Changing lives. Saving lives. Photo Credit: David Dennison, Limpopo EMS

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1 Changing lives. Saving lives. Photo Credit: David Dennison, Limpopo EMS

2 Profile The AMS has become a vital conduit for delivery of emergency and critical healthcare services to rural and urban areas. We work closely with Provincial Departments of Health and health workers in the communities to assess needs and implement appropriate healthcare programmes. Our commitment to saving lives and changing lives knows no boundaries. Established in 1966 by the SA Red Cross Society and formed into an Independent Trust in The SA Red Cross Air Mercy Service (AMS) is a non-profit organisation with bases in the Western Cape (Cape Town & Oudtshoorn), Northern Cape (Kimberley), KwaZulu-Natal (Durban & Richards Bay), Mpumalanga (Nelspruit), Limpopo (Polokwane) and the Free State (Bloemfontein) that provide an air ambulance network, outreach and emergency rescue service to metropolitan areas and remote rural communities. It is the mission of the AMS to contribute to the improvement in the quality of life of all communities, facilitate access to equitable and effective healthcare and the provision of aero-medical and other associated humanitarian services. The AMS plays a vital role in providing not only emergency rescue and air ambulance services but also a community outreach programme taking critically needed healthcare to impoverished communities. The AMS will provide help whenever and wherever it is needed. The AMS is committed to Changing Lives, Saving Lives. VISION To be the most professional and effective aero-medical rescue, healthcare support and relief network to all communities in need. MISSION In accordance with the principles & objectives of the International Red Cross and Red Crescent Movement, and in support of the National Health Systems to: Contribute to the improvement in the quality of life of all communities Facilitate access to equitable and effective healthcare Provide aero-medical and other associated humanitatian services CORE VALUES Our values are based on humanitarian principles. This is achieved by: Integrity, Care & Commitment. THE SOUTH AFRICAN RED CROSS SOCIETY CREED I believe in the service of mercy, wherever disaster calls, there shall I go to alleviate suffering and sorrow. - I ask not who calls but go where I am needed. I have no price for my service, but accept gratitude, that out of its largess I may expand my mission. I have no barriers of race, class, creed or country, no barriers of ideology, no obstacles of rivers, mountains, continents or seas. Wherever human beings are in need, there will I go to minister unto misery under my banner of merciful fraternal love. Whether it be an earthquake, a landslide, fire or flood, ravages of war or disease, all these find me ready for service. I serve all because I am of all, having been born of the finest instincts of mankind and having faith in God and His merciful love of all. You who believe in me, you, so many of whom I have mothered in your sons and daughters, strengthen my hand and re-animate my courage, for I am the spirit of humanity marching beneath her cross. Photo Credit: Image SA, Roger Sedres

3 contents 02 Message from the Chairman 15 Message from Polokwane Department of Health 03 Corporate Governance 15 Regional Statistics 04 Message from the CEO 16 National Operations Centre 06 Corporate Development Report 18 Safety 07 Our Role and Services 19 Quality Management & Technical Support 08 Our Fleet 22 Chief Medical Officer 09 National Operations Report 23 Flight Operations Report 10 Western Cape Review 25 Aircraft Maintenance 11 Message from Western Cape Department of Health 26 Human Resources 12 KwaZulu-Natal Review 30 Tribute to Volunteers 14 Message from KZN Department of Health 31 In Appreciation 14 Polokwane Review 32 Audited Financial Statements Photo Credit: Image SA, Roger Sedres SPONSORED BY: 01

4 message from the chairman On behalf of the SA Red Cross Air Mercy Service (AMS) it gives me great pleasure to present the 2012/2013 Annual Report, which depicts the activities of the organisation for the year under review. Challenging but exciting times beckon us. The establishment of a 24 hour helicopter programme in KwaZulu-Natal (KZN) is part of the transformation the organisation is undergoing to continue to provide high quality healthcare in support of strengthening the South African healthcare system. Night Vision Goggles (NVG s) significantly increase the amount of visual cues available to the air crews and so unsurprisingly increases the safety margins during flights. This is an accepted fact worldwide and is in line with international trends to improve safety around helicopter night flights. The AMS continues to invest in the development of people. The first female candidate of the helicopter pilot development programme is excelling. The AMS is proud to be part of the empowerment of women in our society. Aeromed Africa, the very first conference held in 2012 which brought together delegates from across the world to discuss and debate imperative issues confronting the development and expansion of aeromedical services will now be integrated into the Emergency Medicine Society of South Africa conference (EMSSA 2013).This is a major step in the development of aeromedical services in the developing world. We look forward to collaborating with EMSSA. The AMS is undergoing one of our biggest transformations in recent times. This has been informed by our commitment to increasing our reach, ensuring affordability of our services, giving our partners particularly Provincial and National governments good value for their investment and finally the future sustainability of the organisation. In addition we are of the view that the AMS should be an African resource and not just a South African resource. To respond to these imperatives we have established a separate social enterprise that is aimed at generating revenues to fund and support our community based programmes and to subsidise the services we are providing. We are cognisant that while aero-medical services are needed by many provincial and national governments they often lack the resources to fund this fully. While we are appreciative of the donor funds we have received in the past the demands on our services far outstrip our capacity to generate funds. This Social Enterprise known as AMSOL will enter into joint ventures with partners to provide income generating services. The first of these initiatives is in Ethiopia whereby over a very short period we have been able to establish ourselves in the charter market. Other African countries are identified for future expansion. We are also in discussions with countries in other parts of the developing world to provide consulting and other commercial services. Our staff are our main resource and we have world class expertise that we believe can add value for others while generating income for our programmes that are aimed at creating access for the most disadvantaged in our society. The above changes have also offered us an opportunity to restructure our leadership and staffing to accommodate the need for the future. In this respect after years of serving as the Group CEO of AMS John Stone will step down in the new financial year and serve as the CEO of AMSOL. He will work closely in this structure with Farhaad Haffejee. Dr. Philip Erasmus will serve as CEO of AMS; a role he has been holding and will report directly to the Board of Trustees. Challenging but exciting times beckon us. Prof. Kovin Naidoo Chairman, Board of Trustees 02

