If you are visiting Southern Africa, particularly if you are intending to go on safari in some of the more remote destinations like the Zambezi Valley, you may be concerned about standards of health care and emergency services available to assist in the event of seriously illness or injury.
Zimbabwe is still fortunate to have one of the most efficient and best developed private Emergency Medical Service (EMS) systems on the continent outside of South Africa. Several organisations provide these services, two of which are travel network partners of Wild Zambezi.
To assist visitors coming on safari to Zimbabwe, we asked each of them them to outline their key medical rescue road and air ambulances services, to clarify the situation with regard to insurance and to outline the EMS training that they provide to the safari industry.
1. EMRAS (Emergency Medical Rescue Ambulance Services) (pictured above) is a part of the Premier Service Medical Investments health care Group. While headquartered in Harare, they operate bases in all major centres throughout Zimbabwe specifically Bulawayo, Bindura, Chiredzi, Gweru, Mutare, Kwekwe, Masvingo and Victoria Falls.
Ground ambulances: EMRAS have a fleet of well equipped ground ambulances available to respond in urban centres and to conduct long range road ambulance transfers.
Ambulances are fully equipped with oxygen airway management equipment, IV fluids, emergency drugs, full spinal immobilization equipment, splints, patient monitors defibrillators and where required transport ventilators thereby providing advanced life support (ALS) care when necessary. They employ registered Ambulance Technicians, Emergency Medical Technicians, Registered General Nurses, many of whom have Advanced Cardiac Life Support and they have doctors on call to effect air evacuations or assist on Long Range calls.
Bases operate 24 hours a day and Control Rooms are manned by Dispatchers who will take your call and dispatch ambulances as necessary.
Air Rescue: For medical air evacuations, EMRAS work in partnership with Life Flight – operated by Executive Air who have various aircraft registered and capable of providing medical evacuations from most airstrips, including bush strips, including a King Air 200 and a Caravan, Cessna 402 and Piper Navajo which are more suitable for bush strips in remote areas. Life Flight/Executive Air have approval from the Civil Aviation Authority of Zimbabwe (CAAZ) to conduct medical evacuations, and provide a more cost effective solution for patients where medical aid cover is not guaranteed or refused. Aircraft crew undergo regular Medical
Evacuation courses to ensure they are aware of the effects of flight on patients in various conditions.
The normal crew comprises a doctor and a Flight Nurse all of whom are usually ACLS or ICU trained. Aircraft are based in Harare but most destinations in the country can be accessed within 45 minutes to an hour of takeoff. In most cases, visitors requiring medical rescue are usually evacuated to the most appropriate medical facilities in Zimbabwe, especially back to Harare or air lifted to South Africa.
Insurance: To access the above services from EMRAS, it is essential for patients to be on medical aid or to have a good international health assistance scheme which includes evacuation cover and hospitalization in emergencies. In the normal course of events this information is usually required, and authorisation sought from the insurer prior to effecting an evacuation. This can create a delay. It is therefore advisable, particularly for independent travellers visiting more remote areas, to carry a well stocked First Aid Kit.
EMRAS accepts international medical aid and insurance schemes to cover travelling tourists and as a result, separate local arrangements are very minimal.
Possible delays: EMRAS advises that travellers should be aware that time of day and weather can also cause delays for air evacuation in remote areas. During the rainy season some smaller dirt strips may become inaccessible. Also pilots may be reluctant to fly into strips at night if they are unfamiliar with the strip and it is not adequately lit. Immediate and effective First Aid is therefore essential. Where possible it is advisable to transport a casualty, depending on injuries, to the nearest medical facility. Even a rural hospital or health centre, however basic, may be able to provide some assistance while awaiting evacuation. Movement of suspected spinal injuries however is not advisable without adequate immobilization.
Training: EMRAS offers basic First Aid training to the various players in the industry usually at their lodges or hotels so that they in turn can assist their guests or tourists in times of medical emergencies. The training curriculum is tailor-made to suit common injuries experienced in the tourism industry. Usually, training happens as soon as the tourism players request for one or agree to a suggested or offered EMS training program.
2. ACE Air and Ambulance have bases in both Harare and Victoria Falls with medical emergency training centres.
They operate with their sister company, Halsted’s Aviation Corporation (HAC) and have been granted accreditation by EURAMI - the European Aeromedical Institute, which promotes high quality aeromedical transfers offering an internationally accepted scientific level of care to all patients.
Emergency evacuation from remote and tourism areas: ACE has full ownership of a fleet of three King Air aircraft, with one fully dedicated as an air ambulance 24 hours a day. We therefore do not have to charter an aircraft from a partnering company, which would then have to be reconfigured from a passenger aircraft to an air ambulance, wasting a considerable amount of time that is extremely vital in the case of an emergency.
The King Air aircraft are able and suited to land on nearly any dirt strip in Zimbabwe and our surrounding countries, allowing for the widest reach possible for air evacuation.
ACE has also recently added a Learjet 45 to their fleet, which will very soon be added to their manifest in order to do medical evacuations. The Learjet is able to fly at a far higher altitude and far faster than the King Airs, considerably reducing the flying time between destinations. So, for example, the approximate flying time needed for the Learjet from Harare to Kariba will only be 25 minutes, and from Harare to Victoria Falls will be 45 minutes. The larger interior of the Learjet will also allow two family members to accompany the patient, as opposed to the King Air aircraft, which can only cater for one extra passenger.
The Learjet’s capabilities also allow ACE to transport patients to destinations that are of a much longer range than what the King Air aircraft are capable of.
Evacuation can be directly to the required destination of the patient; this is often Johannesburg. Even when collecting a patient from a remote area, aircraft are fully outfitted with all the ICU equipment needed to fly directly to their end point and are not required to stop in Harare. ACE also employs specialist doctors and flight nurses who are available for every medical evacuation.
The aircraft are equipped with certified life ports, and self-loading ICU life support beds, reducing the risk of handling error. On board blood gas analyzers and ultra sound equipment allow our specialist doctors to provide an in-depth analysis of the patient during the flight.
ACE makes use of live two-way satellite communications, allowing for continuous live updates on the patient’s status during a medical evacuation. This is hugely important as preparations can be made at the destination for exactly what the patient will need, as well as the insurance company and the family being kept updated.
Insurance: Every medical aid/isurance scheme has different ‘levels’ of cover, so each individual would need to ascertain whether the scheme that they are on covers remote evacuations. If an incident does then occur, ACE is required to obtain authorization from the insurer prior to commencing an evacuation. This process can sometimes be lengthy and is usually the cause of the delay if an evacuation is delayed at all. The majority of safari camps in remote areas ensure that their main staff have first aid training, and there is a doctor at ACE headquarters who is available at all times to help give advice over a phone call if the circumstance arises that there is a delay in the evacuation.
ACE was the first emergency service in Zimbabwe to be accredited by the European Aeromedical Institute, EURAMI, and the third in Africa. This accreditation ensures that all their clients will receive the absolute in world-class standards of emergency care. Recently ACE has also received accreditation on the grounds of Service Excellence and Advanced Technology in the pre-hospital setting from the International Assistance Group (IAG), which is based in France.
Training: ACE offers a wide range of training courses, from Basic First Aid, to Advanced Cardiac Life Support courses for health care providers. They have fully equipped training centres both in Harare and Victoria Falls where they provide all their own training, and are accredited by the Resuscitation Council of Southern Africa and follow the guidelines of the American Heart Association. Every course is tailor-made for the specific audience that will be receiving it, in order to provide the students with the greatest depth of relevance possible. Training courses are held very frequently throughout the year, the dates being set as the course is required.