Annexure A
REQUIREMENTS FOR EMERGENCY MEDICAL SERVICES
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| (a) | An Emergency Medical Service will operate in accordance with its licence, and the infrastructure shall be capable of supporting it over the period of its intended operation. |
| (b) | Emergency Medical Services must be registered to provide services within the following categories: |
| (i) | Intermediate life support; |
| (ii) | advanced life support; |
| (iii) | aeromedical service; |
| (iv) | event medical service; or |
| (v) | education institution Emergency Medical Service |
| (c) | Where such service requires in addition to provide medical rescue services, it shall ensure that it has personnel trained in accordance with courses approved by the Health Professions Council of South Africa, be in possession of the appropriate specialised rescue equipment and vehicles registered as Medical Rescue Vehicles in accordance with the National Road Traffic Act. |
| (d) | Event Medical Services and education institution Emergency Medical Services must adhere to the minimum requirements for either Intermediate Life Support or Advanced Life Support or Aeromedical Service and classified as such. |
| (a) | The service must be supervised by an Emergency Medical Service Manager who is qualified in at least Ambulance Emergency Assistant and registered with the Health Professions Council of South Africa. |
| (b) | The service must have a base or station that— |
| (i) | has rest facilities; and |
| (ii) | has permanent, plumbed, clean and hygienic ablution facilities. |
| (c) | There must be available, including a service level agreement with appropriate providers for such facilities— |
| (i) | dirty utility facilities with which to clean contaminated equipment and linen; and |
| (ii) | vehicle washing facilities which have the appropriate medical waste traps built in that comply with Local Municipal By-laws. |
| (d) | There must be an adequate medical waste management system and the Emergency Medical Service must have documentary proof available of a current agreement with a registered waste management disposal company or health establishment for the disposal of such medical waste. |
| (e) | Medical store room that complies with the requirements for the safe storage of medicines and pressurised vessels as per the relevant legislation. |
| (f) | The Emergency Medical Service must be registered in accordance with the appropriate legislation: |
| (i) | In the case of private sector services, the applicant must be registered as a company in terms of the Companies Act, 2008 (Act No. 71 of 2008); and with the Board of Healthcare Funders subsequent to being licensed and prior to commencement of practice; |
| (ii) | In the case of a Volunteer Emergency Medical Service the applicant must be registered as an entity incorporated not- for -profit, as well as a Public Benefit Organisation as per Non- Profit Organisation Act, 1997 and Income Tax Act, 1962 respectively. |
| (g) | Proof of liability insurance must be available for the said Emergency Medical Service, the amount of which must be determined by the type and size of service provision. |
| (h) | An Emergency Medical Service must operate according to the Ethical and Professional Rules of the Health Professions Council of South Africa and the Ethical Guidelines for good practice in the health care professions. The Responsible Person, Supervising Medical Practitioner and Emergency Service Manager must at all times be in good standing with the Health Professions Council of South Africa. |
| (a) | A minimum of two persons must staff an ambulance or medical rescue vehicle, and a minimum of one person must staff a medical response vehicle. |
| (b) | Personnel must be registered with the Health Professions Council of South Africa as determined by the level of service offered and must be as follows: |
| (1) | Personnel must be registered as a Basic Ambulance Assistant. |
| (ii) | Intermediate Life Support |
| (1) | The patient attendant must hold a minimum registration as an Ambulance Emergency Assistant or Emergency Care Assistant, whilst the second crew must hold a minimum registration of Basic Ambulance Assistant. |
| (iii) | Advanced Life Support - Ambulance |
| (1) | The patient attendant must hold a registration of Paramedic or Emergency Care Technician or Emergency Care Practitioner whilst the second crew must hold a minimum registration of Basic Ambulance Assistant, though it should preferably be a person holding a minimum registration of Ambulance Emergency Assistant or Emergency Care Assistant. |
| (c) | The crew of an ambulance, medical response unit or medical rescue unit must hold an appropriate valid driver's licence and, in the case of a patient carrying vehicle both the second crew as well as the patient attendant must also be in possession of a valid professional driving permit which must be in the category "Passengers". |
| (d) | All personnel must be dressed in appropriate uniform protective clothing, with their first name or initial, surname and registration category clearly depicted on the said clothing. |
| (e) | Emergency Care Personnel must at all times, remain in the company of the patient while he or she is in the care of the Emergency Medical Service or until hand over at a health establishment. |
| (f) | Emergency Care Personnel must not exceed the maximum working hours as per the regime of shift workers as guided by the Basic Conditions of Employment Act, 1997 and the applicable Public Service Regulations, 2001, as amended. |
| (4) | MINIMUM STAFF REQUIREMENTS |
| (a) | An Emergency Medical Service must employ the following, minimum number of operational staff members: |
| (1) | In a health district where the total population is more than 150 000 persons as described by Statistics South Africa in the most recently published "Census" report, an Emergency Medical Service licensed at Advanced Life Support level shall ensure that a Paramedic or Emergency Care Technician or Emergency Care Practitioner registered with the Health Professions Council of South Africa, is staffing at least one vehicle per operational shift at all times. |
| (2) | In a health district where the total population is less than or equal to 150 000 persons as described by Statistics South Africa in the most recently published "Census" report, an Advanced Life Support service should employ at least one registered Paramedic or Emergency Care Technician or Emergency Care Practitioner. |
| (ii) | Intermediate Life Support |
| (1) | An Emergency Medical Service should employ a minimum of one Ambulance Emergency Assistant or Emergency Care Assistant per ambulance licensed to the respective Emergency Medical Service at all times for all ambulances that are intended to be operated at intermediate life support level. |
| (2) | This must be in addition to the Emergency Medical Service Manager. |
| (iii) | Medical Response Vehicle |
While it is preferred that this vehicle is staffed by two members, it must be staffed with at least one staff member, who must hold a minimum registration of Ambulance Emergency Assistant with the Health Professions Council of South Africa.
