Johannesburg EMS saves lives despite the serious lack of resources they face

RATING EMS: 4

RATING CAXTON* 3.5
*This score does not reflect the many EMS workers who do the best they can with often limited resources and equipment.

With the City of Johannesburg’s fire department responding to an average of 17 calls a day, and the Gauteng Department of Health, which manages ambulance services in the city, responding to almost 1 million calls in the last financial year, it is fair to say that the Johannesburg emergency management services are busy… Really, really busy. From veld fires to burning hijacked buildings in the CBD, from house calls in the depths of the city’s informal settlements to massive multi-injury pile-ups on Jozi’s multiple highways and byways, firemen and paramedics have their work cut out for them. But how supported are they by the powers that be? Are sufficient resources provided to them to conduct their duties, and how successful are they by international standards? Let’s find out.

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FIRE DEPARTMENT

When it comes to fires, literally every second counts. With the right, or wrong in this case, set of circumstances, a fire can go from a spark to an inferno, almost immediately.
That said, the city’s fire department is one of the most essential services it provides.
In July, Caxton Local Media reported that the fire department only had 11 fire trucks in service. Now, however, they would not be drawn on a number.

Robert Mulaudzi, spokesperson for the emergency management services (EMS), said, “The city has 56 red fleet vehicles. These include skid units, water tankers, heavy rescue, rapid intervention, command units, Brontos, ladders, industrial pumpers and water boats, swift water rescue, and air trucks.”
If divided between the city’s 29 fire stations, that number equates to 1.9 vehicles each, but that includes those unsuitable for actually fighting fires, like support vehicles. These are situated at various locations across the city with ‘big red fire engines’ often responding from areas further away from the nearest station.

EMS received and responded to 6 486 fire and rescue calls in the last financial year

Of the fire department, Ward 101 councillor Ralf Bittkau says, “The fire department is in a failed state.”

He also bemoans what he says is a lack of vehicles, among other shortcomings.

All fire stations are reported to have a full complement of staff, although, if under-equipped, how are they to respond timeously to a fire emergency if needed? This becomes demoralising for fire-fighters, as one previously told Caxton Local Media.
“It is difficult, psychologically, when you continuously report to work but do not have the tools you need to do your job. When someone is badly injured or loses their life from a fire because of a lack of resources, it is devastating.”

How the city fares when it comes to response times
A recent house fire in Orange Grove went from a small amount of smoke coming through a window, to the entire building being engulfed in flames, in a matter of minutes. Fire spreads quickly and response time is of the utmost importance.

Henry Zeiler, SCP Private Fire and Rescue chief, said, “There are not many City of Johannesburg fire engines that are operational, and it is a massive concern.”

He worked for the city’s fire department for 35 years before leaving in 2003.

During the day we had 30 seconds to respond to a call and get the wheels of the truck moving, at night it was one minute

So how does the city compare in 2024?
Mulaudzi says their teams have an average response time of up to three minutes to get to the fire engine and aim to respond on-site within 15 minutes.

Zeiler says, “Fifteen minutes is a long time because, with the right mix of oxygen, heat, and combustible material, it is essential to get to a fire fast, every minute matters, literally.”

Info box: The four biggest challenges EMS staff face according to Mulaudzi are:

• Vandalism of street side water hydrants, which costs precious seconds as fire crews attempt to connect to a nearby water source,
• Attacks on EMS personnel while responding to a call,
• Hijacked and non-compliant buildings which pose safety risks, and
• Illegal electricity connections which become more dangerous when water is present.

EMS personnel also respond to rescue callouts such as responding to natural disasters, drownings, and rescue operations, as was done last week when three plumbers drowned in a sewerage manhole in Marshalltown. They make use of the same fleet of vehicles.

Mulaudzi says the teams have all undergone specialised training to become rescuers. “In seasons where flooding is not prevalent, they respond to fire and other incidents.”

“The rescue team is fully trained, operational, and has sufficient team members.”

Also read: Devastating fire causes extensive damage to Country Club Johannesburg

AMBULANCE SERVICES

In 2021 the provision of ambulance services was moved out of the City of Johannesburg’s control, with the Department of Health at the provincial level taking over.

“This was done to align the department with the National Treasury and to broaden the services. The move also provided more funding and resources which many cities were not coping with before the transition. It was a nationwide decision, not only for the City of Johannesburg,” says Motalatele Modiba, Gauteng Department of Health communications head.

He says since the change, patients are seeing improved service as all functions are now under one umbrella and can be co-ordinated more carefully.

“We have better response times and can reach more people than we could before. We are also working with municipalities to set up satellite offices in areas that were previously not covered.”

The move has been heavily criticised by the DA’s Shadow Minister for Health Jack Bloom and Michael Sun, a member of the Gauteng Provincial Legislature and former councillor in the City of Johannesburg.

Bloom says, “Public ambulances are notoriously badly run, and everyone is complaining about them. For Priority 1 calls, an 80% response rate within 15 minutes is the norm. Our teams don’t even meet 60% within 30 minutes which can cost people their lives.”

Sun said, “This change was a knock for the city’s first responders who were now largely unable to be of service at critical incidents. Disadvantaged communities are also waiting an unacceptable time if they need an ambulance.”

It was Blooms comments in particular that raised the ire of provincial heads in the Department of Health’s emergency services.

