On-scene discharge by Emergency Care Practitioners – a viable option for South Africa?

  • Lara Nicole Goldstein Department of Emergency Medical Care University of Johannesburg https://orcid.org/0000-0002-9427-8710
  • Siyabonga Sibanyoni Department of Emergency Medical Care University of Johannesburg
  • Craig Vincent-Lambert


Background: In South Africa, the national public health sector provides healthcare to the majority of the population, yet many hospitals are in a state of crisis. On-scene discharge or patient non-conveyance to hospital by Emergency Care Practitioners (ECP) may serve as a means for patients to access healthcare services while alleviating the burden on the hospitals.
Aim: The aim of this study was to determine the number of patients being transported by ambulance to a public sector Emergency Department (ED) who could have potentially been managed and discharged on-scene by a South African pre-hospital ECP.
Methods: This was a prospective, descriptive and quantitative study of patients brought to the ED by ambulance over a 72-hour weekend period. The medical care that was provided in the ED was compared to the existing ECP scope of practice. The patients’ disposition was also used as a surrogate to determine whether transportation to hospital was required.
Results: A total of 118 patients were transported to the ED by ambulance, and 85 of these patients consented to participate in the study. Overall, 62.4% of these patients were ultimately discharged from the hospital (60.4% of discharged patients being trauma-related). Most of the treatment modalities prescribed for the discharged patients were within the ECP scope of practice.
Conclusion: Pre-hospital on-scene discharge by ECPs may be a mechanism to alleviate hospital overcrowding in a failing public healthcare system. However, if an ambulance service condones the concept of on-scene discharge, they need to implement monitoring strategies to assess the subsequent outcomes for those patients discharged at the scene.

Author Biography

Lara Nicole Goldstein, Department of Emergency Medical Care University of Johannesburg

Visiting Associate Professor

Department of Emergency Medical Care

Original Research