Being a professional paramedic comes with risk.

Sick people aren’t always in the leafy suburbs, but medics are still required to assist even in the most dangerous areas. According to ER24 General Manager of Quality and Support Services Peter Van Der Spuy, these type of risks were identified in 1988, during a volatile period in South Africa. Van Der Spuy was one of the main people to create a training programme for paramedics that would teach them to react swiftly and decisively in volatile situations. It worked well, but as things simmered down in the country post the 1994 elections, the programme fell by the wayside and eventually stopped completely for many years. But in 2013, in the wake of an increase in crime and ambulance robberies, attacks on staff, theft of equipment, ER24 resurrected the programme as the Emergency Medical Support Hostile Environments (EMSHE) course.

The goal of the current course, says Van Der Spuy, is to equip medics with the knowledge of how to react and respond to volatile situations. Although effectively geared towards urban and rural scenarios, EMSHE also trains medics to operate in adverse weather conditions, sudden disaster situations, as well as mountain rescue and search and rescue scenarios, among others.

The South African Police Service (SAPS) shared expertise, as did specialist public order police, hostage negotiators, the explosives unit, and forensics. “This ensures that all procedures complement one another in order to achieve the goal of minimising risks and further injury,” says Van Der Spuy. The most common danger posed to medics comes from people. Medics have become targets due to the medication and drugs they carry for patient use. Van Der Spuy also points out that they’re exposed to an increasing number of criminal situations, with socio-economic factors adding to the risk. “Medics are seen as soft targets, which makes them vulnerable.” Drug use and erratic and violent behaviour by patients and communities add to the danger factor, Van Der Spuy adds. Another notable situation is domestic violence cases. “These cases are full of emotion and are flagged as highly potentially dangerous situations.” 

EMSHE course: Core lessons

  • Situational awareness
  • Physical conditioning and capability
  • Working as a team when situations call for calm and precise on-the-move decisions
  • Self-defence techniques and understanding the law
  • Special applications of equipment
  • Working in environments when exposed to noxious gases, such as tear gas
  • How to react when attacked or ambushed
  • How to work in make-shift patient transport
  • Austere environment survival and protection against exposure from the elements (shelter, food, water, rest)
  • The right to self-defence.

ER24 Advanced Life Support Paramedic Tao Ann Carstens is someone who has benefited from the course. She says the training has given her a heightened sense of her surroundings and situation. “This helps us to not only protect ourselves but our patients as well.” Carstens describes the challenging two-day course as 99% physical. She says one of the most valuable aspects was learning how to decontaminate herself and others when exposed to dangerous gases. She put this information to good use recently when aiding a patient who had been sprayed with pepper spray before being mugged.

Van Der Spuy says ER24 has always been totally committed to the safety and protection of its staff. “The course is available to all ER24 paramedics,” he says, adding that EMSHE is the only training module of its kind, unique to ER24.