| (1) | Both personnel must be registered with the Health Professions Council of South Africa and at least one of the personnel must hold a minimum registration of Ambulance Emergency Assistant. |
| (2) | In addition to this both personnel must hold a minimum qualification of Basic Medical Rescue or equivalent. |
The senior medical staff member on the air ambulance must be registered in the category of a Paramedicor Emergency Care Technician or Emergency Care Practitioner with the Health Professions Council of South Africa, who must hold valid CAT 138, Aviation Health Care Provider, Advanced Cardiac Life Support, Intermediate Trauma Life Support or Advanced Trauma Life Support and Paediatric Advanced Life Supporter equivalent certificates.
(vi) Second Staff Member on an Ambulance
| (1) | The minimum staffing requirement for the second staff member on an ambulance must be a person registered in at least the category of Basic Ambulance Assistant with the Health Professions Council of South Africa. |
| (1) | A nurse may assist a fully staffed ambulance with a minimum of two ambulance crew members that are registered at a minimum level of Basic Ambulance Assistant. |
| (2) | The nurse must not be considered to be one of the two staff members required to staff the ambulance, unless the nurse in question holds dual registration with both the Health Professions Council of South Africa as well as South African Nursing Council (SANG). |
| (viii) | Supervising Medical Practitioner |
| (1) | One supervising Medical Practitioner with suitable emergency medical qualifications and experience must be appointed to or contracted by the service in a supervisory clinical capacity for each health district in which it operates. |
| (2) | The supervising Medical Practitioner must be registered with the Health Professions Council of South Africa in terms of the Health Professions Act . |
| (3) | The supervising Medical Practitioner must not be contracted to more than three Emergency Medical Services simultaneously. |
| (4) | The supervising Medical Practitioner is regularly consulted by Emergency Care Personnel as and when required. |
| (5) | The Emergency Medical Service must hold a current, written, service level agreement with the supervising medical practitioner that confirms that the supervising medical practitioner is available to assist with clinical governance, medical advice as well as supervision and training, where necessary. |
| (a) | All Emergency Medical Service vehicles utilised must comply with the National Road Traffic Act or the relevant vehicle registration and safety legislation, as applicable. |
| (i) | be configured in such a way that the medical personnel have complete access to a patient in order to begin and maintain life support; |
| (ii) | be fitted with a two way radio or cellular communication system or a combination thereof which allows for communication at all times with the dispatch centre; |
| (iii) | be fitted with red warning lights that must be visible from the front, rear and both sides of the vehicle at all times, and siren in accordance with the relevant vehicle registration and safety legislation; |
| (iv) | display the word "Ambulance" on the front and rear of all ambulances and must adhere to the following minimum dimensions: 600mm X 150mm; or large as possible proportionate to make of the vehicle. |
| (v) | be configured in such a way that the interior of the patient compartment, excluding the driver's cab section, must be a minimum of— |
| (vi) | be configured in such a way that adequate, permanently installed lighting is provided in the patient compartment; |
| (vii) | have installed within the ambulance a minimum of a 2 000 watt electrical inverter, capable of providing a 220 volt power supply to the patient treatment compartment of the vehicle; |
| (viii) | have an adequate entry that allows for the loading and off-loading of the patient without compromising the condition of the patient; |
| (ix) | be configured in such a way that a patient can be carried in the supine position with specialised medical equipment fitted; |
| (x) | have an approved restraining device fitted for all patients and emergency care personnel; |
| (xi) | have a stretcher restrained with a restraining device, approved by the manufacturer of the stretcher, which shall be permanently fitted to the vehicle and shall restrain both the front and rear of the stretcher; |
| (xii) | have a stretcher that is secured in such a way that it allows medical personnel clear view of, and access to, the patient and specialised medical equipment; |
| (xiii) | have a stretcher that is fitted in such a way that it does not block the entry or emergency exits of the vehicle; |
| (xiv) | have a stretcher that is fitted in such a way that it does not block access to the airway of the patient and in such a way that the performance of advanced airway techniques will not be hindered; |
