''We're kind of screwed'': perspectives of emergency medical workers on the Western Cape EMS system

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.