A perspective on regulation of paramedics in SOUTH AFRICA

Do you think registration in South Africa was a good thing for paramedics?

Registration was introduced in the late ‘80’s and was an essential step in getting paramedics recognized as health professionals in South Africa. We were more accepted by other professions including health, which lead to a massive diversification of the potential career paths open to us. It boils down to a question of quality assurance and transparency. The product is guaranteed to meet published standards and the consumer can be confident in the quality. If the standard is not met the consumer can appeal to the authority and be confident of a transparent assessment of their complaint.

Were there any particular advantages for you?

On the strength of my South African registration, I was able to get professional medical registration in other countries even though those countries didn’t have registration for paramedics. In fact they didn’t have any form of emergency medical service, unless you count a driver wearing a white coat as a badge of competence! However after gaining registration I was able to work with a full scope of practice, and procure all my drugs and equipment. There was also an advantage in monetary terms. Salaries improved significantly in the years after registration was introduced, both in the public and the private sector.

Were there any downsides?

Not really. People point to the disciplinary potential of registration, however on the flip side the professional body can also shield its members from malicious or unfounded allegations both through the transparency of the body’s codes and requirements and also by defending a members valid actions.

Were all ambulance officers covered by the regulation? (In NZ the debate is whether regulation should only cover Intermediate Life Support and Advanced Life Support or all Practice Levels, including Basic Life Support as well. Do you have views on this?)

Initially it only covered Paramedics however registration now covers all levels of qualification. Even first responders (including fire or police personnel) should be registered if they are expected to engage in any form of patient care in the normal execution of their duties.

In my view all practice levels in New Zealand should be registered. Currently, non-transport options are open to all practice levels, and this is probably an area most likely to result in harm to patients. Administration of vasoactive substances has been made available to BLS officers – in my view another area for medical misadventure claims.

Do you think patients are any safer now than before and if so why?

I believe that registration has improved the quality of practice. There may be several reasons for this including greater levels of personal responsibility and accountability, pride in the quality of care provided, fear of the repercussions of being negligent and a desire to be as good as, if not better than my peers. I guess that would translate to improving patient safety when taken across all practitioners.

Has it improved training of paramedics?

The registering body mandates the licensure of training establishments, and requires that any trainers/tutors/lecturers must be at least one qualification level higher than the level of the course that they are leading. ILS can teach up to BLS, ALS to ILS, doctors or Emergency Care Practitioners (ECP’s) to ALS. It has certainly had an impact on the Continuing Professional Development required to maintain registration. Unlike the narrow CCE requirements, there is a large range of options to gain CPD credits.

Has it lead to new roles for paramedics?

Definitely. Paramedics are able to work in trauma units or emergency departments, for example. It has opened up options for paramedics to specialize in aviation medicine, remote medical operations, health and safety, specialist rescue, tactical support, communications, industrial settings, management, education.

Was it a good thing for the ambulance services?

By law ambulance services also need to be licensed to operate and have to meet set criteria in terms of equipment, crewing levels, etc. So in this respect it was a very good thing for ambulance services. Something New Zealand could benefit from?

Do other health services now see ambulance officers in a different light? i.e. more like fellow health professionals and not just people who just transport patients to hospital.

The Emergency Care Professional Board prescribes codes of conduct, ethics, education, authorized scopes of practice and protects and enhances the body of knowledge and particular skills of Emergency Care. I suppose it’s akin to staking our claim to our territory. This, along with multidisciplinary training courses (ACLS, APLS, ATLS, FMA, etc) broke down many barriers and built mutual respect between doctors, nurses and paramedics.