''We're kind of screwed'': perspectives of emergency medical workers on the Western Cape EMS system
Date
2014-11-05
Authors
Pelzer, Juanita L
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Abstract
The World Health Organization honours Emergency Medical Service (EMS) systems as a
vital part of any effective health care system and as such, it remains an important topic for
research. Literature on South African EMS systems is limited and thus a need exists to better
understand South African EMS systems. The aim of this study was to explore the perspectives
of Emergency Medical Workers (EMWs) on the Western Cape provincial EMS system. In
addition, the study aimed to uncover the insights of the EMWs into the daily operations,
struggles, communication and interactions within the EMS system. Obtaining these insights
were thought to be important since South African EMWs face multiple challenges in their
occupations, such as burnout, critical incident exposure, occupational stress and so forth. In
part, these challenges are a result of the effect that the country’s political history of
Apartheid has had on EMS, as well as the current burden of inequality, poverty, poor
infrastructure, multiple communicable diseases (such as HIV/AIDS and Tuberculosis) and
the high rate of trauma and violence. In order to meet the aims of this study, a qualitative
paradigm with open, unrestrictive methods was employed. Three semi-structured focus group
discussion (consisting of four, four and six EMWs respectively) were conducted. The analysis
was inductive or data-driven and specifically involved a thematic analysis, combined with a
matrix and saliency analysis. This open, inductive approach was not only appropriate to the
explorative nature of the study, but also allowed for new and unique insights to emerge. The
analysis firstly revealed that the EMWs perceived the EMS to be a complex, interdependent
system that is hierarchically organized and politically influenced. In addition, the EMWs
perceived themselves to be at the bottom of this hierarchy, yet they also placed emphasis on
the expertise and prestige associated with their occupation. As such, they seem to have a dual
identity and position within the EMS system. Secondly, by exploring the EMWs’ perceptions
of and interactions with the other role-players in the EMS system (call-takers, dispatchers
and management) it was found that communication plays a vital role within the EMS system
and permeates the system in both a broader and more subtle way than initially postulated by
previous research. The EMWs also indicated that they wanted the other role-players in the
EMS system to experience and better understand their day-to-day tasks and struggles.
Thirdly, the EMWs revealed how they are passionate about and dedicated to their jobs and
that their first priority is to provide quality care to the patient. Yet they also raised some
concerns around how the occupation has potential adverse effects on their physical and
psychological well-being. Finally, it was found that the EMWs faced many daily struggles
and obstacles, of which finding the correct location of the incident and getting to the scene of
the incident within their time targets was a major concern. Overall the EMWs that the issues
that cause a lot of aggravation and distress for them are actually those minor aspects which
are often overlooked by the management of the EMS. In other words, for the EMWs, the devil
lies in the details. To conclude, this research yielded unique and new insights into a South
African EMS system and into the occupation of the EMWs. These results serve as an
important exploratory step from which further research in this area may be extended and it
also has the potential to generate interventions for improving the working environments and
job satisfaction of EMWs and as such may have an impact on the efficiency of the EMS
systems in general.
Keywords: Emergency Medical Workers, Emergency Medical Services, South Africa,
Teamwork, Hierarchies in Emergency Medical Services, Communication, Work Engagement,
Identity of Emergency Medical Workers, Coping Mechanisms, Political influences on Public
Health.
Description
Submitted in fulfilment of the requirements for the degree of
Masters of Arts in Research Psychology
At the
University of the Witwatersrand
April 2014