International Perspectives: South African Ambulance Services in 2020

Abstract

Prior to 1980, ambulance services in South Africa were almost solely rendered by public sector emergency services. Levels of care and associated training differed between regions and provinces. There was little or no recognition for emergency care providers as independent healthcare professionals. Consequently, working on an ambulance was often seen as an “unwanted” add-on or adjunct to a more formally recognised primary role of municipal traffic officer, firefighter or civil defence volunteer. The lack of professional recognition and standing was in part as a result of an absence of formal higher education qualifications in emergency medical care at that time. Emergency care training which did occur was in-service and largely “skills based,” taking the form of short courses which ranged from only a few weeks to months. Post 1994, service delivery failures of an under-resourced public sector resulted in the emergence and rapid expansion of private ambulance services. Since the mid-nineties we have seen the South African emergency care profession begin to professionalise. The professionalization of ambulance services has been characterised by a gradual movement away from the historical “doctor-driven” technician system of the 1980s toward a separate self-regulated autonomous stand-alone profession. Emergency care practitioners now able to register and function as independent clinicians / practitioners and the historical short-course training system is in the process of being phased out in favour of formal 1-, 2- and 4-year higher education qualifications. Consequently, in South Africa the responsibility for clinical decision-making, interrogation, critique and development of prehospital medical protocol and direction is now largely driven and owned by South African paramedics themselves.