5 corporate governance Corporate Governance is a system by which organisations are directed and controlled which include strategic direction, executive action, supervision and accountability. Corporate Governance is aimed at promoting corporate fairness, transparency and accountability through policies and practices that further the fundamental duties of good faith, care, skill and diligence. board of trustees The Board of Trustees governs and oversees the activities of the organisation: Prof. Kovin Naidoo Chairman Alan Marshall John Martin Ray ka Msengana Dr. Sam Gulube René de Wet Lwazi Mboyi John Stone Group CEO Audit, Risk and Compliance Committee: This committee comprises of trustees nominated by the Board of Trustees. The committee s role is to assist the Board of Trustees in overseeing and assessing the organisation s risk management process, legal and regulatory compliance, financial reporting, financial controls and internal and external audit processes, and to liaise between the Board of Trustees and the external auditors. Management and Administration: The CEO is responsible for the day-to-day management of the organisation and reports to the Board of Trustees. Medical and aviation decisions are taken in consultation with the Management Committee (MANCO) and the Quality and Safety Committee. Day-to-day financial administration is handled by management staff in accordance with the budget approved by the Trustees. All meetings are minuted and conform strictly to the acceptable standards of corporate governance practice. Although the Group CEO retains overall responsibility and reports to the Board of Trustees, the primary focus and the responsibility of this position has shifted to develop the Social Enterprise of the AMS. This unit will pursue revenue opportunities abroad to support and ensure the sustainability of the AMS operations in South Africa. Human Resources and Remuneration Committee: The committee comprises of Trustees nominated by the Board of Trustees. The committee assists the Board of Trustees to establish Human Resources strategies and policies as well as to ensure compliance with all applicable legislation and best practices. Management Committee (MANCO): MANCO is a statutory meeting chaired by the CEO. MANCO comprises of the CEO, Corporate Development Manager, National Operations Manager and co-opted members. The committee aims to improve the communication flow and keep everyone abreast of developments in the organisation. MANCO is also a sounding board for the CEO. Quality and Safety Committee: The Q & S Committee comprises of the CEO, National Operations Manager, AMO Maintenance Manager, Flight Operations Manager, Safety Manager and Quality Manager. The committee meets weekly to address all matters pertaining to safety and the quality of services. SPONSORED BY: 03

6 message from the ceo I find it nearly impossible to describe the 2012/13 financial year other than another rollercoaster! The extension of the aero-medical programme in Kwa-Zulu Natal (KZN) to provide helicopter services at night from both the King Shaka and Richards Bay based programmes has signalled a major step forward in the level and sophistication of services provided by the AMS and its Government partners to the citizens of our country. The introduction of Night Vision Systems, inclusive of Night Vision Goggles (NVG s), associated with the enhanced safety aspects as well as the associated responsibilities is an exciting prospect for all involved but mostly so for the increased access to high quality healthcare that will be created through aero-medical helicopter services, even at night. This will be complementing the already existing fixed wing night service. The commitment of the senior management team in the KZN Department of Health towards developing a world class aero-medical service for its citizens is remarkable. The introduction of remote weather stations within the Province is in process and the development of GPS approaches to remote airfields is being researched to further enhance access to services. Although the focus has been on emergency aero-medical services for the last few years in the build-up to and aftermath of the 2010 FIFA World Cup, it must not be forgotten that the Rural Health Outreach ( Flying Doctor ) Service has the potential to reach many tens of thousands of people in need of healthcare in striving for the goal of equitable access to healthcare for all regardless of location. A renewed focus on this aspect is necessary and the shared vision with the Department of Health in KZN in this regard is very encouraging. The model that is developed in this Province through the Department of Health AMS partnership will hopefully serve as a blueprint for the National Health Insurance (NHI) system. The single biggest obstacle to the development of a comprehensive, high quality aero-medical service in our country is poorly researched tender documents with short term horizons. No service provider who is committed to a high quality, international standard aero-medical service can commit to the very expensive capital outlay needed with the risk associated with a three year horizon. This unfortunately opens the door for competitors with lower quality products. The decision of the Department of Health in the Western Cape to rather opt for a five year contract period is certainly a step in the right direction. The fixed and rotor wing air ambulance services combined with the sophisticated highly technical aero-medical rescue programme that has been developed in the Western Cape, in association with our partners in the Provincial Department of Health, remains unique on the continent and is certainly an example that can compare with the best internationally. The role of the organisations affiliated under the Wilderness Search and Rescue (WSAR) umbrella organisation (many of them non-profit and volunteer organisations) must be recognised for their contribution to developing this service over the last ten years and longer. In the Western Cape there has been an increasing focus on the standard of clinical care. The development of super specialised neonatal retrieval teams in association with Red Cross War Memorial Children s Hospital and the Emergency Medical Services Department in the Western Cape forms part of this area of 04

