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Community-based paramedics save lives – and need no SAPS escorts

Unlike paramedics operating elsewhere in Cape Town – or across South Africa – the crews of the Hout Bay Volunteer Emergency Medical Service do not fear attack while on duty. They have been safe since the organisation launched in 1994, allowing them to respond without delay to life-threatening emergencies instead of having to wait for a police escort.

“We know the communities and leaders in Hout Bay and our experience has been good,” says volunteer paramedic Matthew Rosenberg, who has worked for the service for 13 years, but also has a full-time job.

The ocean and mountains isolate Hout Bay, and the geography gives an ambulance based in the valley significant advantages over traditional services in responding to emergencies, reports the Sunday Times.

A study found that the Hout Bay EMS mostly met the target time of 15 minutes or less for priority calls between 2015 and 2020. It also eased the load on the provincial government’s over-stretched services.

Dr Shaheem de Vries, medical director of the Western Cape government’s emergency medical services, says the volunteer ambulance service is a model for how to partner with the people they serve, and get active citizen support.

“To provide critical services we need to heed their lessons, to build stronger relationships, particularly in ‘red zones’.”

Ambulances no longer enter high-risk areas without police protection in Cape Town, where 78 paramedics were attacked while on duty in 2021, says Western Cape EMS spokesperson Deanna Bessick.

The risk of violence against paramedics is a national problem, says Mpho Mpogeng, president of the South African Emergency Personnel’s Union.

“We raised the issue of safety long before COVID but the government has not implemented a single solution we proposed, like vest cameras,” he says. “All the provinces have no-go zones and the attacks are not stopping.”

Hout Bay, a tourist destination, is not exempt from violence or crime and has extreme disparities in living conditions.

“The most common calls are for assaults, which dropped off sharply in lockdown, and for chronic conditions like heart problems or TB, or an acute attack like asthma,” says Rosenberg. “I have even delivered five babies at home.”

In February, the volunteer ambulance transported a gravely injured patient off Chapman’s Peak Drive after her car plunged over a cliff and burst into flames. Rescue and EMS teams working together got her to safety.

Ewald Bonzet, who volunteers for the NSRI and the air-sea rescue unit, says: “I volunteer on the road to keep as current as possible with medical conditions and to keep me sane for my desk job.”

The teams usually cover at least eight hours and sometimes 12 hours or more per shift.

Rosenberg says of the provincial EMS: “Their workload is endless and relentless. You hear it over the radio.”

Last weekend the Western Cape EMS responded to 5,211 incidents, more than a third of which were life-threatening conditions requiring urgent treatment.

In the African Journal of Emergency Medicine, the first author of the recent study, Dr Charmaine Cunningham, of UCT surgery’s EMS division, writes with her co-authors that “developing community-based ambulance services, especially in areas that are remote due to distance or topography” has proved beneficial.

But volunteer services are confronting staffing challenges now that short courses for lay people in basic and intermediate life support – such as Rosenberg did in his university holidays – no longer exist.

“My dad was a volunteer at St John’s Ambulance for years and 70% of my staff, if not more, started their careers as volunteers,” says De Vries.

Cunningham says that training community first-aid responders who can slot in with ambulance services must be a priority. A paramedic and critical care nurse with a PhD in emergency medicine and an MBA, she has an overview of what emergency services need from the ground up.

“If we can test this model in an active community like Hout Bay – which has resources, leaders, community structures and apps – and demonstrate it works, this model could be scaled up for rural areas and even rolled out across Africa,” she says.

Study details

The activities and impacts of a community-based volunteer ambulance service in Cape Town, South Africa

Charmaine Cunningham, Matthew Rosenberg, Jurgen Kahle.

Published in African Journal of Emergency Medicine on 10 June 2022



Volunteering yields valuable benefits to communities, yet globally there is limited published data regarding emergency medical volunteering in communities. Hout Bay Volunteer Emergency Medical Service is thought to be the oldest volunteer ambulance service in Cape Town. The objective of this paper is to quantify the contribution of the community service to the Western Cape Government Health: Emergency Medical Service. This paper describes the inputs, key stakeholder relationships, and the impact of COVID-19 on volunteer input and community needs.

Electronic Computer-Aided Dispatch records were used for analysis. Data extracted included detailed information about all recorded incidents between 1 January 2015 to 31 December 2020. Data were analysed in Google Sheets using Pivot Tables and summary statistics.

Between 2015 and 2020 HBVEMS responded to approximately 12% of all call-outs in the Hout Bay area, which equates to 2187.16 h of operational time spent on calls. This excludes standby time, i.e., time spent waiting to be dispatched. There was an expected noticeable difference between response times for ambulances based within Hout Bay, and those from outside Hout Bay. Despite a decline in average call-out rate during the 2020 Level 5 lockdown, the volunteers were able to do more shifts and thus more calls within the community. Call-outs during 2020 were visualised as a ratio of trauma to medical calls. In this period there were noticeably fewer trauma calls.

There is a growing need for emergency medical care, and volunteer ambulance services can have a meaningful impact on the continent. The findings support the benefit of developing community-based ambulance services, especially in areas that are remote due to distance or topography. The model can be expanded to other communities across the continent. A key factor for success is actively managing stakeholder relationships which include community-based relationships as well as governmental or formal emergency medical services relationships.


Sunday Times article – How to rid the ‘red zones’ of fear for emergency services (Open access)


PubMed article – The activities and impacts of a community-based volunteer ambulance service in Cape Town, South Africa (Open access)


See more from MedicalBrief archives:


Ambulance shortages and paramedic attacks cripple Gauteng emergency services


IFP demands that KZN institutes measures to protect under-fire paramedics


Cape Town paramedic shot while under SAPS escort


Police to escort paramedics in 6 'troublesome' Johannesburg areas




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