Please take the time to read through the disclaimer at the end of this document.

It is commonly known that “a chain is only as strong as its weakest link”. Consider the South African environment when you look at the above four links in the diagram above of a “chain” in the pre-hospital emergency environment for children:
There are many interventions that are made for sick and injured children in the pre-hospital environment but, for simplicities sake and to emphasise the most important aspects of pre-hospital management of the sick or injured child, these have been narrowed down to only 4 crucial steps. Combined, these interventions have been called the “Paediatric Chain of Survival”.
Developing the Paediatric Chain of Survival was not haphazard. Only after compiling many years of research and considering many expert opinions was this chain developed and proposed by the American Heart Association.

Before reading further take a few minutes to consider your environment and how these four links would relate to your circumstances. Out of those four “links” which would you say are the weakest and which are the strongest links?

(Go back to the diagram of the Paediatric Chain of Survival)

The first link in the Paediatric Chain of Survival is “Prevention of Injury and Arrest”.
Although the cliché “prevention is better than cure” seems obvious it appears that this wise adage is not taken seriously in South Africa especially when considering road safety. All one needs to do is stand outside the parking area of a primary school and see how many parents and child minders don’t strap children into their cars properly. Unrestrained children, standing on seats of cars or sitting on adult’s laps is a common sight but potentially fatal!
For this reason the symbol that the American Heart Association uses to depict this first link is a Child Car Seat. This emphasises the importance of using restraints in motor vehicles.
Some of the most common causes of injury, disability and death to children are the following:

• motor vehicle passenger injuries
• pedestrian injuries
• bicycle injuries
• submersion
• burns
• firearm injuries
• assault
• war crimes

Other than using car seats further prevention of injury strategies include:

• Educating children about the dangers of heat (fire, cooking, matches, flammable liquids etc.)
• Storing hazardous chemicals and medication out of the reach of children
• Encouraging children to wear helmets and other protective attire when cycling (or rollerblading / skating etc.)
• Teaching a child to respect water (whether that water is in a bucket or in the sea) and teaching them how to swim from an early age
• Locking away firearms and ammunition in a child-proof safe (which includes “teenage-proof” – admittedly not easy!)

In my opinion this is a very weak link in South Africa.
Do you agree or disagree?

(Go back to the diagram of the Paediatric Chain of Survival)

Unfortunately a child can easily become a victim of a life threatening emergency despite our best efforts to prevent sickness and injury.
CPR is the second link in the Paediatric Chain of Survival. CPR is an acronym for “Cardio-Pulmonary Resuscitation”. It involves artificially assisting the “cardiac” (heart) and “pulmonary” (lung) system when a victim’s natural system fails for some reason.
The pictures often used to depict this second link in the Paediatric Chain of Survival are either artificial ventilations or chest compressions that are performed by the rescuer.
Unfortunately very few people know how to do effective CPR. And even if they do unfortunately it is performed too late.
I often remark that just because someone has seen Baywatch on TV (or any other sitcoms or movies that often portray CPR) doesn’t mean that they will know how to do CPR – especially when it comes to children! Although CPR is a relatively easy skill it still needs to be taught and practiced. Furthermore, in an approved course curriculum, many other crucial skills are taught, not only CPR.
In South Africa there are many institutions that offer courses in CPR but sadly many are not registered or approved with the governing bodies that assist in ensuring quality courses are delivered. Make sure that you complete a course with only an accredited institution and report any institution that claims to be registered and is not.
RescueRoxy (association incorporated under Section 21) are proud to align themselves to the Emergency Care Global (Pty) Ltd Health and Safety training institute (www.emergencycareglobal.co.za).

To see the six most basic steps to remember when considering doing CPR click on “The Emergency Alphabet” – however, please remember that this does not qualify anyone to do CPR. I encourage everyone to attend an accredited course as soon as possible – this is a life or death decision!

In my opinion this is a very weak link in South Africa.
Do you agree or disagree?

(Go back to the diagram of the Paediatric Chain of Survival)

The symbol used for the third link in the Paediatric Chain of Survival is the “telephone” – because this is the manner in which the EMS are most often called.
EMS stands for “Emergency Medical Service”. Unfortunately the response times of all EMS providers in South Africa, both private and government, are dismal! Ideally the response time from collapse (when the victim loses consciousness) to providing Advance Life Support measures should be less than 10 minutes. There are very few places in the world that come close to this time but nevertheless this is the goal. This is why this time frame has been nicknamed the “Platinum 10” as opposed to the now outdated “Golden Hour”.
There are many telephone numbers that could be utilised throughout South Africa. But, instead of being helpful, it unfortunately simply confuses the public and results in additional delays which ultimately decrease the chances of survival for a critically sick or injured victim.
The numbers that the Resuscitation Council of South Africa endorses are:
From a Mobile Phone: 112
And from a Landline: 10177
These numbers are free.
Most cellular phones will divert to the 112 number even when there is no SIM card in the phone. Furthermore it is the international emergency number for mobile phones – if you are visiting another country this number should usually divert to the local emergency services (I have personally tested this number in some countries that I thought it would not work and it did).
The landline medical emergency number “10177” is unfortunately possibly the longest government provided medical emergency number (5 digits) in the world.

