The Western Cape government's emergency medical services (EMS) is spending R256 million on a five-year ICT project that it hopes will speed up ambulance response times to the point where 90% of all incidents in urban areas are responded to within 15 minutes.
While it has contracted Dimension Data to handle the implementation of a new system that will integrate all aspects such as calls, fleet management and patient records, a fundamental drawback in emergency medical responses still exists.
Across SA, the lack of a national 112 emergency number and regulations giving effect to the centralised centres means emergency services do not have access to vital information that will provide the exact location of callers using cellphones to report emergencies.
The province's minister of health, Theuns Botha, says the R256 million contract is a "major investment in EMS infrastructure" and should accelerate vehicle response times.
Speedier services
Director of health in the province, Dr Cleeve Robertson, says the system is expected to improve emergency medical performance by 5% in the financial year that started on 1 April, as there is no budget for other improvements. "The clock is ticking."
Currently, 66.7% of all life-threatening emergencies in urban areas are responded to within 15 minutes, says Robertson. He adds that the new system should take this up to 75% within the next year, before hitting the province's 90% target.
The objective of the refresh of the current 10-year-old system is to get emergency response vehicles to the scene as fast as possible, says Robertson. He adds that the information management services are a nice additional benefit.
A fleet management system will identify the closest vehicle and dispatch it, says Gordon Govender, Dimension Data's public sector sales manager for the Western Cape. He adds that a full inventory system will enable dispatchers to send the vehicle best equipped to handle the incident, such as one equipped with cardiac care resources for such an incident.
Govender adds the system will eliminate an oversupply of vehicles to the scene, as well as unnecessary transfers between hospitals. It is a turnkey solution that covers the entire province, he explains.
Robertson says there are a number of modules that will be implemented, including call-taking, dispatch, fleet management, human resources, supply chain, billing and electronic patient records, all of which are integrated.
Govender says the new system will eliminate discrepancies in aspects such as odometer readings, which are currently written down. The solution includes the communication layer, integrating the transport layer, as well as call centre software, and will optimise workflow, he adds.
There are 171 ambulances, as well as other response vehicles available every hour, which will be equipped with on-board computers to interface with dispatch, says Robertson. The on-board devices, which will be equipped with mapping software, will reduce the amount of voice traffic and also make dispatch more accurate, he adds.
Once the vehicle is back at the depot, patient-related data will be downloaded to save transmitting large files over a cellular network, Robertson explains. In addition, redundancy is provided through the current Terrestrial Trunked Radio (Tetra) system.
Patient data will also be used to pick up whether paramedics require more training in a specific field if they have not responded to certain types of emergencies for a while, says Robertson.
Govender says the aim is to optimise the system to the point where as little human intervention as possible is required. Dimension Data will provide the technology, training, support and services for five years, and hopes the project is so successful it will be rolled out to other provinces, he says.
Dilemma
However, the drawback with any ICT solution for emergency services in SA, including the new product, is that there is no national 112 emergency number, says Robertson. As a result, regulations that would allow services access to geographic coordinates, which would speed up response times, have not been implemented.
Some 80% of all emergency calls come in from cellphones, he notes.
Robertson says location information from cellphones is fundamental, especially in areas where there are no street addresses. This problem still needs to be solved, but the department is in talks with mobile operators and Telkom to get a solution in place. "For us, it's a public safety issue."
Last month, the Department of Communications cancelled its tender for a service provider to render 112 Public Emergency Centres. However, the concept is expected to be revived although the Department of Public Services and Administration is currently probing irregularities around the initial pilot project.
The implementation of 112, as a single national emergency number, has been on the cards for several years, but the project has been cancelled and restarted several times. The pilot call centre reportedly cost R80 million, and was stuck in pilot mode for more than four years.
Govender says call location technology will be incorporated going forward. However, Vodacom points out that the use of location information is strictly limited by law, and gaining access usually requires a court order as there are privacy issues.
Robertson, however, points out that there are applications that use such data on smartphones, and privacy issues can be overcome.
In the future, it should be possible for callers to send videos or images of the incident to the call centre and be talked through aspects such as mouth-to-mouth resuscitation, says Robertson. He adds the solution provides the potential for telemetry.
Phased approach
The project will implemented in three phases, with the first phase in the 10177 Cape Town call centre by November. This will see the current communication-aided dispatch technology upgraded. Once it is complete, all six call centres in the province should be able to provide fast and efficient data capturing and quick dispatch of emergency resources to incidents.
Robertson says the entire province should be covered in two to three years. He adds there is a need to roll out to the rest of SA as case management systems are not integrated.
Before 2003, the province ran a paper-based system with minimal electronic assistance, says Robertson. However, it was a "nightmare" handling 500 000 calls a year and the province needed technology to coordinate the calls and response teams.
Robertson says the province procured a disaster management system, but could not integrate it with other aspects such as vehicle tracking.
Three years ago, the province did a rapid assessment to determine gaps in the system, which revealed 56 holes. He says IBM wrote specifications based on the province's requirements, which ran to 600 pages.
The province went to market and adjudicated six bids, of which only Dimension Data met the minimum threshold, says Robertson. After a visit to Europe, Dublin-based mobile healthcare software company Valentia Technologies' CareMonX software was selected.
The product, according to Valentia's Web site, has a range of functionality for the operation of emergency medical services, including real-time patient and incident data collection and transmission, incident reporting, and management of fleet inventory and staff work schedules.
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