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Emergency medical response in Zimbabwe — A Hifa perspective

Those living here and visitors to southern Africa and in particular Zimbabwe are often concerned as regards the standards of health care and emergency services available to assist them in the event that they are taken seriously ill or are injured while working  in or visiting the country.

Zimbabwe, despite several difficult years in so far as the economic downturn is concerned, is still fortunate to have one of the best developed private Emergency Medical Service (EMS) systems on the continent. This availability of air and road evacuation capabilities has for many years provided peace of mind to resident, tourists, and professionals visiting Zimbabwe. However, even the best systems worldwide have limitations and it is important to be  aware of these when visiting or travelling in the region.

Private EMS in Zimbabwe is provided primarily by two services, Emergency Medical Rescue Ambulance Services (Emras) a part of the Premier Service Medical Investments health care group being one of the largest. This service has been in existence for many years and therefore has a wealth of knowledge and experience in the area of road and aero medical evacuation in Zimbabwe and the region. While headquartered in Harare, the capital city, Emras operates bases in all major centres throughout Zimbabwe specifically Bulawayo, Zimbabwe’s second largest city, Gweru, Mutare, Kwekwe and Masvingo. The service provides ground ambulances available to respond in urban centres and also to undertake long range road ambulance transfers. Ambulances are fully equipped with oxygen, airway management equipment, IV fluids, emergency drugs, full spinal immobilisation equipment, splints, patient monitors, defibrillators and where required transport ventilators thereby providing advanced life support  care when necessary.

Emras employs registered ambulance technicians, emergency medical technicians, registered general nurses, many of whom have  advanced cardiac life support training and they have doctors on call to effect air evacuations or assist on long-range calls.

Bases operate 24 hours a day and control rooms are manned by dispatchers who will take your call and dispatch ambulances as necessary.
For those travelling outside Harare during or after Hifa Emras has a fixed wing aeromedical capability with aircraft and pilots on standby to effect evacuations. A  range of aircraft are available with Emras currently utilising a  King Air 90 while it has access to a Cessna 402, Navajos and Cessna Caravan all ideally suited to accessing short bush strips as well as longer regional flights.

Aircraft are configured as air ambulances and provide ALS levels of care. The normal crew comprises a doctor and a flight nurse all of whom are ACLS or ICU-trained. Aircraft are based in Harare but most destinations in the country can be accessed within 45 minutes to an hour of takeoff.

To access the service it is essential for visitors to the country to have a good international health assistance scheme which includes evacuation cover and hospitalisation in emergencies. In the normal course of events private services will require this information and are usually required, in terms of the policies to seek authorisation from the insurer prior to effecting an evacuation. It is advisable, particularly if visiting more remote areas to carry a well stocked  first aid kit.  Factors which may delay an air evacuation  are time of day and weather. During the rainy season some smaller dirt strips may become inaccessible. Also pilots may be reluctant to fly into strips at night if they are unfamiliar with the strip and it is not adequately lit. Immediate and effective first aid is therefore essential. Where possible in remote areas it is advisable to transport a casualty, depending on injuries, to the nearest medical facility.Even a rural hospital or health centre, while  basic may be able to provide some assistance while awaiting evacuation. Movement of suspected spinal injuries however is not advisable without adequate immobilisation.

In an emergency be guided by the teams coordinating the evacuation they will do all they can to assist and advise you and they know the local conditions constraints and facilities better than you do. Remember, they are there to assist you but they themselves may be facing challenges if weather conditions for example, preclude on air evacuation. Assist them by providing as much information regarding the nature of injury or illness to enable them to make informed decisions regarding evacuation and further management.

Most casualties will be evacuated to Harare in the first instance. There are several reasonably good private hospitals in the capital but a good international assistance is essential to gain admission. If the patient’s condition is such that further intervention, not available locally is required Johannesburg in South Africa is only an hour and half away by air and Emras will coordinate and effect these transfers where necessary.

While parts of Africa can be remote and potentially dangerous if an acute illness or injury occurs with infrastructure available in Zimbabwe in terms of private EMS response a lot can done to mitigate against such dangers. Limitations however do exist and prior planning and preparations on the part of visitors is therefore essential if tragedies are to be avoided.

Craige E. Turner is general manager of PSMI Emras. He is a registered general nurse and ambulance technician with a diploma in health teaching. He has over thirty years experience in the field prehospital care in Zimbabwe and the region.

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