7 focus. The lessons learned and procedures developed during this process will serve as an example of clinical excellence and will spill over to other areas where we operate. On the academic front there has been further positive development. Despite the success of the Aeromed Africa conference that was hosted by the AMS in the previous financial year, it was decided to further enhance the academic profile of aero-medical services in the country and on the continent by partnering with the Emergency Medical Society of South Africa (EMSSA) to become part of the EMSSA Conference in November We are looking forward to working together with this internationally recognised academic body to contribute to the development of aero-medical services in the developing world. The focus on Safety and Quality assurance is a never ending commitment. We are also in the process of reviewing our aviation fleet composition with regards to appropriateness for our type of operations which has now been extended to include night helicopter operations with night vision systems as mentioned. A very interesting process indeed. We are also proud to report that we are expanding our Pilot Development Programme (PDP) under the leadership and guidance of our Training Manager, the aviation stalwart, Capt. Nic Vallentgoed. Eight new candidates are in the process of joining us on the fixed wing programme whilst our first development pilot on the rotor wing has now completed her training and is participating in the Cape Town based rescue service on a regular basis. The development of female rotor wing pilots over the last decade in our country is phenomenal and we are quite proud to have four female rotor wing captains on board in our organisation. We unfortunately had to terminate some of our operations during the course of the year and had to say goodbye to a few very loyal people. Although we could absorb some of the staff involved in other operations. In this regard it is virtually impossible to think of the AMS without a person like Alett Vermeulen, our Northern Cape Base Manager for the last 16 years. We thank her for almost a lifetime of commitment and service to her people, the people of the Northern Cape. Whilst not taking our eye off the ball locally, we are increasingly exploring offshore Social Enterprise opportunities which has the ultimate goal of supporting (cross funding) the local operations in South Africa. We do however have a commitment to provide technical and operational support to these operations especially during the start-up phase. I thank our staff for their commitment in this regard. The year ahead will still be another tough one as the constraining global financial environment will still be affecting us. I thank our Trustees and our Group CEO for their guidance, our staff, our volunteers and their families for their commitment and our clients and Government partners for their support. Dr. Philip Erasmus Chief Executive Officer On the academic front there has been further positive development. Photo Credit: Independent Newspaper SPONSORED BY: 05

8 corporate development report With the upheavals of the previous year behind us, 2012 proved to be a year of settling into the new space which we found ourselves playing in. It seems that the old adage of every cloud having a silver lining became very relevant to us as we discovered new creativity thriving in what we thought were times of adversity! We have continued to find support with some of our traditional supporters during the last year; Investec, Airports Company South Africa (ACSA), The Anglo American Chairman s Fund, Air Traffic Navigation Services (ATNS), Newsclip, Dennis Jankelow & Associates, Agusta Westland and Eurocopter have all contributed towards the AMS operation. There are many other companies and individuals who make continued, valuable contributions to the AMS and it is impossible to mention everyone. The support from every single one of you is acknowledged and appreciated. Your unceasing support allows the AMS to continue to make a difference to the lives of ordinary South Africans on a daily basis. Once again, Venessa Horn, our PR and Fundraising Officer must be acknowledged for the relentless effort that she puts in to raise funds from an ever-shrinking donor base in these trying economic times. The organisation underwent a successful transition of IT service providers during the last year. However, as technology improves and our IT infrastructure ages while demands continue to increase, we find ourselves straddling the divide between struggling on with what we have or making the quantum leap (at considerable expense) to the next required level. This is something we will now have to monitor and evaluate very seriously in order to ensure that we are able to continue to effectively manage the organisations IT requirements. The establishment of a Social Enterprise unit within the AMS is starting to take root. The project which started in Addis Ababa, Ethiopia with a local aviation operator to do charter as well as aero-medical operations was initially targeted at the private sector. There is a huge amount of potential (in all sectors) in Ethiopia to establish a decent business but, as with any developing country, it takes time to get things done. In addition, it is exceptionally difficult, especially during the tough economic period which we find ourselves in, to start business projects without any real capital. We are now busy preparing a business case with enough detail to be able to raise capital so that this project can be given the chance that it deserves to be successful. We have also found that we are receiving queries from interested parties throughout the African continent who would like to start an aero-medical service. Of course, funding is always an issue but we have committed to assisting wherever possible through the Social Enterprise Unit to achieve the ultimate vision of broadening the accessibility of healthcare to all via aero- medical means. Aeromed Africa has now partnered with the Emergency Medical Society of South Africa (EMSSA) and will form part of the EMSSA conference in November This will give Aeromed Africa the impetus and enhanced profile that it deserves to become an internationally recognised aero-medical conference for the developing world....we discovered new creativity thriving... National Health Insurance (NHI) has already been rolled out to pilot sites in various Provinces and will be scaled up over the next few years. This public health intervention brings with it enormous opportunities that will benefit the most marginalised communities in our country. We are excited about the role that we will have to play in this amazing initiative as we partner government in changing the landscape of health and improving the lives of our compatriots. Thanks must be given to the Board of Trustees and my colleagues for their continued support and advice. As we approach this new year with its new challenges, I will increasingly look to the Trustees for their valuable guidance. It remains a privilege for me to be a part of such a great team and organisation. Farhaad Haffejee Corporate Development Manager 06

