Submitted in fulfillment of the requirements for the degree of Master of Health Sciences in Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2017. / Introduction: Response times are considered to be one of the oldest and most popular indicators which are used to measure the efficiency of Emergency Medical Services (EMS), particularly to cases in which the patient’s condition is deemed to be life threatening. Purpose: To analyse emergency response times within the public sector Emergency Medical Services in KwaZulu-Natal and to compare these to the national norms. Methods: Using a mixed method approach, the study was conducted in two phases. The first phase involved collecting quantitative data for all the cases logged in the Umgungundlovu Health District Communications Centre over a period of one week (seven days). Phase Two involved the collection of qualitative data from focus group discussions which were conducted with three groups which had been identified. These groups included the communications centre staff, operational staff and supervisory staff. The aim of these focus group discussions was to identify factors that influenced response times as well as to propose strategies which would improve these response times. Content analysis was utilised to interpret the qualitative data which had been collected. Results: Quantitative data was collected from a total of 1 503 cases of which 680 were categorised as priority 1 (P1), 270 as priority 2 (P2) and 553 as inter facility transfer (IFT). The majority of the cases (895) had occurred in urban areas. A total of 406 cases were exempted as no patient was transported. The number of these cases was greater on days when the total case load was higher as compared to days with a lower total case load. The mean response time to cases in rural areas was 129 minutes and 110 minutes to cases in urban areas. All the time intervals were found to be longer for cases in rural areas as compared to those for cases in urban areas but with the exception of the EMD response interval. P1 cases had the shortest mean response times for both urban area cases (33 minutes) and rural area cases (95 minutes) as compared to the other case categories. Nevertheless, the national norm of 15 minutes in urban areas and 40 minutes in rural areas was not achieved in the majority of the cases. The mean Emergency Medical Dispatch (EMD) response interval was 41 minutes for P1 cases, 56 minutes for P2 cases and 96 minutes for IFT cases. The qualitative data revealed factors that impacted on the response times and helped to explain and account for the quantitative data results. Challenges regarding the availability of resources, including vehicles, staff and equipment, as well as the way in which such resources are managed, were highlighted. The high demand for services compared to the available resources was raised by the focus group participants with this high demand resulting in extended EMD response intervals. This was exacerbated by the overwhelming demand for IFT cases which are serviced by the same resources as emergency cases and which have a much longer mission time, thus delaying response times continuously. Exempt cases were also found to impact negatively on response times as, although operational vehicles are committed to these cases, services are not required. Inconsistencies with regards to case prioritisation and dispatch triage also emerged. External factors, including poor road infrastructure, lack of road names and house numbers, weather conditions and long distances between EMS bases, the patient or incident location and health care facilities were also identified as factors that resulted in extended response times. Strategies to improve the situation were explored. These strategies included the effective management of resources in order to ensure optimal availability, the introduction of a formal, computer aided, dispatch system, the adoption of demand pattern analysis and dynamic location/relocation models, standardised processes and procedures to guide all areas of EMS operations and the education of both the public and staff. Conclusion: South African EMS response time national norms for both rural and urban areas are unachievable under the majority of circumstances and, thus, they may be said to be unrealistic. Until these national norms, against which the efficiency of EMS in South Africa is measured, are revised, the service will be deemed to be incompetent. / M

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / Earthquakes are the most frequently occurring natural disaster around the world and it is associated with a large outpouring of humanitarian assistance from the world. Existing models for humanitarian non-governmental organizations (NGO) focus on a variety of preparation and response decisions for aid distribution, but tend not to discuss medical rescue teams responding to international disasters and where they would fit into. Aim The aim of this study was to explore the preparedness of South African Non-Governmental Organisation relief teams for international earthquake response. The ultimate aim was to develop a framework for SA NGO teams responding to international earthquake disasters. Methods This qualitative study made use of a range of data collection tools including documentary sources and interviews, so that it could illuminate the study from all sides and to ensure all relevant data from people and organisations that span the globe could be collected. Conclusion and recommendations The result of the study was a conceptual map of the study recommendations which can be used in the development of a framework for improving South African NGO relief teams‟ response efficiency and effectiveness to international earthquake disasters. The research concludes with a series of recommendations which include: assigning the teams under a leading international academic and operational body and to identify qualified, well prepared and professional personnel on a database for rapid deployment. / Research and Post Graduate Development and Support.

