Poor transport facilities for ICU care put patients at risk

Poor transport facilities for ICU care put patients at risk

A recent study published in the South African Medical Journal suggests that the shortage of suitable emergency transport services for patients needing intensive care is putting patients’€™ lives at risk and results in an increase in medical costs.

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The audio is in isiZulu. See the English summary below.

MABUTHO: Inhloso yalolucwaningo obeluxhaswe ngabe Critical Care Society of Southern Africa bekungukuthola izindlela zokwenza ngcono isimo sokusebenza kwama wadi abagula kakhulu ezibhedlela zikahulumeni kanye nalezo ezizimele. UProf. Sats Bhagwanjee oyinhloko kwi Anaesthetic Department eWits University nongumunye wababhali balolucwaningo uthi ukwentuleka kwama ambulance alungele ukuthutha iziguli ziyiswa emawadini abagula kakhulu kwenza ukuthi iziguli zigcine sezithuthwa ngezimoto ezingekho esimweni esifanele. Lokhu, uProf. Bhagwanjee, uthi kwenzeka kakhulu ezibhedlela zikahulumeni ezingenawo amawadi abagula kakhulu uma kuthuthwa iziguli ziyiswa kulezozibhedlela ezinama wadi abagula kakhulu. Uthi  kwesinye isikhathi ukwentuleka kwezokuthutha kuze kuphoqe imindeni ukuba isebenzise izimoto ezejwayelekiile ukuthutha isiguli nathi kuyinto engamukelekile.

PROF. SATS BHAGWANJEE: Patients are being transported in regular ambulances and in some instances critically ill patients are even transported by public transport. In other words, the patient’€™s family identifies a vehicle and assists with moving the patient to an appropriate facility. Both of those are actually totally unacceptable because you’€™re putting a patient at tremendous risk and it is something that needs to be seriously dealt with.

MABUTHO: Okunye okuvelile kulolucwaningo ukwentuleka kwamabhanoyi okuthutha iziguli ezigula kakhulu. UProf. Bhwagwanjee uthi nakuba kuthathwa ngokuthi ukuthutha ngebhanoyi kuyabiza kodwa kungcono kakhulu kune ambulance uma isibhedlela lapho isiguli sithuthelwa khona sikude. Uthi isizathu salokho ukuthi iambulance uma ithatha amahora angu 6 ukufika esibhedlela esine ICU isiguli asilutholi usizo ngesikhathi. Uthi lokho kubeka engcupheni impilo yesiguli futhi kwenza ukuthi uma sesilashwa sihlale isikhathi eside ewadini labagula kakhulu, lokho okusho ukwenyuka kwezindleko kungafani noma ngabe sihanjiswe ngebhanoyi.

PROF. SATS BHAGWANJEE: A critically ill person who is transported in an ICU ambulance might take six hours to reach his destination. It is more appropriate to transport that person by air. And the reason is that even though the air transportation, on the face of it, might seem expensive, by transporting by vehicle you are increasing the length of his ICU stay because it takes longer for him to receive the care and you do a lot of catching up. In doing that you spend a lot of money than you will if you used fixed wing aeroplane or helicopter transportation.

MABUTHO: UProf. Bhagwanjee uthi kulolucwaningo bathole ukuthi lenkinga yokwentuleka kwama ambulance alungele ukuthutha abagula kakhulu kuyinto ekhungethe lonke leli laseNingizimu Africa kodwa bese kuba khona izifundazwe ezisesimweni esingcono kunezinye.

PROF.SATS BHAGWANJEE: The problem is nationwide, but to be generically correct, it is however worse in other provinces compared to others.

MABUTHO: NgokukaProf. Bhagwanjee isixazululo salenkinga ukuthi kwandiswe ama ambulance alungele ukuthwala abantu abagula kakhulu kuphinde kusetshenziswe namabhanoyi, kodwa uma sikhona isidingo. Uthi okunye abakuphakamisile kulolucwaningo lwabo ukuthi kube nohlelo olulandelwayo lokuthi uma kuba khona isiguli esigula kakhulu kwazeke ukuthi siyiswa kusiphi isibhedlela esinewadi yabagula kakhulu. Uthi lokho kungavimbela isimo lapho isiguli sizolokhu sehliswa senyuswa kufunwa isibhedlela okumele siyiswe kusona.

PROF. SATS BHAGWANJEE: Increase ICU transport – ambulances and, where appropriate, use air transportation for specific categories of certain patients.

MABUTHO: Nokho akuveli kulolucwaningo ukuthi ngabe mangaki ama ambulances adingakalayo alungele ukuthutha abantu abagulayo beyiswa kumawadi abagula kakhulu. Kodwa okuyikhona okuvelayo ukuthi kunokwentuleka okukhulu konesi abaqeqeshelwe ukusebenza emawadini abagula kakhulu njengoba kubikwa ukuthi kudingeka onesi abangu 8000 kulama wadi.

See the English summary below.

Poor transport facilities for ICU care put patients at risk

A recent study published in the South African Medical Journal suggests that the shortage of suitable emergency transport services for patients needing intensive care is putting patients’€™ lives at risk and results in an increase in medical costs.

The study, covering all public and private hospitals in the country, was commissioned by the Critical Care Society of Southern Africa. The aim was to assess the efficacy of the current system of transportation for critically ill patients and the functioning of Intensive Care Units.

According to Professor Sats Bhagwanjee, head of the Anaesthetics Department at Witwatersrand University and the study co-author, the shortage of suitable emergency transport services is greater in public hospitals with no ICUs. He says it is a common thing for critically ill patients to be transported using unsuitable emergency transport.    

‘€œPatients are being transported in regular ambulances and in some instances critically ill patients are even transported by public transport. In other words, the patient’€™s family identifies a vehicle and assists with moving the patient to an appropriate facility. Both of those are actually totally unacceptable because you’€™re putting a patient at tremendous risk and it is something that needs to be seriously dealt with’€, said Prof. Bhagwanjee.

He says the shortage of air transport is also a cause for concern because transporting critical patients by road for a long distance is risky and can be costly.

‘€œA critically ill person who is transported in an ICU ambulance might take six hours to reach his destination. It is more appropriate to transport that person by air. And the reason is that even though the air transportation, on the face of it, might seem expensive, by transporting by vehicle you are increasing the length of his ICU stay because it takes longer for him to receive the care and you do a lot of catching up. In doing that you spend a lot of money than you will if you used fixed wing aeroplane or helicopter transportation’€, he said.

According to Prof. Bhagwanjee the shortage of suitable emergency transport to transfer critically ill patients is nationwide, ‘€œbut’€¦it is however worse in other provinces compared to others’€, he said, adding that the solution to the matter can only be solved by increasing suitable emergency transport ‘€œand where appropriate, use air transportation for specific categories of certain patients’€.

The study fails to say how many vehicles are needed to address the shortage. However, it suggests that the country needs 8 000 more trained nurses to work in ICU facilities.