. On arrival at the scene they found a Doberman trapped under the car.The dog was struggling to breathe. Jacks were placed under the vehicle by Bezuidenhout and the Geyers

to pick the car up a bit.Members of Cobra Towing helped lift the vehicle up further to remove the dog.Upon assessment it was found that the dog sustained abrasions and lacerations.The dog was wrapped in a blanket and taken to the local SPCA for further assessment.The dog is said to be doing fine at this stage. It is understood that the dog ran in front of the car after it was frightened by lightning.It is understood that the driver thought the dog ran away however, he stopped when he realised that something was wrong. He then found the dog under the car.

Left: ER24 Bloemfontein Branch Manager, Lucas Bezuidenhout.

Above: The Doberman that was rescued.

cost a fortune. We were sent boxes of supplies to refill these bags. We are so happy.” ER24 is proud to assist where possible as it believes that rhinos and other endangered animals should be protected against poaching. Having been to Care for Wild Africa on a number of occasions it is evident that animals brought to the facility need all the help they can get. Just recently, SANParks veterinarian Doctor Markus Hofmeyr, surgeon Dr Noelene du Plessis and surgeon Dr Jan Louis Ras, both based at Mediclinic Nelspruit, as well as ER24 paramedics, Nieuwoudt and

her staff tended to an injured rhino calf. The calf, named Lulah, had been severely wounded by hyenas resulting in her losing both ears and suffering bad bites to her legs. The calf was taken to Care for Wild Africa for treatment and the team worked tirelessly to save her. Sadly, her wounds were too severe. Despite all efforts to save her she did not survive. Another baby rhino, LoFo, arrived at Care for Wild after his mother was brutally killed by poachers. The calf was found after it had roamed the bush alone for five days. Field rangers rescued the calf and Dr Hofmeyr attended to

its wounds. Lofo was taken to Care for Wild. He had a wound from a piece of wood that had pierced his front right leg, and two deep cuts on his back believed to have been from poachers. With the help of Dr Ras and Dr Du Plessis as well as veterinarians Dr Ferreira du Plessis and Dr Albertus Coetzee, LoFo’s health continues to improve. ER24 is glad that the medical equipment and supplies donated assisted the team of doctors. We are proud to be associated with Care for Wild and such a great team that is dedicated to the preservation of endangered animals.

ER24 Lowveld recently visited Care for Wild Africa to hand over two first aid kits donated by the ER24 Head Office. Pictured are Jeandri Barnard, Greg Wilcox (ER24 Lowveld Branch Manager), Jaun Beetge, Ursela Kriel, guards and Petronel Nieuwoudt (founder of

Care for Wild).



The Reinhardt Drewel Foundation SA (RDF SA), founded and launched in 2015, is South Africa’s first registered NPC (2016/068951/08) targeting national drowning prevention awareness and education.RDF SA was founded by Rina van Schalkwyk, Mrs Grand South Africa 2016.It is the only charity in South Africa supporting children disabled by non-fatal (near) drowning or other cerebral hypoxic injuries. RDF SA recently entered into a medical partnership with ER24 and a drowning prevention partnership with Lifesaving South Africa.RDF SA hosted South Africa’s first annual drowning prevention campaign on 19 March at the BP Oasis One Stop on Beyers Naude Drive on the N1 south in Randburg. ER24 head of communications, Werner Vermaak, and spokesperson Russel Meiring, both medics, and 12 Lifesaving SA Linden Lifesaving Club lifesavers and nipper volunteers stood

Raising drowning prevention awareness

by and assisted RDF SA organisers and ambassadors in handing out beach buddy buckets branded with the safe code and basic CPR instructions to assist in an emergency situation to children. This on-going initiative is the first of many planned and strives to make children and parents equally aware of the importance of water safety and how drowning affects our country as a whole. Through this initiative, RDF hopes to:• Provide aid and

equipment to children who are disabled as a result of non-fatal drowning in the hopes of improving their quality of life.

