The Namibian Pre-hospital System
Guest Author: Nadine Seymour & Edited by: Jo Park-Ross
Pre-hospital Emergency System in Namibia
Namibia lies in Southwest Africa; it is largely and sparsely populated with vast distances. Windhoek, the capital, is the largest city & is found almost in the centre of Namibia, surrounded by mountains. Namibia’s health system is mainly state run, providing health care to the majority of the population. Currently there is a ratio of 1 nurse per 500 people; 1 doctor per 4000 people & 1 emergency care practitioner per 7000 people. Windhoek has 3 privately run hospitals & 2 state hospitals. Each of the major towns surrounding Windhoek have state hospitals with the smaller towns, villages & rural settlements serviced by clinics & health centres, these are all operated through the Ministry of Health & Social Services (MoHSS).
Pre-hospital emergency care services are vastly spread throughout Namibia with the majority of pre-hospital practitioners being found in Windhoek since around the late 1990’s. There are to date a number of private ambulance services which are comparable to 1st world countries, 2 of which are capable of providing evacuation & transportation by fixed wing & 1 by rotor wing, with the occasional use of the Namibian Police helicopter when required. The 2 state run ambulance services found in Namibia are provided by the MoHSS & City of Windhoek Emergency Management Division. The MoHSS ambulance service still uses Basic Life Support (BLS) & some Intermediate Life Support (ILS) practitioners to drive the ambulances while nurses provide treatment to the patients. The private & state EMS services mainly provide basic (BLS) & intermediate life-support (ILS), with very few advanced life-support (ALS) practitioners registered & working in Namibia.
EMS Practitioners & Training
Currently there are around 35 registered ALS practitioners with even fewer of them actually practising in Namibia. The scope of practise for BLS, ILS, ECT & ALS was fashioned on the South African Health Professions Council protocols & scope of practice. The protocols for BLS, ILS, ECT & ALS have been re-addressed to focus on the needs & resources of Namibia; however these are still waiting to be accepted by the Health Professions Council of Namibia (HPCNA).
Training in Namibia is very similar to that of South Africa. There are private & state institutions that provide BLS & ILS short course training; however there are no short course ALS training facilities in the country. The Polytechnic of Namibia, which has now transformed into the Namibia University of Science and Technology (NUST), is the only institution that provides tertiary training in Pre-hospital Emergency Medical Care. This programme was established with help of the Motor Vehicle (MVA) Fund of Namibia back in 2009 & to date we still endeavour to work closely with each other.
The programme provides a Bachelor’s degree in Pre-hospital Emergency Medical Care (NQF 7) & covers aspects similar to that of South African institutions, including that of Rapid Sequence Intubation (RSI), this enables registration with the HPCNA as an advanced life-support (ALS) practitioner. The course however only provides a Basic Medical Rescue course as part of the qualification; which includes light-motor vehicle extrication, basic fire rescue, high-angle 1 & hazardous materials awareness. The qualification also allows students to exit after the second year with a Diploma (NQF 6) in Pre-hospital Emergency Medical Care enabling them to register with the HPCNA as Emergency Care Technicians (ECT). Most of these ECT’s that have qualified have already been absorbed into private, parastatals & the surrounding mining industry to provide medical care to workers on site.
EMS has additional assistance from the City of Windhoek Emergency Management Division who also provides a rescue service to the community. There is no officially established rescue outfit in Namibia & therefore all services rely on the City of Windhoek to assist where needed.
Patients are transported via ground ambulances within Windhoek & the closer surroundings; however fixed wing aircrafts are often used due to the vast distances outside of Windhoek to the northern & southern areas of Namibia as well as outside the country. Occasionally rotorwing aircraft are used for rescue scenarios in & around Namibia.
Although these areas have access to BLS & minimal ILS, there are few to no ALS practitioners available outside of Windhoek. This makes for increased response times due to the vast distances. This is further compounded by the under-resourced areas, limited ALS qualified practitioners & poor socioeconomic conditions.
Opportunities in the Making
The EMS system is still very young & therefore great opportunity lies within EMS itself to have an African system that caters to Namibian needs.
The Namibian Emergency Care Practitioners Association (NECPA) has recently been established to bring together EMS practitioners, industry & the HPCNA in order to drive the profession into the future.
Links to a few websites:
www.polytechnic.edu.na or Find us on Facebook: Polytechnic of Namibia EMC