Acting CEO of Gauteng Emergency Medical Services Reuben Ruiters says, “We have a full fleet of ambulances and paramedics and other staff to run them to the highest standards and we take exception to people who speak untruths.”

It is a blatant lie that we are below par in responding to emergency calls

Ruiters speaks of the international standard called the ‘Golden Hour,’ a unit of time that is renowned as being the time within which medical interventions are needed to give a patient optimal chances of a positive outcome from a medical incident.

Info box: Response times

• Within 60 minutes 88% of calls have been attended to.
“There are urban and rural areas within the province, and problems like very bad road surfaces, remote houses, or delays in attending to people in dense informal settlements, all count against achieving a higher score.”
• Priority 1 calls (serious medical emergency): 30 minutes
• Priority 1 calls in rural areas: 40 minutes
• Interfacility patient transport: 30 minutes

In the last financial year the department attended to 980 000 calls

“Gauteng’s EMS services are the largest in the country which often sees us assisting neighbouring provinces,” Ruiters said.

Both Ruiters and Modiba spoke at length of some of the difficulties EMS personnel face – in particular, violence, theft, and intimidation.

“A call is placed asking for an ambulance to an odd place where the crew are robbed and items were stolen out of the ambulance or the ambulance hijacked.”

Health care and EMS staff cannot offer a service that costs them their lives

Ruiters said, “We have got to get the message out to our communities to help prevent these acts of violence. If we don’t do that – some areas will become no-go zones where paramedics will only enter with an armed police escort, which could delay treatment which is potentially life-threatening to the patient.”

HOSPITAL EMERGENCY DEPARTMENT

Emergencies often result in a victim needing to be transported to a hospital for urgent medical care. While healthcare is not in the control of the City of Johannesburg, as it falls under provincial responsibilities, it is nonetheless an important cog in the broader emergency services ambit.

The Helen Joseph emergency department is often where patients are taken.

Tom London, a broadcaster, recently found himself there for two nights and three days before he was taken up to a ward.

“I cannot complain about the clinical care I received in casualty, but the facilities were not great.”

There is only one toilet for the throngs of people waiting to be seen by a doctor or waiting to be sent up to a ward.

He describes being in the long queue to go to the toilet. Not being able to wait any longer and defecating on himself. “They sorted me out and I was in a ward that night.”

“There were so many sick people, and I was scared that the one toilet was somehow going to transfer germs or something to me. By 11:00 each day the toilet was an absolute mess and disgusting.”

London says he was quickly seen by a nurse who gave him oxygen, but it was a couple of hours before the doctor saw him. “This can be true too of private hospitals, so I am not complaining about that. The doctors in casualty were very good in my opinion.”

The hospital confirms that, “Severe emergencies will be dealt with by the resuscitation team immediately. Others will be seen initially at triage and then will wait their turn to be seen by a doctor. Not all patients who come in via ambulance are considered to be severe emergencies,” says Lethabo Mashile, assistant director of communications.

“The timing for when patients are seen depends on their triage score. In the case of severe emergencies, patients are seen within 3 minutes, less severe cases within 10 minutes, and others within 4 hours.”

London says, “It was so frustrating seeing people being taken up to the wards while I was languishing, but I have no way of knowing if it was because they were sicker than me or had been there longer than me – but the waiting was tough. After a few days, you saw others who had been there for a long time too.”

He slept on an examination bed or sat on the floor if the bed was needed for new patients. “There was no linen or pillows, but I did receive a blanket on the second night. I also had to ask for food on the second day and after a few hours something was given to me.”

“I had to remain in casualty for so long because there were no available beds in the ward.”

He says small things, ‘like providing more toilets and constantly cleaning them can change the patient’s experience and improve the staffs’ environment enormously, and I don’t know why it is not done’.

Mashile said when talking about beds in the ER, “An emergency department cannot predict how many patients will come in on any given day or at any given time. Also, there are times that patients are waiting to go to wards and these patients occupy the stretchers which may otherwise be used for new patients.

“Sometimes the number of critically ill patients exceeds the capacity of our resuscitation area, which has seven beds. In situations where we have more patients, and a new emergency arrives, our team will do whatever is necessary to provide care, even if that means treating a patient on the floor. This is a challenging situation, happening at least once a week, and can be described as a disaster scenario.”

The shortage of nurses

“The nursing gap continues to be a major challenge. Adding to this, the department is currently taking longer to fill vacant doctor positions. As doctors resign, permission needs to be granted by head office for replacing them, further reducing the staff available to care for and treat patients,” said Mashile.

Info Box: When asked what their biggest challenges were Mashile said:

• Staffing, as discussed above,
• Exit or access block, which occurs when there are not enough beds in the wards to admit patients, causing delays,
• Aggressive patients and family, which only hinder our ability to do our jobs and does not help anyone in the process,
• Aging infrastructure at the hospital, which frequently breaks down. We also face electricity outages, and now daily water challenges due to the citywide water issues, and
• Population growth of the increased drainage area has meant that the hospital serves a significantly larger population than what the hospital was built to serve. The number of beds available hasn’t grown accordingly and this contributes to the access block.

Mashile also said they regularly face verbal abuse from patients, and threats from family members over issues that are beyond their control. Despite all of these challenges, their team remains committed to providing care for those who need it most. Disgruntled voices are always the loudest and they treat thousands of patients successfully each month.

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