Motion of NO Confidence in the Pre-Hospital Board of Emergency Care with the HPCSA
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The implementation of "NEW" Clinical Management Guidelines will have detrimental effects on South African citizens. People involved in any medical emergency out of hospital will be receiving less life saving treatment and gold standard treatment as of the end of December 2018. The "new" guidelines by the HPCSA (PBEC) are taking away lifesaving skills from proficient emergency care personnel (1524 ANT Registered Paramedics) , and letting only a select group of providers (633 Registered BTECh Registered Paramedics) perform certain skills that has been historically initiated by the ANT Registered group. The current Pre-hospital Emergency workforce namely CCA and N.dip will be de-skilled/ able to do less for patients after December 2018 and be disenfranchised from an already hard industry to work in an the BAA, AEA & ECT workgroups will have no career progression unless they resign from full time employment and get accepted to do a ECP university based course for 4 years.
There are just not enough of the B.Tech Degree personnel to cover all the areas especially remote areas in South Africa- this is by no means picking a fight within the emergency care environment, it is all about numbers and doing things for the greater good and putting our patients first, as it is supposed to be.
There is a simple remedy that could have easily been applied, by initiating short course that would up-skill emergency care personnel or to train them in better ways of doing certain skills, thereby helping more patients in the pre-hospital setting. This would have lessened detrimental outcomes of critically ill and/or injured patients and keep the current workforce engaged and advocating for patients when they the patients could not advocate do for themselves.
Currently changes will take effect at the end of this year 2018. These amendments to the Advanced Life Support Paramedics CMG's will STOP them from being able to place definitive airways (ETI's), and stop career progression via short course, stop ALS Paramedics learning a safer option of Rapid Sequence Intubation that would only be available on the BTECH register.
A short course to make Rapid Sequence intubation available to all ALS Paramedics would remedy this and could be taught over a couple of days (Study has been done in Australia), EBM shows better outcomes of ETI's placed with safer pharmacological agents.
The skill of Intubation, has been historically done in the pre-hospital field in South Africa for more than 25 years. Rsi has been proven to be more effective and a safer option and could be trained within a couple of days to ALS paramedics as they have already mastered the skill and would be able to apply this skill with better pharmacological agents in a safer way in the field with evidence based backed outcomes.
The PBEC has ignored recommendations from past reviews in 2016 that identified shortcomings in CMG's that was based on South African conditions.
The HPCSA are de-skilling the proficient workforce and taking away lifesaving skills and knowledge (12 Lead ECG Interpretation, ETI just to name a few) without thinking about the wider consequences for the public especially in rural communities.
Short courses can be initiated to bridge the knowledge gap thereby saving more lives and lessen the burden of illness and post injury conditions due to sub-gold standard treatment, unless the Health Minister steps in and review the CMG's shortcomings against previous recommendations supplied to the PBEC.
The government and Health Minister should take sole responsibility for the consequences of these irresponsible pre-hospital clinical management guidelines that will increase mortality in patients.
The NDoH will be responsible for civil medico legal litigation, and the pre-hospital workforce will apply for protective strike action till stakeholders could remedy the irresponsible changes to the Pre-Hospital Clinical Management Guidelines that will place countless lives at risk and cause certain death and place a bigger strain on the South African Emergency Health Services and Allied Health Services.
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