9 our role and services our role 1. To manage and act as the overall coordinator of the aero-medical, emergency rescue service and rural health outreach in the various provinces in terms of assessing the needs, planning, day to day operations, monitoring and feedback to Provincial and National Health Authorities. 2. To access the volunteer network (aero-medical) of the AMS to support the Provincial Departments of Health (DoH) by supplementing the skills pool. 3. To source funding to support the development and expansion of the service. Photo Credit: Image SA, Roger Sedres our services The Flying Doctor and Rural Health Outreach Service Provides delivery of appropriate and effective healthcare to rural communities, by flying specialists many of whom are volunteers, as well as support personnel to outlying hospitals. Provides specialist support to district and secondary hospitals. Decreases elective referrals from district hospitals to higher level facilities. Addresses acute backlogs at district hospitals for patients in need of specialist care. Addresses important community primary healthcare needs. Improves rural skills by training local and medical personnel. The KZN service has been extended to include ground support units to access areas that has limited access by aircraft. The ground support vehicle is also used to get to hospitals which are in close proximity to doctors supply. The Air Ambulance Service Complements the local road ambulance services by providing rapid emergency aero-medical transportation of patients who are critically ill or injured. The Rescue Service Provides specialised medical, mountain and surf rescue services, working closely with local Metro and affiliated rescue organisations. SPONSORED BY: 07

10 our fleet pilatus pc-12 Fixed Wing (single turbine) agustawestland 119Ke Rotor Wing (single engine) Fully equipped, 24-hour Air Ambulance, with a dedicated, medical intensive care-type interior. Nine seater with a capacity of up to three stretcher patients. Pressurised cabin. Cruises at ±450km/hr, can reach altitude of ft, ideal operating range > 250km. Perfect for short strip-landings. Utilised for transporting personnel on the outreach service. Air Ambulance and Rescue Fully equipped with a dedicated, medical intensive care-type interior, with sling, winch capacity and emergency floatation gear for operations over the sea. Cruises at 250km/hr, operating radius of 200km, but can be utilised for further distances. Has a capacity for two pilots, three crew members and one stretcher. Utilised for mountain and surf rescues, as well as inter-hospital transfers and primary calls. augustawestland 109 Grand Rotor Wing (twin engine) eurocopter ec130 Rotor Wing (single engine) Latest Addition to the AMS Fleet Twin engine, single pilot instrument rated air ambulance for 24 hours a day operations. Fully equipped with a dedicated, medical intensive care-type interior. Cruises at 270km/hr, operating radius of 300km, but can be utilised for further distances. Has a capacity for two pilots, three crew members and one stretcher. Utilised for mountain and surf rescues, as well as inter-hospital transfers and primary calls. Air Ambulance Fully equipped with a dedicated, medical intensive care-type interior, and sling operations with emergency floatation gear for operations over the sea. Cruises at 200km/hr, operating radius of 200km. Has a capacity for two pilots, two crew members and one stretcher. Utilised for inter-hospital transfers and primary calls. 08

11 National operations report The outcome of the national aero-medical tender process had forced the AMS to terminate services to a few communities that we had successfully served for many years. Long standing relationships with our partners and well established services sadly came to an abrupt end. The changing environment however created new opportunities for the AMS. Ashwin Krishna National Operations Manager Afzal Khan Regional Manager KZN Andre Oliphant Cape Town Base Manager Kogie Naidoo KZN Base Manager Chris Broomhead Regional Manager Polokwane Alett Vermeulen Kimberley Base Manager Aircraft Maintenance Operations (AMS) 1045 under the leadership of Mr Lawson had spent many hard working hours ensuring that we have an operational fleet ready to respond to emergencies when required. Thanks to the AMO team for an impeccable service availability record. Our KwaZulu Natal (KZN) operation has expanded to boast three fixed wing aircraft and two helicopters, now with 24 hour coverage on the helicopter side as well. A great partnership with the Department of Health and a firm focus on improving service delivery has the team pressing ahead ensuring equitable healthcare access available to all citizens in the province. The outreach clinics are still very successfull, reaching deep rural communities and the poorest of the poor. The KZN team have the support of a very dedicated volunteer core of specialists and other healthcare providers, without whom the programme will have been quite impossible. We wish the KZN team the very best in rolling out their new plans in setting world class standards for aero-medical programmes on the African continent. The Western Cape operation runs a very well established Air ambulance and Rescue programme. These services are supported by a well managed ground ambulance system with world class health quality systems in place. This programme has successfully been serving the Western Cape community for decades and I have no doubt it will be for decades to come. We bid farewell to an icon in the EMS sector in the province; Dr Cleeve Robertson who has worked closely with the AMS for many years and will be sadly missed. Our Limpopo operation has historically responded to the calls of many very ill patients. Our regular clinical analysis of calls show that this service is appropriately utilised accessing very real aero-medical calls. The Limpopo helicopter now affectionately known as The Pride of Limpopo was part of one of our biggest rescue operations that took place at the end of January with the evacuation and relocation of more than 120 people who became stranded by flood waters along the Limpopo and Sashe Rivers. Our appreciation goes to the EMS rescue team who assisted greatly with logistics on the ground as well as to De Beers Venetia Mine who assisted with refueling. The local EMS management have been supportive in ensuring that the programme has room for expansion and possibly introduction of additional rescue capabilities this year. We focused on improving clinical quality oversight across all bases to ensure that AMS patients have access to the best care possible. Appreciation to Dr Roos, our Honorary Chief Medical Officer on his superb guidance and continued support in this regard. We will continue to shift the clinical bar upward to ensure world class medical care to all. The AMS has opened a clinic at the Cape Town International Airport, offering an array of services from General Practitioner (GP) consults, dentistry, occupational health, wellness clinics, psychological counselling to mention a few. This is to service a niche need at this national key point, but we hope to expand the services to the surrounding community in true AMS style! The AMS crewed ground ambulance at the airport is providing a vital and top quality service as well. We have successfully run the Aviation Healthcare provider courses in Cape Town and KwaZulu-Natal this year. We are looking forward to making a few more of these courses available together with the Department of Health in the year ahead. I would like to thank all AMS staff, volunteers and partners in the Department of Health the South African Civil Aviation Authority (SACAA) and all those associated in any way with our operations for their support. Let us continue to ensure that this essential service reaches all when needed. Ashwin Krishna National Operations Manager SPONSORED BY: 09

