Most people see paramedics as angels of mercy — but some have been accused of racing like tow-truck drivers to get to an accident scene before the competition.
One paramedic has already died on the way to an accident, with observers alleging that she was racing another company to get to the scene first.
This has raised concern over what appears to be increased competition between the two main private ambulance companies, Netcare911 and ER24, owned by the country’s largest hospital groups.
Although the paramedic died and her colleague was seriously injured while negotiating a bend in wet weather, Johannesburg’s emergency services spokesperson Malcolm Midgley said witnesses later said she had been racing to beat the opposition to the scene.
”I have trained emergency workers and I always tell them you don’t kill yourself on the way to an emergency,” he said.
Dubbing it ”sirenicide”, Midgley believes the race is an increasing risk to other road users, and causes traffic congestion. He fears that private companies are taking control of accident scenes away from provincial emergency services.
Although it is agreed that the most highly qualified paramedic will take care of patients, overall control still rests with provincial services. Midgley said that there have been recent occasions when the provincial authorities were not notified of an emergency at all.
Private ambulance workers in KwaZulu-Natal have come to blows with provincial staff in arguments over which facility patients should go to, or even whether they require medical care at all.
”I get calls from journalists saying ‘there’s a huge accident, there’s loads of emergency vehicles’,” said Midgley. ”I investigate and it turns out it’s minor but all three emergency services are there, each with a response car and an ambulance — Netcare911, ER24 and the provincial services. Then there’s the fire engine … two Metro police vehicles to do scene control, the SAPS [South African Police Service], and thrown into the cavalcade are the tow-truck drivers.
”All those vehicles rushing to the scene increases the risk of another accident on the way. Most people don’t know what to do when they hear a siren,” said Midgley, who himself was hit as he nosed into an intersection, sirens wailing, on the way to an incident.
Johannesburg hospital’s Professor Ken Boffard said the rushing is unnecessary as a controlled experiment has proved that the time difference between ambulances racing across town with sirens and lights and another driving at normal speed is just one minute.
”Many medical aids and short-term insurance policies offer free ambulance cover to get to hospital. Racing around makes the private companies visible,” Boffard said.
”They say they will respond to anything, anywhere, anytime — it’s good marketing to be seen racing around.”
Both companies deny that they race to the scene purely for financial gain, with Netcare911 saying it wrote off R39-million last year and posted an operating loss of R32,5-million, and ER24 saying it was ”kind of” making ends meet.
Both said that once they receive a call they have an ethical and moral obligation to respond, regardless of whether the person patient has cover.
At accident scenes emergency workers try to find proof of a medical aid to determine which hospital the patient will go to and who will pay. Private costs range from between R500 to R1 500 for basic life support, or a R240 starting cost for a provincial ambulance.
Whether a patient can pay or not, by law, whoever is there first must provide treatment and transport a patient to the nearest facility, said Shaughan Jackson, assistant director of the Gauteng health department’s emergency management services.
They are also obliged to inform a conscious patient of private costs if they opt for a private service. Patients cannot be forced to pay for a private service if they had not called them out.
”And if they leave the scene and a patient dies, they will be liable for that death,” Jackson said.
However, while the private companies maintain that they are not making profits for their holding companies — Netcare911 for Netcare Healthcare Holdings (which had a R6-billion turnover last year) and ER24 for MediClinic — the possibilities of getting reimbursed are varied.
Some medical aids like Discovery Health service individual claims based on set tariffs, while others — like the 32 medical aids administered by Medscheme — pay a R4 to R5 per member per month capitation fee to Netcare911 for blanket cover for all their members.
Even though many people do not have a medical aid, some do have ambulance cover through other products such as Edgars Club, the Automobile Association, some security companies, people who have bought a new Ford or Mazda and even Cell-C subscribers.
In qualifying cases there is also the possibility of a claim to the Road Accident Fund.
Although Netcare911 has negotiated most of the free ambulance cover deals, chief operating officer Trevor Glass said this does not improve its chances of payment at a scene as people who can afford their products fall into a very defined income group.
ER24’s chief executive officer, Andrew Bowden, said that when it entered the market there were ”a couple of tense moments” but now its relationship with rival Netcare911 is ”superb”.
The company, owned by MediClinic and Afrox, says it also assists provincial services with maternity calls to townships.
”At a big accident there is no way just one company can cope,” Bowden said.
This was confirmed by Campbell MacFarlane, professor of emergency medicine at the University of the Witwatersrand.
”The public service is in overload constantly and [the private services] are not, so they can respond more quickly. They do assist the public service and they will sometimes deliver people to a public hospital. It’s a nice collaboration.”
Although it was Bowden’s company that the ill-fated young paramedic and the paramedics in two subsequent non-fatal accidents worked for, he denied instructing employees to make sure they get to a scene first.
”If a staff member breaks a driving code, disciplinary procedures follow immediately,” he said.
Both companies also deny allegations that they break the law by driving past the closest facility to take patients to their holding companies’ hospitals.
However, Netcare911 was recently the catalyst for an urgent meeting between private ambulance representatives and the KwaZulu-Natal health department following allegations that patients had been taken from a provincial facility to a private one.
The provincial health department refused to provide details, other than to confirm a removal and that there had been fisticuffs between provincial and private staff. Glass ”would not confirm or deny” the allegation, and both parties say the matter has been resolved.
Both private and provincial services say the reason they race to an accident scene is often because witnesses call all the ambulance groups ”just in case”, and operators are not given accurate details, resulting in many ”emergencies” turning out to be minor matters.
Midgley confirmed this, and urged the public to provide as many details as possible when reporting an emergency and to notify 10177 of an emergency.
A single control room handling calls to both private and provincial ambulances has been suggested but, said Midgley, it is unlikely that competing companies will agree to this.
He urged ambulance companies to give provincial authorities a ”courtesy call” to notify them that they too are on the way to a scene.
But, said Boffard, although there are risks and controversies, patients gain from the apparent competition.
”If anything, the greatest danger is too much expertise,” he quipped. — Sapa