(The following Debate was delivered during a Sitting of the KZN Legislature held earlier today)
Emergency Medical Services (EMS) is often the first point of contact for many patients entering the healthcare system. Its efficiency therefore has a direct impact on patient outcomes and the overall performance of the health system. Unfortunately, the current reality is that as the demand for EMS services increases, resources available to provide these services are not keeping pace.
Key challenges affecting EMS in KwaZulu-Natal (KZN) include infrastructure, human resources, fleet management, communication systems, increasing service demand and financial constraints.
Infrastructure challenges
Many EMS bases are not purpose-built facilities. Several operate from park homes originally purchased decades ago as temporary structures, but are still in use today. These structures are now in poor condition and do not meet the operational requirements of modern EMS services.
In addition, many bases do not comply with the requirements of National EMS Regulations. A particular concern is the lack of appropriate wash bays and sluice facilities required for proper cleaning and infection control of ambulances.
Infrastructure has identified 35 sites where wash bays must be constructed or upgraded. While some projects are underway, progress has been slow due to contractor challenges and legal disputes. At present, there is also no clear plan to replace temporary park-home structures with permanent EMS facilities.
The Democratic Alliance (DA) recommends that EMS facilities be prioritised within the Infrastructure Development Plan, ensuring that future upgrades of hospitals, community health centres and clinics include purpose-built EMS bases.
Human resource shortages
KZN currently has 3 052 approved EMS posts, of which 2 731 are filled. This means that 321 posts are technically vacant. However, some posts were abolished due to budget constraints and therefore do not appear as vacancies in the Persal system.
Supervisory capacity is particularly concerning. Of KZN’s 167 shift leader positions, 89 are vacant. This significantly affects the ability to maintain effective 24-hour operational oversight.
In terms of operational staff, KZN currently has:
• 1 012 Intermediate Life Support staff – with 179 vacant posts
• 1 325 Basic Life Support staff – with 132 vacant posts
• 34 Emergency Care Practitioners – with 42 vacant posts
• 26 Emergency Care Technicians – with 3 vacant posts
• 29 Emergency Care Assistants – with 1 vacant post
The Emergency Care Practitioners shortage is particularly critical, as they provide advanced life support and are essential for managing critically ill patients.
The current roster system also contributes to excessive overtime. Staff frequently work well beyond the standard 160 hours per month required by labour legislation, resulting in high overtime expenditure. A revised roster has been proposed to reduce overtime costs and allow funds to be redirected toward filling vacant posts.
Training and Professional Development
Historically, short courses such as Basic Life Support, Intermediate Life Support and Advanced Life Support were widely available. These courses have since been discontinued and replaced by tertiary-aligned qualifications, including Emergency Care Assistant, Emergency Care Technician and Emergency Care Practitioner programmes. Unfortunately, limited training capacity at the College of Emergency Care means that many staff are unable to upgrade their qualifications.
EMS Fleet
The EMS fleet situation presents one of the most serious operational risks. KZN currently has 487 ambulances, 38 advanced life support response units, and 11 rescue units. However, 248 ambulances – more than half the fleet – have exceeded their useful lifespan of 250 000 kilometres, as stipulated in the Vehicle Replacement Policy. These vehicles remain in service because there are insufficient funds to replace them.
As a result, maintenance costs are extremely high and vehicle breakdowns are frequent. Minor repairs can take between one and three months, while major repairs may take three to six months.
The current fleet maintenance contract has also presented challenges, with service providers failing to meet turnaround times. Rural districts face additional delays because many service providers are located in urban areas, requiring vehicles to travel long distances for repairs. The unavailability of spare parts, some of which must be imported, further increases downtime.
In the last financial year, KZN’s Department of Health (DoH) purchased 38 new ambulances to add to the fleet. However, this number is insufficient to address the broader fleet replacement requirements.
According to national norms there should be one operational ambulance for every 10 000 people. With a population of approximately 11.9 million, KZN should have around 1 189 operational ambulances. Currently, the baseline operational capacity is only 212 ambulances. This leaves a gap of approximately 977 ambulances.
EMS communication centres
Centres that communicate emergency responses face operational limitations. A total of 302 staff members work in these centres, operating across four shifts, to ensure 24-hour service.
However, KZN does not have an electronic vehicle dispatch or fleet management system. Instead, EMS relies on a paper-based process. Calls are recorded manually, triaged by the call taker, and then physically handed to a dispatcher who communicates with ambulances using analogue radio systems.
While this system continues to function, it is outdated and inefficient. The introduction of a Computer Aided Dispatch system would significantly improve call logging, vehicle tracking, coordination of emergency responses, and reporting. However, the implementation cost is currently beyond available funding.
Growing EMS demand
KZN EMS attends to more than half a million emergency and non-emergency cases each year – and this demand continues to increase. A significant portion of this workload involves inter-facility transfers of patients between hospitals. When the Planned Patient Transport Services cannot accommodate these transfers, they overflow into the EMS system, diverting critical resources away from true emergency cases and contributing to longer response times.
Long travel distances between rural facilities and tertiary hospitals further increase turnaround times, particularly when critically ill patients require specialised equipment or advanced life support skills.
Several additional factors also contribute to response delays, including incomplete information from callers, communication challenges, traffic congestion, poor road conditions, and adverse weather.
Financial constraints
Financial constraints remain the underlying issue affecting most aspects of EMS operations.
Budget limitations restrict fleet replacement, equipment procurement, maintenance and the filling of critical staff posts. Some districts operate with maintenance budgets as low as R250 000 annually, which is insufficient for high-mileage emergency vehicles.
Without increased funding, EMS is forced to continue operating ageing vehicles, delay recruitment, and postpone critical infrastructure improvements.
Despite these challenges, several interventions have been proposed to strengthen EMS services. These include;
• Large-scale recapitalisation of the ambulance fleet
• Introduction of maintenance plans for new vehicles
• Revision of staff rosters to reduce overtime expenditure
• Development of retention strategies for scarce skills including Emergency Care Practitioners and;
• The implementation of a Computer Aided Dispatch system.
Additional measures include strengthening training and capacity building, improving coordination between EMS and health facilities, enhancing community engagement, exploring public-private partnerships and investing in technology and infrastructure improvements.
While EMS plays a critical role in the healthcare system – representing the first point of access to care for many patients – the service is currently operating under significant strain due to infrastructure limitations, staff shortages, ageing fleet, increasing service demand, and insufficient funding.
If EMS is unable to sustain its current operations, it will not be possible to expand services to meet the needs of the growing population. It is therefore essential that it be prioritised within the broader health system to ensure that it can continue to provide timely, effective and life-saving care to the communities it serves.