12 REGIONAL REVIEWS western cape service statistics The year under review turned out to be another busy year for Cape Town and Oudtshoorn bases respectively, with the Western Cape Department of Health maximising the utilisation of the fixed wing and rotor wing air ambulance platforms. Dedicated Department of Health Fixed Wing Advanced Life Support (ALS) flight crew in the Cape Town Base has significantly improved the efficiency rate, with the crews achieving over 100 air ambulance flying hours per month. This team has flown 946 patients at an average of 1.9 patients per mission for the financial year under review. The contribution of the dedicated Cape Town base volunteer fixed wing pilots to the longest running fixed wing air ambulance service in the country cannot be under estimated. There has also been increased involvement of the neonatal and paediatric specialists from the Red Cross War Memorial Children s Hospital, with regard to providing specialists to accompany paramedics to retrieve critically ill and injured children coming for specialist care in Cape Town. During the latter part of the financial year the AMS in partnership with a team of specialist from the Cardiology Department of the Red Cross War Memorial Children s Hospital embarked on the very first outreach programme in the Western Cape to George Provincial Hospital. The objective of the outreach programme was to provide tertiary cardiology expertise at hospital level instead of patients embarking on long road trips with their parents to the City. A portable echocardiography machine was used to assist with patient assessment. Expert echocardiography is otherwise not routinely available to patients at regional hospitals. A total number of 43 patients were seen on the day. The benefits associated with this outreach programme: Patients are seen at their regional hospital. In order to facilitate easy access for patients to cardiology services by attending the cardiac clinic at their local regional hospital, and To triage those patients that will require further tertiary level investigation and procedures at Red Cross Children s Hospital. It is cost-effective to transport an outreach team to the regional hospital to see patients rather than transporting those patients and their mothers to Cape Town, this equates to approximately 20 ambulance trips to Cape Town which is freed if the specialists are flown to the designated hospital. It was a truly rewarding day with so many little patients seen to in one visit. It was a very early flight and a very long day for this group of paediatric cardiology specialists but it was well worth it in the end after receiving positive feedback from both parents and staff at George hospital. The impact of the mission was further realised when parents explained the details of how this mission alleviates the pressure on the family having to travel to Cape Town. Close to 90% of those seen will now not need to travel to Cape Town for this consultation. The Rotor-Wing Service in Cape Town and Oudtshoorn are the two busiest helicopter air ambulance operations and the only operations fully equipped for mountain and sea rescue at all times in the country. Call rates in Oudtshoorn significantly increased during the last quarter. Rescue training and pilot conversions have also taken place in Oudtshoorn which is ideal due to its mountain ranges and rural positioning. A select group of highly trained Advanced Life Support Rescue Technicians from METRO Western Cape has ensured that we have conducted over 200 rescues in and around Cape Town without any adverse incidents. We train these Technicians in aviation rescue to match and in some instances out class the standard seen in first world countries. Working together with other rescue organisations such as National Sea Rescue Institute (NSRI) and Wilderness Search and Rescue (WSAR) has built strong bonds between the various disciplines all working towards the same goal, saving lives. We have a unique monthly Quality & Audit review system that ensures that every flight done is screened and measures are put into place if inadequacies or shortcomings have been identified. Positive feedback using the Just Culture principle has ensured that medical staff are regularly reviewed and updated on the latest developments in Aviation Medicine. We would like to thank all our volunteer pilots for offering up their family time over the festive season to ensure that our aircrafts are in the air, servicing our Province. Andre Oliphant Cape Town & Oudtshoorn Base Manager Cape Town Fixed Wing 2012/ /2012 Patients flown Missions Hours Flown Cape Town Rotor Wing 2012/ /2012 Patients flown Missions Hours Flown Oudtshoorn Rotor Wing 2012/ /2012 Patients flown Missions Hours Flown

13 message from western cape DOH The partnership between the Western Cape EMS and AMS realised new heights during the 2012/2013 financial year with service levels in terms of flight hours, kilometres and patient numbers exceeding all previous performance. The AMS has become fundamental to Emergency Medical Services (EMS) in achieving its ambulance performance targets by ensuring that long distance acute transfers are done by air thereby reducing risk to the patient and improving access to emergency services by local communities. The quality of care provided in this critical care environment has been open to clinical audit by stakeholders in the public health sector and this essential oversight ensures that technical clinical quality continues to improve. EMS and AMS face significant challenges in the delivery of this service not least of which the real economics of managing a medical aviation service, runway and landing zone infrastructure in distant communities, retention of skills in a highly technical medical and aviation environment, corruption in government and the private sector which threaten continuity and stability in a sensitive service platform, increasing service demands within and without our borders and many others. These challenges can only be met by a secure contracted partnership in a longer term relationship with robust collective reflection and adaption. We service this Province and region with distinction and support the economics of a wide range of industries and society by the security that our services provide and South Africans can be proud of the service standards we deliver through our compact with our many stakeholders and clients. On a personal note this will be my last comment on the AMS as I make the move from Government into the private sector. I have seen the AMS grow during my tenure from a single aircraft, single staff and fledgling service run by volunteers to a full professional and highly technically competent medical rescue service that is an integral part of the South African Health Services. I have been proud to be part of this journey and to be able to contribute to the legacy of AMS. My very best wishes remain with all the volunteer pilots, professional pilots, paramedics, rescue technicians, aircraft mechanics, administration and management of AMS, I salute you. Dr Cleeve Robertson Head of EMS Services Western Cape Department of Health We service this province & region with distinction... SPONSORED BY: 11

