Failing emergency medical services.

Failing emergency medical services To the Editor: I refer to the scientific letter entitled ‘Emergency centres lack defibrillator knowledge’.1 I am a recently retired UK accident and emergency consultant who is now attempting to plough back knowledge gained in the discipline of emergency medicine (EM) and trauma to peripheral hospitals in the Western Cape and KwaZulu-Natal (KZN) under the umbrella of Outreach. This includes ward rounds, clinics, shop-floor teaching, checking and demonstrating equipment (defibrillators, ventilators, monitors) pertinent to emergency departments (EDs), and most importantly demonstrating correct drug usage to doctors and nurses. In KZN many doctors are foreign qualified and poorly taught in emergency medicine. In the Western Cape I have personally taught at 33 central, district and regional hospitals, where most departments are now well equipped and well laid out, with enthusiastic doctors and nurses. This is in sharp contrast to the 26 similar hospitals in KZN where I have taught (the exception is Ngwelezana Hospital, overseen by an accredited EM specialist). The EDs in most KZN peripheral hospitals were failed by the FIFA-accredited doctors, with reports submitted to head office indicating no improvement in equipment or drugs. Nonfunctioning ECGs, ventilators, monitors or defibrillators were found at 80% of these hospitals. So how can we improve on this diabolical situation, knowing how poorly Outreach EM is taught in South Africa? This is a fact bemoaned by many of these doctors and nurses. On completion of these hospital visits a proforma developed by the Western Cape is given to the hospital manager and submitted to head office highlighting deficiencies and making recommendations. At the same time we hand out EM protocols and ACLS, ATLS and PALS updates. Thirty years ago Professor Coen van der Merwe, Mr Alan White and myself were instrumental in setting up the Dip PEC to address the problem of EM in peripheral areas. At the same time Trauma, the EM journal, was started. Little or no help is forthcoming from the very departments that are well established. The fine line between life and death can often be defined by where an accident or medical event occurs. The more fortunate may be successfully treated at an ED with fully trained medical and nursing staff in a properly equipped unit. Otherwise, living medical problems may become dead certainties if we do not address these problems appropriately.