1. In the EMS Communication Centre, I have learnt that it is important to obtain the following information from the caller; the name and the contact number of the caller, the location of the incident, this include; the street name, house, building or office number, the suburb and the landmark of the location. The nature of the incident must also be obtained from the caller, the description of the incident; the caller should be interrogated according to the Medical Priority Dispatch System (MPDS) protocol. And lastly the call taker should allocate priority to the incident of the caller. This information is important for the dispatchers and for the emergency responders as well, the dispatchers use the information gathered by the caller takers to dispatch the emergency responders, but the information is mostly important to the responders because they are the ones who uses the information; they use the address of the caller to locate the patient that they need to attend, they can use the callers contact number to call them back when they get lost on the way to the patient. The nature and the description of the incident is also important because it prepares the responders on what they should expect when they get to the patient and to bring enough equipment to serve the needs of the patient.
2. The EMS service uniform policy, according to the Standard Operations Procedures 2012 of the Emergency Medical Services; their uniform must be worn by all ranks, their uniform display a visibility of competence, accountability, integrity and responsiveness. The operational personnel uniform that is being issued by the employer include; a long medical green cotton shirt or a short-sleeved shirt, it must have two breast pockets and epaulettes. Medial green utility pants and they should not be faded. Black leather ankle boots with rubber sole. All weather jacket, the jacket should be lime green with medical shouldersand lower sleeves, it must have a reflective tape of at least 50mm wide around the chest, upper arm and on the waist, the back of the jacket should have a reflective label of the words ‘Medical’, and the material of the jacket must be breathable, water resistant and non-fading. A black leather belt, navy blue woolen socks. Long sleeved jersey or waist jacket style in medical green with shoulder epaulettes. Reflective vest that is prescribed as reflective utility jacket. A white helmet is required for all clinical ranks that have the qualification as appropriate on both sides of the helmet in letters of 50mm of height. The Doctors should wear a medical green helmet. The peak cap and the beanie must medical green in color and must have the Metro EMS badge on the front of the peak cap and the beanie, and the badge should be clearly visible. The South African flag should be worn on the left sleeve of every shirt and the dimension should be 70mm x 50mm. The name tag or the label must have one initial and the surname of the individual and should be worn above the left breast pocket on every shirt, jersey or jacket, this should be issued once the design has been confirmed. The reason for a name tag is that the patient has the right to be treated by a named health care practitioner. The letters on the name tag should be a minimum of 15mm high and 10mm wide and the letters should be white in color on a navy-blue background. Qualification tag or label should be worn above the right breast pocket as ALS, ILS, BLS and Medical Rescue Technician, the letters should also be white on a navy-blue background. The name and the qualification should be displayed on the right breast of the jackets. Service insignia; the qualification badge or patches should be worn on the upper right sleeve. Jewelry; for safety reasons, jewelry is restricted to a watch and wedding bands, Medic Alert bracelets are permitted, earing studs may be worn in the ears only and by females only. Hair; both for males and females, hair must be neat, for safety reasons; long hair must be tied up, for males; beards must be close shaven.
3. Nursing Assistant: they perform personal hygiene care for patients (cleaning and bathing), helping patients use the toilet and dress, repositioning patients to prevent bed sores, assisting with transition from bed to wheelchair, relaying information to nurses, checking vital signs and serving meals and helping patients eat.
Certified Nursing Assistant: they are responsible for taking vital signs on a regular basis, which includes blood pressure and temperature, charting vital signs and other information, rendering assistance with personal hygiene performance such as bathing or showering, repositioning the patient on a regular basis to prevent the development of bed sores and performing range of motion exercises with patients with limited mobility
Hierarchy of Nursing Professionals: these are licensed practical nurses, they collect information on patient history with appropriate charting, perform wound cleaning, care and changing of dressings, inserting catheters and performing catheter care.
Registered Nurse: they are medical professionals who have received advanced education and training in the field of nursing and have passed a nursing exam to become licensed. They take detailed patient medical history, administer medication orally, by syringe or through an IV, starting intravenous drips (IVs), charting changes in patient’s medical condition, consulting with and making recommendations to the primary physician, operating specialized medical equipment such as monitors, provide other medical care to patient as deemed necessary and educating patient and family members about management of medical condition after patient returns home.
Nurse Practitioner: they are responsible for making medical diagnoses of illness, providing childhood vaccinations, conducting healthcare physicals, performing certain surgical procedures, developing treatment plan for illness, ordering lab work such as x-rays and blood work and prescribing certain medications.
Certified Nurse-Midwife: they perform physical exams and prescribing medication, ordering lab tests, giving prenatal care, assisting mothers during labor and delivery of births that are low risk and providing education and medical care after birth as necessary.
Certified Registered Nurse Anesthetists: they
take detailed health history from patient prior to surgery, administer anesthesia during surgery, ensure that patient handles anesthesia well during surgery and checking patient after surgery.
Doctor of Nursing Practice: they are doctoral degree designed to prepare nursing professionals to perform more responsibilities within their job, making diagnoses in certain circumstances and setting up a course of treatment for patients.
4. A Registrar works in a hospital or medical clinic and spends his or her days registering patients. The forms must be explained, taking payment for appointments, and collecting demographic and health history information.
A Medical officer is a doctor in charge of the health services of a civilian or military authority or other organization.
An intern is a student or trainee who works, sometimes without pay, to gain work experience or satisfy requirements for a qualification.
A specialist is a person who concentrates primarily on a subject or activity; a person highly skilled in a specific and restricted field.