14 kwazulu-natal operations KwaZulu-Natal is an exciting place to be with all the innovation, changes and willing stakeholders that are constantly pushing boundaries in service delivery. The aero-medical services has expanded significantly in the last year and continues to grow. The Outreach on the other hand has been affected by the weather and many other factors that stunted its growth. In addressing the outreach matters there was also opportunity to re-think and realign the service to meet the needs of health delivery in the province. As a spin-off from the redress process the partnership between the KwaZulu-Natal Department of Health (DOH) and AMS was reaffirmed and many new ideas born. Outreach The Flying Doctors Service has reached out to more than patients that received specialist care across KwaZulu-Natal. This is the evidence of the outlying community s ability to access specialist health services through the joint initiative of the KZN Department of Health and AMS. All gratitude to the healthcare practitioners that have volunteered their time and expertise to support the outreach programme. There is no doubt that their interventions through specialist consultations, teaching ward rounds, surgery and other efforts have impacted positively on the morbidity and mortality rates in the province. We often receive feedback from patients that share their appreciation for services received and we hope that it was not just healthcare that was metered out, but also the restoration of patients dignity and better quality of life that has been afforded to them through outreach....exciting new times many new interventions... The multifaceted outreach model also supports health care practitioners posted to the outlying facilities. In the past year approximately 4200 health practitioners participated in capacity building efforts by visiting specialists. Outreach has become a powerful medium for teaching and learning thereby helping to maintain standards and quality control. It also provides a mechanism for drawing in expertise that has been lost from the local government health system and we encourage greater participation by specialists in the private, public, religious groups and other public benefit organisations. In the rethink of outreach services governed by new policy and greater responsibility by health practitioners, the outreach is set to develop into a more structured process. Through the leadership of senior health officials there is a concerted effort to strengthen outreach for the gain of further coverage, to afford greater access, to encourage more participation and refine logistical support to make services more efficient. Photo Credit: Chris Botha - Netcare Outreach Service 2012/ /2012 Orthopaedic surgeons Surgery (all specialists e.g. Obstetrics & Gynaecology, Ear Nose & Throat, Orthopaedic.) Physician Consultation Ear, nose and throat Obstetrics & Gynaecology Patients Paediatric Patients Ophthalmology (cataract operations) Ophthalmology (screening) Anaesthetics Psychiatry Psychologist Radiology - - NICU SR General surgeon Consultations Optometric consultations Dental consultations - 3 Orthotic and prosthetic patients treated Occupational therapist Consultations 13 5 Audiology consults General Practitioner Consults 36 - Urology 3 - Dermatology 61 - Total Capacity building and training: 2012/ /2012 Special Lectures & Teaching Rounds (attendance)

15 Air Ambulance Service The KwaZulu-Natal Emergency Medical & Rescue Service (KZN EMRS) is emphasised with the medical crew working side by side with AMS pilots as a team. In the highly stressful aero-medical environment all decisions are taken jointly and safety is central to all operations. On the medical side the provision of brand new equipment allocated to aero-medical services was welcomed and makes the treatment of critically ill patients that much less stressful. The increase in the number of dedicated aero-medical staff definitely impacts on safety and quality of services rendered. In the near future, permanent medical crew appointments for both Durban and Richards Bay Operations will allow for a full roster schedule and greater coverage in extended hour operations. The formation of a local reservist medical contingent will also help boost local available medical resources and is attracting huge interest. We are inundated with requests by medical practitioners to be aviation trained and after a gap of seven years the Aviation Health Care Provider (AHCP) Course was reintroduced in Kwazulu-Natal. The AMS and KZN EMRS College of Emergency Care drew expertise from each other s resources and presented a successful programme that was very well received. We hope to increase the frequency of AHCP Course as well as other much needed aviation programmes. On the whole the aero-medical services have advanced dramatically with the introduction of night flying with helicopters in the province. Records reflect a marked increase of serviceable case requests received in the late afternoons which previously could not be undertaken by helicopters. These after hour calls have now become routine with the roll-out of night operations. The highly trained and experienced aviation team is breaking new ground with night flying in KZN. This is the first for KZN and a first for the country when civilian services start to use technology that has only previously been used by the military. We are proud to lead the industry by introducing Night Vision Goggles (NVG) for the night flying operations. This will help with greater reach and effectiveness in using helicopters at night beside the hugely enhanced safety factor. These are exciting times with many new interventions being introduced to enhance service delivery in KZN. Some initiatives include the purchase of weather stations by DOH for hospitals that will help make decision on flying conditions in the localities. The outlay may be minimal but the cost saving can be substantial when decisions are based on accurate information resulting in higher rates of mission success. In the Air Ambulance Service 2012/ /2012 Total patients transported both FW and RW Total patient flights both FW and RW Total patient flying hours both FW and RW Total provincial patients transported both FW and RW Total private patients transported both FW and RW Total provincial patient flying hours both FW and RW Total private patient flying hours both FW and RW Total Hrs on RW for both Durban and Richards Bay Total Hrs on FW for KZN both Province and Private Photo Credit: Image SA, Roger Sedres longer term planning the Department of Health is committed to aero-medical service development. This is reflected in the decision to build landing zones at all provincial hospitals so that they can also receive these scarce resources. There is a concerted effort to reach every area of the province in order to turn the tide on the high maternal and child mortality rates and other strategic health focus areas. Together with the management team of the Department of Health management we hope to develop a health delivery model that is in line with the National Health Initiative (NHI) planning. KwaZulu-Natal is the place to be not just because of the pleasant winters but mainly to be part of a progressive team that is changing the face of aero-medical services in the country. We could do a lot more but we chose to take the conservative approach and develop at a pace that does not compromise the safety or quality of operations and also implement change that is sustainable. There are lots of opportunities and potential for many programmes on the radar but we will rely on the guidance from our joint management and expert teams to plan ahead. With gratitude to all our combined staff, Department of Health partners, private & other NGO volunteers and all those who make our health system work in the spirit of ubuntu! From the Zulu Kingdom! Afzal Khan Regional Manager SPONSORED BY: 13