PhD (Environmental Management) / Mining and mining-related activities remain the world’s most intensive, primary industrial activity undertaken with severe environmental impact. Coal mining falls within these primary undertakings, while coal burning for energy use further adds to environmental degradation. Coal burning is by far the least expensive and thus the most affordable means of energy supply to the South Africa low-income communities. It is likely that this status quo will continue indefinitely. The use of coal as an energy source in South African communities has been inherited with its resultant environmental (physical), social and economic implications. The physical implications are the actual hazards associated with coal during and after mining activities. “Physical hazards” include processes generating coal dust, coal ash and gaseous emissions, and hazards that manifest themselves from the existence of coal mining at a particular site, such as spontaneous combustion, surface instability and acid mine-water drainage. “Social hazards” are mostly the social and economic effects that are related to health. Social hazards associated with coal mining, coal processing and coal usage include dilution of cultural values, ethics, norms and the growth of informal sectors, for example, settlements and trade. Some of these hazards are immediate, while others are long-term and cumulative. Emphasis was placed on the cumulative effects of mining activities and the need to address issues relating to communities that live close to mining operations. This process of addressing community concerns is known as “creating a sustainable mining community”. South Africa hosted the 2002 World Summit on Sustainable Development and is a signatory of the working plan of action known as the Johannesburg Plan of Implementation. Therefore, one would expect to see that mining communities in South Africa are acting on and benefiting from this plan of action. The aim of this research is to assess the effectiveness of the 2002 World Summit on Sustainable Development and the Johannesburg Plan of Implementation in promoting sustainable mining and sustainable communities through changes in practices, perceptions and community participation in decision making. The research, undertaken during February to June 2007, examines the role of stakeholders and local authorities in basic environmental decisions. Environmental decisions examined were the provision of education and information to the community, uplifting community welfare through corporate social investment and corporate social responsibility. The surrounding communities of eMalahleni (formerly Witbank) in the Mpumalanga (Highveld) coal-mining region – were identified as a suitable area for this case study. Social research tools, comprising multiple-choice and open-ended questions administered to 6 790 respondents (3 930 learners and 2 860 general adult population), 650 voluntary comments, six individual interviews, and a 20 member focus group discussion, were used. Photographic images and personal observation provided meaning to results by presenting the quantitative and qualitative data visually. A blended methodological approach was used to analyse the data using descriptive statistics and a t-test for variance. Tables, bar graphs and pie charts were the various representative techniques deployed during the analysis. Data were analysed comparing statistical input and responses of the learners and the general population. Results presented show that the studied community is aware of some hazards associated with coal from the mining process to indoor combustion. The community studied is aware of the need for pro-active measures to protect their community. Members of the community are not aware of company decisions affecting the community with regard to coal hazards. They are also unaware of the existence and application of environmental legislation. Awareness was not linked to education or information obtained from a reliable source, such as a mining company or a local authority. It was based on personal experience, longevity of dwelling in the community and observation of the health conditions of relatives and friends. Some voluntary comments from the respondents and photographic images are included to support the community’s outlook. The research concluded that there are more unidentified hazards in the community than were covered in the structured questionnaires. The responses received to the questionnaires exposed the mining industry as being dismissive when it came to applying the law. This evasive behaviour emanates from the laxity of the enforcement departments and responsible authorities. More needs to be done to attain the requirements of the Johannesburg Plan of Implementation as agreed upon at the 2002 World Summit on Sustainable Development.