5. The Maroon epaulette and Council badge worn by a Registered General Nurse. The navy-blue epaulette and Council badge worn by a Registered Psychiatric Nurse. The dark Saxe blue epaulette and Council badge worn by a Registered Mental Nurse. The light Saxe blue epaulette and Council badge worn by a Registered Nurse for Mental Defectives. The yellow epaulette and Council badge are worn by a Registered Fever Nurse. The mauve epaulette and Council badge worn by a Registered Sick Children’s Nurse. The green epaulette and Council badge worn by a Registered Midwife or Accoucheur. Registered nurse, midwife or accoucheur may be registered in more than one category. In such h cases, he /she must wear the specific color epaulettes prescribed in the regulations for such persons. One or more of the following colored bars must be attached to the prescribed epaulettes: the navy-blue bar worn if the person is also a Registered Psychiatric Nurse. The dark Saxe blue bar worn if the person is also a Registered Mental Nurse. The light Saxe blue bar worn if the person is also a Registered Nurse for Mental Defectives. The green bar worn if the person is also a Registered Midwife / Accoucheur. The white bar worn if the person is a Tutor (holds a qualification in Nursing Education). The silver bar worn if the person holds a qualification in Nursing Administration. The yellow bar worn if the person holds a qualification in Public Health Nursing (Community Nursing Science). The Fever and Sick Children’s Nurses have no prescribed bars. The examples of the unique devices that are worn by a Registered Nurse (General, Psychiatric and Community) and Registered Midwife: Registered General Nurse wear maroon epaulette and Council Badge, Registered Psychiatric Nurse wear Navy blue bar, Registered Midwife wear Green bar, Qualification in Community Nursing Science wear Yellow bar. The Distinguishing Devices for Enrolled Nurses and Enrolled Midwives: The white epaulette and maroon badge worn by an Enrolled Nurse. The white epaulette and green badge worn by an Enrolled Midwife. The white epaulette and half maroon / half green badge worn by a person who is both an Enrolled Nurse and an Enrolled Midwife. The brooch worn by an Enrolled Nursing Auxiliary.
6. Level 1 – District hospitals there are limited specialist services. District hospitals are categorized into small, medium and large district hospitals with the following number of beds: small district hospitals with no less than 50 beds and no more than 150 beds; medium size district hospitals with more than 150 beds and no more than 300 beds; and large district hospitals with no less than 300 beds and no more than 600 beds.
District hospital must help a defined population in a health district and support primary health care; deliver a district hospital package of care on a 24-hour basis; have general practitioners and clinical nurse practitioner’s primary health services; provide services that include in-patient, ambulatory health services as well as emergency health services; and where practical, provide training for health care service providers. District hospital receives outreach and support from general specialists based at regional hospitals. District hospital only provide the following specialist services; pediatric health services; obstetrics and gynecology; internal medicine; general surgery; family physician. Eerste River District Hospital is an example.
Level 2 – regional hospitals which have at least two specialist services. A regional hospital must, on a 24-hour basis, provide health services in the fields of internal medicine, pediatrics, obstetrics and gynecology, and general surgery. health services in at least one of the following specialties: orthopedic surgery; psychiatry; anesthetic; diagnostic radiology; trauma and emergency services; short term ventilation in a critical care unit; services to a definite regional drainage population, limited to provincial boundaries and receives referrals from several district hospitals; and where practical, provide training for health care service providers. The regional hospital receives outreach and support from tertiary hospitals. A regional hospital has between 200 and 800 beds. Khayelitsha District Hospital is an example.
Level 3 – academic hospitals which have most specialist services. A tertiary or academic hospital provides specialist level services provided by regional hospitals; provides intensive care services under the supervision of a specialist or specialist intensivist; may provide training for health care service providers; receives referrals from regional hospitals not limited to provincial boundaries; and has between 400 and 800 beds namely Groote Schuur, Red Cross and Tygerberg hospitals.
7. Hemorrhage: antepartum, intrapartum or postpartum
Complications of abortion
8. In the EMS service the procedure that needs to be followed when an individual sustains a needle prick injury is as follows; the injured individual is encouraged to squeeze the injured site manually until it bleeds, the injured area must be washed with normal saline, soap or spirits. The injured individual must inform the communication Centre officer immediately. The operational shift manager must immediately bring the post exposure prophylaxis to the scene, the post prophylaxis must be taken within one to two hours of the incident. The individual must report the incident at the hospital and obtain medicines and treatment from the medical staff that is on duty. In cases of rural ambulances whereby the officer may not be able to reach the staff member on time, the PEP check should be carried with on the ambulance. The PEP pack must be stored in a container that protects it from heat.
If the patient is conscious, he/she must be informed of the incident and ask the patients status with respect. The blood sample of the source patient must be taken, but consent must be given by the patient. Blood specimen should be taken by the competent individual and be collected in appropriate receptacle. In the case of a medical case whereby a needle stick injury has occurred, the paramedic or officer on scene must be informed. Permission should be requested from the family members for the blood specimens to be taken. When the individual is unsure of the needle prick, the medical officer should be contacted for advice or transport the patient continuing CPR.
In the case of CPR whereby a needlestick injury has occurred, consent must be obtained from the family for blood specimen. If a family member is not available, then the health care provider should contact the OHS manager or the medic on call. The pathologist that is conducting the post mortem must be reachable to contact the family member to ask for consent to obtain blood specimen. The exposed individual must complete the exposure and WCL 2 forms. For the Metropole, the blood specimen of the source patient and the forms must be taken to GSH staff support clinic or TBH hospital staff clinic during office hours, after hours the individual must report to the GSH or TBH trauma units.
For rural, the blood of the source patient must be taken to the government hospital in the district.
The exposure forms are to be completed and given to the officer after the shift and sent to the Occupational Health and Safety Coordinator. The staff member injured must go for a follow up in 3 months, 6 months and 9 months.