16 message from KZN doh KwaZulu Natal Department of Health s association with the South African Red Cross Air Mercy Service (AMS) continued with the awarding of a new contract for 3 years by the National Treasury Health. The new contract has extended hours of services with the introduction of night operations. The Joint Management Committee was revived culminating with a 2 day workshop that has chartered exiting projects amongst them the introduction of Night Vision Goggles to enhance the night operations, a first in the Aeromedical Services in Africa. 2012/2013 was a year of improvement in Aero-medical Services, KZN. Emergency Operations, consisting of Helicopter Emergency Medical Service and the Air Ambulance Service; undertook more interfacility transfers with the focus on reducing maternal and neonatal mortality. The Authorisation Process and the Flight Criteria were revised to suit the needs of the KZN Department of Health s strategic Objectives. With the increasing demand for this service and limited Advanced Life Support Personnel available in most districts, a plan to commence night HEMS operations began in May After extensive planning, the Richards Bay Night Operations commenced on the 1st of August The implementation of Night HEMS operations, saw many challenges brought to light. These challenges were addressed and further planning on mitigation of risk was conducted. The Durban HEMS night Operations commenced on the 1st of December The rollout of Night HEMS operations is from Landing Zone to Landing Zone with services provided to institutions that meet the night operations Criteria. The plan to rollout night HEMS operations to all districts will be implemented in the next financial year. Night HEMS operation is the first for KZN and despite the many challenges has added great value to service delivery in EMS. Another Milestone for KZN, is the Outreach Program, also referred to as the Flying Doctor Service. As the only Province in the country to provide this service, the aim is to provide continual specialist support to all patients. The service relies on specialists within the Department of Health and on volunteer groups to render assistance to institutions based on demand. The outreach program not only provides specialist services but also reduces the number of referrals to Tertiary Institutions out of the districts. 2013/2014 will see the implementation of many improvement strategies. Aeromedical Services is an expensive resource which is a necessity in this Province. In fact, our services extend across our borders of KZN and South Africa. We will be working in conjunction with Accident and Emergency Units to improve the quality of care provided to patients with the focus being on effective mass casualty incident management. The way forward in the new financial year is to make this service a Strategic Business Unit so that it becomes self sustaining. Dr. Sibongile Zungu Head of Department: KZN Department of Health Polokwane service statistics The Polokwane base has yet again had a busy year in operation. The base provides rapid access to emergency medical care to the rural communities of Northern South Africa. The operation has been well utilised and once again has covered the major arterial routes during peak seasons in and out of South Africa. A healthy relationship that continues to grow has enabled the Polokwane Team, The Pride of Limpopo to develop into a streamlined unit. The team comprises of both Provincial and AMS staff. One of our biggest operations took place at the end of January with the evacuation and relocation of more than 120 persons who became stranded by flood waters along the Limpopo and Sashe Rivers. Our appreciation goes to the EMS rescue team who assisted greatly with logistics on the ground as well as De Beers Venetia Mine who assisted with refueling. In line with the Ministers focus on maternal and neonatal care, the Polokwane team is in the process of developing a programme with the Pietersberg and Mangkweng Hospital Complex. The programme will allow specialists to accompany identified critical patients from the referring hospital. Two flights have already been completed, one with a specialist pediatrician and the other a neonatologist. We would like to thank our Provincial partners, colleagues and fellow crew from the Limpopo Department of Health for their continued support to our operation. Chris Broomhead Regional Manager Limpopo Rotor Wing 2012/ /2012 Patients flown Missions Hours Flown Photo Credit: David Dennison, Limpopo EMS 14

17 message from Limpopo EMS The Limpopo EMS/AMS aero-medical programme entered its fith year of operations. The helicopter was and is key during all major events held within the Province, ranging from the World Cup in 2010 to the annual Easter weekend pilgrimages. We cannot replace the role the service plays in responding to all critical patients especially when it has to cover vast distances. The service has become such an integrated part of EMS and is viewed by all to be an essential service rather than a luxury within the health care environment. The service is uniquely managed and AMS staff are viewed as colleagues and together with EMS make up the Provincial team. Recently EMS branded the Helicopter as the Pride of Limpopo expressing the pride felt by the Province and its staff. I wish to thank all EMS staff members engaged in the programme as well as the helicopter pilots who are committed and professional when performing emergency work under challenging conditions. David Dennison Manager Operations : Limpopo EMS Photo Credit: David Dennison, Limpopo EMS Air Ambulance and Rescue Patients Transported by AMS The following bases were operational for only a small part of the financial year under review free state service statistics Bloemfontein Rotor Wing 2012/ /2012 Patients flown Missions Hours Flown mpumulanga service statistics Northern cape service statistics Flying Doctor Service 2012/ /2012 Clinic Patients Missions Hours flown Clinics Specialist flown Administrative staff Nelspruit Rotor Wing 2012/ /2012 Patients flown Missions Hours Flown SPONSORED BY: 15