| (xv) | be configured in such a way that medical equipment and medical gas cylinders are secured in brackets that are attached to the body of the vehicle and do not allow any vertical or horizontal movement of the medical equipment or medical gas cylinders within the compartment of the ambulance; |
| (xvi) | be configured in such a way that medical equipment and medical gas cylinders are fitted in such a way that they do not obstruct the entry or emergency exits of the vehicle or pose a potential threat to personnel or patients; |
| (xvii) | have medical gas cylinders and outlets marked in accordance with SANS Codes of Practice and that have been subjected to visual and hydrostatic inspection by a Department of Labour approved testing facility; |
| (xviii) | have an adequate supply of convenient hanging devices that are fitted for intravenous therapy - such must be fitted in such a way as not to inflict injury to patients or medical personnel; |
| (xix) | have a patient compartment that is lined with a non -porous material to avoid blood and other body fluids from contaminating the area, and allows for the cleaning of the compartment; |
| (xx) | have surfaces and equipment within the ambulance free from the visible appearance of any and all contaminants including but not limited to: dust, dirt, blood, faeces, urine, vomit, human tissue or any other bodily fluid; |
| (xxi) | have a patient compartment separated from the driver compartment in such a way that the patient, treatment of the patient, and actions of the patient must in no way interfere with the driving of the vehicle; |
| (xxii) | in the case of a vehicle with a gross vehicle mass which exceeds 3 500kg, be fitted with retro- reflective red and retro- reflective yellow chevron strips on the rear of the vehicle, as required by the National Road Traffic Act; |
| (xxiii) | in the case of a vehicle with a gross vehicle mass which exceeds 3 500kg, be fitted with yellow, retro- reflective strips to both the sides of the vehicle as well as the rear of the vehicle, in addition to the chevron, which must be fitted no more than 600mm from the lower part of the body of such vehicle, as required by the National Road Traffic Act; |
| (c) | The number of emergency medical response vehicles registered to an Emergency Medical Service may not exceed the number of ambulances registered to that Emergency Medical Services unless there is a service level agreement with an accredited Emergency Medical Service. The accreditation requirements of the contracted party will also be reviewed to ensure compliance with these Regulations. |
| (d) | The vehicles included on the licence for the Emergency Medical Service must be listed as being owned by the applicant of an Emergency Medical Service and registered in the category "Owner" on the "Certificate of Registration" as per the National Road Traffic Actor other relevant vehicle registration and safety legislation. |
| (e) | Volunteer Emergency Medical Service registered as an entity incorporated not-for-profit, as well as a Public Benefit Organisation as per the Non-Profit Organisation Act, 1997 and the Income Tax Act, 1962 respectively, are permitted to register a maximum of three (3) medical response vehicles. |
| (f) | Each vehicle operated as an ambulance, medical response vehicle or medical rescue vehicle must be clearly marked, licensed, registered as per the National Road Traffic Actor relevant vehicle registration and safety legislation and in accordance with nationally approved livery. |
| (g) | Livery that is not reflective of the functions of an emergency medical service will not be approved. |
| (6) | EMERGENCY TELEPHONE NUMBER |
| (a) | Every emergency vehicle operated by the emergency medical service must display the emergency telephone number of the respective ambulance service on the rear and both sides of the respective emergency vehicle. |
| (a) | All ambulances, medical response vehicles and medical rescue vehicles operated by the Emergency Medical Services must display a valid licence token in a prominent position on the windscreen of the ambulance where it is easy to view in terms of the National Road Traffic Act. |
| (a) | In the case of an aero-medical service, the aircraft operator must hold the appropriate G7 licence and CATS /Part 138 accreditation as specified by the Civil Aviation Authority of South Africa. |
| (a) | All Emergency Medical Services must have an appropriate communication system that allows for easy communication between the station and vehicles. |
| (a) | All Emergency Medical Services must have an appropriate complaints mechanism that aligns with the National Complaints Management Protocol for the Public Health Sector of South Africa, 2014 the details of which must be made available to Emergency Medical Service users, including by the clearly visible posting of such details in each vehicle and at each Emergency Medical Service station. |
| (a) | All ambulances, medical response vehicles and medical rescue vehicles must have, as a minimum, the equipment as listed in Annexure B. |