• Fostering research in the prevention, treatment and outcomes of children with hypoxic brain injuries and associated disabilities.

• Partake in drowning prevention and water safety campaigns and education programmes.

• Advocacy for changes to standards, legislation, regulations and their enforcement to improve the safety of domestic swimming pools and to improve safety around all other aquatic sources.

• To establish long-term collaboration and partnerships.

The campaign also forms part of the greater international water safety awareness education initiative that is celebrated worldwide. This initiative furthermore aims to get African Nations to partake in it by the year 2020. Their message is simple: “One drowning or child disabled is one too many.” For more information, email [email protected] or visit www.mrsgrandsouthafrica2016.co.za

Yaseen Khan, Rina Van Schalkwyk (Mrs Grand South Africa 2016) and Werner Vermaak.

Buddy buckets ready for distribution.


If you don’t have a medical aid and you travel on our roads, you can’t afford to be without an ANGEL. If you are a medical aid member who tries not to exhaust your medical savings but would like the comfort of knowing that you will be fine should there be a shortfall, accidentANGELS™ can take care of this. accidentANGELS™, established in 2010, provides guaranteed access to private medical treatment on scene in the event of a collision as well as guaranteed treatment at a private medical facility.There are two available products. The first is for any collision (excludes motorbike incidents but includes pedestrians), involving a mode of transport on a national road. The second is for people who use motorcycles as a mode of transport. Below are further details:

accidentANGELS™• ER24, an exclusive

partner to accidentANGELS™, provides medical emergency transportation to hospital.

• accidentANGELS™ MasterCard that is used as a form of identification as well as a trauma benefit card up to a R10 000 limit.

• Guaranteed medical treatment at a private medical facility up to a limit of R200 000.

• RAF claims management.• R149 for the main

member and R90 for each dependent added (excludes motorbike incidents).

bikeANGELS• ER24 medical emergency

transportation.• accidentANGELS™

MasterCard that is used as a form of identification as well as a trauma benefit card up to a

R10 000 limit.• Guaranteed medical

treatment at a private medical facility up to a limit of R200 000.

• RAF claims management.• R249 for the main

member and R249 for each dependent added (includes car accidents).

Services by accidentANGELS™ are supported by all private hospital groups. Funds are transferred onto a member’s accidentANGELS™ MasterCard within minutes of being notified of the incident by ER24. The MasterCard enables payment to a trauma unit on arrival. Funds are used exclusively at the trauma

centre for medical treatment.All guarantees are prearranged ensuring hassle free hospital care. You can join accidentANGELS™ via their website. One of their superANGELS will contact you. Alternatively, call 080 264 3576.

ABOUT accidentANGELS™accidentANGELS™ is brought to you by Trust Care Communications (Pty) Ltd, a registered credit provider, NCRCR6815. Trevor Case, who heads up Trust Care Communications, has been actively involved in the health insurance industry for more than a decade. He successfully

developed an HIV insurance product for the mass market that provides a degree of HIV cover for one million families. It is operational today. Trevor’s passion is healthcare and finding suitable solutions for individuals who currently have a small degree of health insurance, or in creating products for those who do not. Through his varied client base and business dealings, Trevor has come across many families under the mistaken impression that they have sufficient medical cover, only to find that they are misinformed regarding a gap between what medical aid covers and what specialists charge. This led to Trevor introducing Gap Cover, a product provided by Ambledown Risk and Underwriting Managers (also a partner of accidentANGELS™), to the many clients who need it. During this period, Trevor gained an appreciation for just how many people do not have any form of medical cover. There are those who have short-term insurance which pays the member a lump sum per day that they spend in hospital, but this still does not guarantee access to a private medical facility. These products are popular because they are far more affordable than traditional medical aid. Trevor discovered that people purchase medical cover through fear of not being able to provide for the needs of family and concerns associated with motor vehicle accidents - what happens when you cannot talk for yourself? Trevor got to thinking: “What if we could guarantee our members and their families access to private hospitalisation if they are involved in a car accident?” And so accidentANGELS™ was born. The rest, as they say, is history ... only ours is in the making.