Other emergency numbers to consider in the South African context are:
10111 – This is the number for the South African Police Flying Squad. It is a useful number. However if you are phoning for a medical emergency the call-takers will have to divert your call to the 10177 call-takers (which is obviously an additional delay). This number can be phoned from a mobile phone as well. On some cellular networks it is a free call but on other networks normal cellular charges will apply (check with your service provider).
082-911 – This number is answered by the Netcare 911 call centre. Normal cellular call charges apply – it is not free. This is why I am reluctant to teach this number to some people that may only have a “pay-as-you-go” and not a contract (especially teenagers at schools).
084-124 – This number is answered by the ER24 call centre. Similarly to the above normal it is not free – cellular call charges apply. Again, I am reluctant to teach this number to some people that may only have a “pay-as-you-go” and not a contract (especially teenagers at schools).

Considering all these options it is clear that calling the EMS can be a challenging task. If it were me and my loved one was in a life-threatening emergency I would call all these numbers. This will increase the chances of a prompt response time in an emergency. There are almost always bystanders and family members who are willing to help in anyway they can; for this reason I teach all these numbers but obviously emphasise the free numbers (112 and 10177).

I implore you to do the same: Memorise all these numbers and allocate numbers to willing helpers:

I encourage you to print these numbers out several times and have them in strategic places (fridges, handbags, near telephones, in your car and your family member’s cars etc.). I have included spaces for 3 additional numbers such as the number for the closest fire department or police station.
Furthermore I have left a space for you to add the number for the “Poison Control Centre” – unfortunately this number has changed too often for me to add it in as a permanent number. The 112 call centre may be of assistance with the most up-to-date Poison Control Centre number.
When the first emergency service provider arrives on the scene they will relay the relevant information to their dispatcher who can dispatch additional assistance and can also cancel any other unnecessary responders.

In my opinion this is a very weak link in South Africa.
Do you agree or disagree?

(Go back to the diagram of the Paediatric Chain of Survival)

The symbol used for the fourth and final link in the Paediatric Chain of Survival is usually a picture of a doctor, a paramedic or a syringe (symbolising intravenous medication given by advanced life support providers).
The reason I say that this is a relatively strong link is that the training of paramedics in South Africa is generally very stringent and the experience of working in some tough environments in South Africa results in top-notch professionals able to handle some of the most difficult scenarios. The quality of Advanced Life Support skills and interventions that the average South African paramedic delivers (or should be able to deliver) is usually exceptional.
Generally, the sooner a patient receives advanced life support interventions the better. This is why paramedics often respond in faster vehicles in order to get to the patient quicker (a controversial topic in itself).
Unfortunately the public generally don’t understand what a paramedic actually is. In South Africa a paramedic is a person who is trained to administer Advanced Life Support to sick and injured victims. When a paramedic is simply considered as an “ambulance driver” the public will unfortunately not appreciate the importance of this link and ultimately it will be weakened.
The community need to be educated about these facts. For more detailed information on what it takes to become a paramedic go to the RescueRoxy website.
Overseas companies, however, have learnt the value of South African paramedics (and other health care professionals) and also realise that South Africans will accept contracts at a lower wage than their international counterparts. Unfortunately this is why so many paramedics leave South Africa.

But, this link is the very LAST link in the pre-hospital chain of survival. The public are responsible for the first three links – whether they know it or not!

In my opinion this is possibly the only strong link in the South African context.
Do you agree or disagree?

(Go back to the diagram of the Paediatric Chain of Survival)

Please note that in three of the links the word “early” is used. This is a very important point – it emphasises the need for a sense of urgency. It is said that the brain can only last for about 4 to 6 minutes without oxygen before permanent brain damage starts to occur. This is why it is important that these life-saving interventions are performed quickly and that there is as little delay as possible!
Also notice that the FIRST THREE LINKS (75%) of the Paediatric Chain of Survival generally relies on the public’s actions. Each individual’s answer to the following three questions highlights the possible threat to the health and safety of the children of South Africa:
1. Do you use appropriate car restraints for all the passengers in your car (such as a safety belt or an approved child car seat for younger passengers)?
2. Do you know how to do effective CPR (using the latest techniques)?
3. Do you know the telephone number of the Emergency Medical Services

Disclaimer: This document and any reference to other documents are intended as a guide and for information only. Reading through this article or any other by no means qualifies anyone to do any of the steps or procedures outlined therein. RescueRoxy Pty (Ltd) (an association incorporated under section 21) and its representatives advise all readers to complete an approved and accredited course with a reputable training institution. If you have any concerns, recommendations or corrections, please notify RescueRoxy immediately by telephone +27 11 326-4363 or by email manager@rescueroxy.co.za. Any unauthorised use; alteration or dissemination of the contents of this document is strictly prohibited. In no event will RescueRoxy or any of its representatives or referenced companies or organisations or their representatives be liable in any manner whatsoever to any person for any loss, injury or death or any direct, indirect, special or consequential damages arising from use of the information supplied in these documents.