18 national operations centre The National Operations Centre (NOC) continues to play a critical role in ensuring that the closest appropriate aircraft and medical team are dispatched to the patient in the greatest need. The function of the NOC is to facilitate communication, support operations and provide an overview of AMS operations to ensure safety and awareness of events as they unfold. During the 2012/2013 financial year, the NOC handled incoming telephone calls on our AMS emergency line and coordinated 771 air ambulance missions. The AMS national operational database has been rolled out to all bases and has provided a unified data collection and analysis tool. The database has been able to provide significant insights into the utilisation trends and patient load in the Western Cape and has been of significant benefit to the Western Cape Department of Health. We had to say goodbye to Sr. Monique Niehaus who made a significant contribution to the NOC. We also welcomed Theresa Cotter to the team. I would also like to thank the NOC staff for their dedication and commitment in a year with many changes and challenges. Training The training department said farewell to the Training Manager Cheryl Pedersen, who left for the United Kingdom. Cheryl was instrumental in developing the Medical Crew Resource Management (CRM) course which was implemented with great success in the Northern and Western Cape in Cheryl was also very successful in obtaining students for some of our courses from the United Nations and International Medical Companies. Other courses presented during the year included Intermediate and Advanced Life Support Aviation Healthcare Provider, Advanced Airway Management and Ventilation, CAT OPS 138 and Aviation Rescue. AMS operates the Emergency Medical Response Team at Cape Town International Airport for the Airports Company South Africa (ACSA). This allows AMS the opportunity to employ and develop Basic and Intermediate Life-Support personnel, AMS would like to thank the volunteer doctors, nurses and paramedics who lectured and instructed on these courses. We would also like to thank Riaan Smit from the South African Weather Service, the Cape Peninsula University of Technology Survival Centre for Helicopter Underwater Escape and Survival Training, Wilderness Search and Rescue, the South African Air Force: 22 Squadron and the Provincial Government of the Western Cape College of Emergency Care for their support in providing quality instruction and training to medical professionals in the field of aviation healthcare. Cape Town International Airport Emergency Medical Response Team Airport Clinic In October 2012, AMS opened an Occupational Health Clinic at Cape Town International Airport. Sr. Caryl Lansdell brings a wealth of occupational health nursing experience and knowledge to this new project. The clinic offers an occupational health service to ACSA and airport stakeholders, as well as providing a response base for the Emergency Medical Response Team. as well as providing a means to assist ACSA who has continued to provide support for AMS operations nationally. Hilton Sampson resigned as supervisor during the year; we welcomed Jason Japhta as the new supervisor. AMS will be introducing a General Practitioner, Dentist, Wellness and Beauty Therapy, as well as Travel Medicine services. Garth Moys Manager: NOC, Training and Special Projects. 16

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20 safety The focus for the Safety Department this year has firstly been to review and reinforce the AMS safety systems and secondly increasing the safety awareness and accountability amongst the Management & Safety teams for dissemination to all staff levels. I would like to express my appreciation to all our staff for their support. The backbone of the safety system depends on the commitment of both the line management and the Base Safety Representatives who deal with the bulk of the identified risks from a frontline perspective and whose active involvement is pivotal for the success of the safety management system. For this reason the broad objective of the Safety department this year was to engage with the AMS management team on safety responsibility, accountability, the increase in hazard and risk identification and reporting. It is my current perception that this objective has to a greater extent been achieved amongst the management team. The next objective is to get all staff onboard in terms of recording risks identified. My observations during the auditing process is that as an organisation the AMS is identifying hazards and dealing with these hazards at a front line level but what is lacking is the recording of these risk management activities and so our record of safety risk management is weaker than our actual activities undertaken. So an area for continued improvement is the recording of the identified hazards in the correct reporting structure. This information is vital to allow the organisation to move from a largely reactive/proactive safety response to a predictive safety culture. Standardisation and safe practice within the organisation were reviewed during the internal Safety Audits conducted last year with no significant safety findings identified. The Global Risk Reduction graph below for the 2012/2013 financial year, clearly shows how the organisational risk can be reduced by identifying hazardous situations and actively managing them through the AMS Safety Management System (SMS). I would like to express my appreciation to the Base Safety Representatives (BSR s), the line managers and all our staff for their support of our Safety Strategy during the last year and I look forward to again working with you all in the coming year towards higher safety standards and reduced risk exposure. Yours in Safety. Gary Mc Cormick Safety Manager Global Risk Reduction Based on all ASR s Risk Value Reporters Assessment Safety Initial Assessment Safety Final Assessment Note: 1) Definitions: Reporters Assessment is the risk score that the reported attaches to the safety related occurrence. Safety Initial Assessment is the score attached by the safety trained representative based on zero mitigation. Safety Final Assessment - is the residual risk score after mitigation steps have been taken. 2) The Global Final Safety Assessment score for 2013 is marginally higher than the previous year. After reviewing the data, this is as a result of improved recording of identified hazardous occurrences, although exposed to previously were not recorded in the system - which have an acceptable yet higher residual score. 18