Why you need accidentANGELSAdvertorial

Trevor Case.

Events


Providing the appropriate medical resources to an event is key. ER24 is doing just that with its unique ER24 Safety Zone. The Specialised Medical Services Department (SMSD) at ER24 ensures that adequate analysis and preparation takes place in order to deliver these services to every contracted client. It does not matter how small or big an event is, depending on the type of event, medical standby is often required by

law. Larger events require a longer preparation time as these require specialist staff members and equipment. ER24’s specialised medical services team completes a full risk assessment on events and drafts an operations plan unique to each event. Very often, the operations plan is requested by the local municipality before the event is given the green light. Risk assessment and operational plans are influenced by the

amount of participants at an event as well as the type of event. All our 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 thus be assured of efficient medical care and standby that is financially feasible.Operational plans are shared with event organisers

and risk factors are taken into consideration. The operational plan is a “living” document prior to the event and can be implemented to cater for the most basic needs. Event location inspections take place prior to the event and key areas such as evacuation areas, mobile clinics and ambulance access is identified. The operations plan then becomes a “locked” document after various risk factors and general

Appropriate medical resources at an event is key

by Alan Winstanley, Manager of Specialised Medical Services: ER24

ER24 SMSD providing medical standby at Unika Primary for the Tau League earlier this year.

Events

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

assessments have been taken into consideration. An action plan is put together based on risks identified and incorporated into the operations plan. Communication plays a vital role to ensure the client is well covered in case of a medical emergency. An ER24 specialised medical services co-ordinator meets with the event organisers and local municipality to form a joint operations centre where details of the event are discussed and the operations and action plans are reviewed. Usually the joint operations centre will also form part of the event’s “control room” on the day of the actual event. This ensures that seamless communication takes place between the event organiser, medical personnel, security and support services. The client is constantly kept up to date regarding further risk assessments and medical logistics of the event.The primary function of the medical team at the event is to deliver a positive and professional patient experience. Interaction between the patient, medic, hospital and event organisers is key to ensure that all

deliverables are met.The co-ordinator and joint operations team meets after an event to discuss risk factors and incidents attended to. An in-depth post event report is then shared with the client to enable them to identify future risks or incidents associated with the event.Some of our key events include: • 2015/16 CEO Sleep Out

in Johannesburg• 2016 World Duathlon

and Triathlon in Cape Town

• 702 Walk the Talk since 2010

• Medical standby at three out the five national rugby stadiums

• Solar Challenge, Pretoria to Cape Town

• Medical standby at numerous track and off road motor sport events on a national basis

• National association with the South African Rugby Union

• Roof of Africa since 2013• 2016 Trans Cape

Mountain Bike Race, Knysna to Franschoek

• 7-day Munga MTN 24 hour challenge, Bloemfontein to Franschoek

ER24 SMSD at the SANParks Honorary Rangers Indada in Langebaan.

ER24 SMSD at the Chasing the Sun Trail run in Muldersdrift.

PRI RITYONEER24Ambulance

ER24EMS ER24EMS

@ER24EMS

THANK YOU TO OUR CONTRIBUTORS:Derrick BanksCraig van RensburgHenry HorneGenevieve SerraBertram Malgas Russel Meiring At GroblerChitra BodasingSamantha WalpoleDr Kumeshan MoodleyWillem StassenDr Vernon WesselsDr Robyn HolgateFlow CommunicationsAndrew LeeMediclinicMargie SaundersMichael EmeryMarius KoekemoerJohann McDermottLourens SmitMichelle ConradieDr Janne KillopsWerner VermaakShane FascioPetronel Nieuwoudt Greg WilcoxLuca BezuidenhoutRina van Schalkwyk Trevor CaseAlan WinstanleyTyler Badenhorst

er24 priority one - june 2016 q2

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