A spatiotemporal analysis of emergency medical services use for palliative situations in Cape Town, South Africa
DOI:
https://doi.org/10.7196/Keywords:
EMS, Paramedic, Palliative Care, Access to health, Geospatial, SpatiotemporalAbstract
Background. Approximately 56.8 million people worldwide require palliative care annually, while only 14% receive such care. Within low- to middle-income countries (LMICs), this imbalance is prominent, as these countries contain up to 80% of patients requiring palliative care. To correct this imbalance, palliative care integration with other disciplines has been recommended. One developing area of integration in the South African (SA) LMIC context involves emergency medical services (EMS).
Objectives. To describe the geographical and temporal distribution of the EMS and palliative situation intersection in Cape Town, SA.
Methods. A descriptive, retrospective patient record review was employed at two hospitals in Cape Town. Records of patients who received palliative care at hospitals after EMS transport between 1 January 2020 and 31 December 2020 were included. EMS intersection with palliative situations according to the time of day, working hours, day of the week and month of the year were subjected to χ2 testing for temporal analysis. Geospatial data were investigated using cluster and proximity analyses.
Results. Overall, 494 instances of EMS palliative situation transport were identified. Most occurred in peri-urban areas (78%, n=385), during the daytime (52%, n=257), out of office hours (53%, n=261) and on weekdays (76%, n=375). Statistically significant variation in distribution was found according to time of day (p<0.001), with 38% (n=188) of cases occurring between 13h00 and 19h00, and month of year (p<0.001), with 54% (n=267) occurring from June to October. Proximity analysis revealed a mean driving time of 6.69 minutes and distance of 3.65 km to palliative care facilities.
Conclusion. EMS are frequently used for access to palliative care at any time of the day, week or year, particularly in peri-urban areas. EMS may further improve access through integration with palliative care. This efficient use of constrained resources should be pursued in SA, focusing on areas of increased demand.
References
1. Poudel A, Bhuvan KC, Shrestha S, Nissen L. Access to palliative care: Discrepancy among low-income and high-income countries. J Glob Health 2019;9(2):1-5. https://doi.org/10.7189/jogh.09.020309
2. Van der Plas WY, Benjamens S, Kruijff S. The increased need for palliative cancer care in Sub-Saharan Africa. Eur J Surg Oncol 2020;46(7):1373-1376. https://doi.org/10.1016/j.ejso.2020.03.212
3. Pillay-van Wyk V, Msemburi W, Laubscher R, et al. Mortality trends and differentials in South Africa from 1997 to 2012: Second National Burden of Disease Study. Lancet Glob Health 2016;4(9):e642-653. https://doi.org/10.1016/S2214-109X(16)30113-9
4. National Department of Health, South Africa. National Palliative Policy Framework. Pretoria: NDoH, 2022. https://www.health.gov.za/wp-content/uploads/2020/11/ NationalPolicyFrameworkandStrategyonPalliativeCare20172022.pdf; 2020 (accessed 22 May 2024).
5. DrenthC,SitholeZ,CurB,etal.PalliativecareinSouthAfrica.JPainSymptomManage2020;55(2):170- 177. https://doi.org/10.1016/j.jpainsymman.2017.04.024
6. World Health Organization. Assessing the development of palliative care worldwide: A set of actionable indicators. Geneva: WHO, 2024. https://apps.who.int/iris/handle/10665/345532; 2021 (accessed 29 April 2024).
7. PeranD,UhlirM,PekaraJ,etal.Approachingtheendoftheirlivesunderbluelightsandsirens–scoping review. J Pain Symptom Manage 2021;62:1308-18. https://doi.org/10.1016/j.jpainsymman.2021.04.023
8. Gage CH, Stander C, Gwyther L, Stassen W. Emergency medical services and palliative care: A scoping
review. BMJ Open 2023;13:e071116. https://doi.org/10.1136/bmjopen-2022-071116
9. Surakka LK, Peake MM, Kiljunen MM, et al. Preplanned participation of paramedics in end- of-life care at home: A retrospective cohort study. Palliat Med 2020;35(3): 584-591. https://doi.
org/10.1177/0269216320981713
10. Dent T, Tipping I, Anderson R, et al. Hospice advice and rapid response service for ambulance clinicians. BMJ Support Palliat Care 2020;10:296-299. https://doi.org/10.1136/bmjspcare-2019-001911
11. Burger H, Krause R, Blanchard C, et al. Position paper on undergraduate palliative medicine education for doctors in South Africa. Afr J Prim Health Care Fam Med 2022;14(1):e1-e7. https://doi.org/10.4102/ phcfm.v14i1.3202
12. Gage CH, Geduld H, Stassen W. South African paramedic perspectives on prehospital palliative care. BMC Palliat Care 2020;19(1):153. https://doi.org/10.1186/s12904-020-00663-5
13. Gage CH, Spies B, Crombie K, et al. The use of emergency medical services for palliative situations in Western Cape Province, South Africa: A retrospective, descriptive analysis of patient records. S Afr Med J 2023;113(11):41-46. https://doi.org/10.7196/SAMJ.2023.v113i11.1136.
14. Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD ) Statement. PLoS Med 2015;12(10):e1001885. https://doi. org/10.1371/journal.pmed.1001885
15. Western Cape Government. Population data. Cape Town: Western Cape Government, 2020. https:// www.westerncape.gov.za/assets/departments/health/h_102_2020_covid-19_population_data.pdf; 2020 (accessed 22 May 2024).
16. South African Government. South Africa’s people. Pretoria: SA Government, 2021. https://www.gov.za/ about-sa/south-africas-people; 2021 (accessed 22 May 2024).
17. StatisticsSouthAfrica.GeneralHouseholdSurvey2021.Pretoria:StatsSA,2021.https://www.statssa.gov. za/publications/P0318/P03182021.pdf; 2021 (accessed 22 May 2024).
18. WesternCapeGovernment.Hospitalclassification.CapeTown:WesternCapeGovernment,2023.https:// www.westerncape.gov.za/dept/health/documents/public_info/W/19578?toc_page=4#:~:text=Level 1 - district hospitals where,Red Cross and Tygerberg hospitals; 2023 (accessed 22 May 2024).
19. HealthProfessionsCouncilofSouthAfrica.Emergencycare.Pretoria:HPCSA,2024.https://www.hpcsa. co.za/?contentId=0&menuSubId=45&actionName=Professional Boards; 2024 (accessed 22 May 2024).
20. Gilbert EH, Lowenstein SR, Koziol-McLain J, et al. Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med 1996;27(3):305-308. https://doi.org/10.1016/s0196-0644(96)70264-0
21. Carter AJE, Arab M, Harrison M, et al. Paramedics providing palliative care at home: A mixed-
methods exploration of patient and family satisfaction and paramedic comfort and confidence. CJEM
2020;21(4):513-522. https://doi.org/10.1017/cem.2018.497
22. Hutchings P, Willcock S, Lynch K, et al. Understanding rural-urban transitions in the Global South
through peri-urban turbulence. Nat Sustain 2022;5(11):924-930. https://doi.org/10.1038/s41893-022- 00920-w
23. Sahana M, Ravetz J, Patel, et al. Where is the peri-urban? A systematic review of peri-urban research and approaches for its identification and demarcation worldwide. Remote Sens 2023;15(5):1316. https://doi.org/10.3390/rs15051316
24. Besada D, Eagar D, Rensburg R, et al. Resource requirements for community-based care in rural, deep-rural and peri-urban communities in South Africa: A comparative analysis in 2 South African provinces. PLoS ONE 2020;15(1):1-19. https://doi.org/10.1371/journal.pone.0218682
25. Behnisch M, Krüger T, Jaeger JAG. Rapid rise in urban sprawl: Global hotspots and trends since 1990. PLOS Sustain Transform 2022;1(11):e0000034. https://doi.org/10.1371/journal.pstr.0000034
26. MacagnanoEV.Peri-UrbanAreasofSouthAfricanCities:InnovativeTechnologiesforSustainability. Southamptom: WIT Press 2002. https://doi.org/10.2495/URS020151
27. Sadiki P, Ramutsindela M. Peri-urban transformation in South Africa: Experiences from Limpopo Province. Geo J 2002;57(1):57-63. https://doi.org/10.1023/A:1026027104185
28. Juhrmann ML, Vandersman P, Butow PN, Clayton JM. Paramedics delivering palliative and end- of-life care in community-based settings: A systematic integrative review with thematic synthesis. Palliat Med 2021;36(3):1-17. https://doi.org/10.1177/02692163211059342
29. Breyre A, Taigman M, Salvucci A, et al. Effect of a mobile integrated hospice healthcare program on emergency medical services transport to the emergency department. Prehosp Emerg Care 2022;26(3):364-369. https://doi.org/10.1080/10903127.2021.1900474
30. Hongoro C, Dinat N. A cost analysis of a hospital-based palliative care outreach program: Implications for expanding public sector palliative care in South Africa. J Pain Symptom Manage 2011;41(6):1015-1024. https://doi.org/10.1016/j.jpainsymman.2010.08.014
31. Kato K, Fukuda H. Comparative economic evaluation of home-based and hospital- based palliative care for terminal cancer patients. Geriatr Gerontol Int 2017;17(11):2247-2254. https://doi. org/10.1111/ggi.12977
32. Rosa A, Dissanayake M, Carter D, Sibbald S. Community paramedicine to support palliative care. Prog Palliat Care 202130(1);1-5. https://doi.org/10.1080/09699260.2021.1912690
33. Eaton-Williams P, Barrett J, Mortimer C, Williams J. A national survey of ambulance paramedics on the identification of patients with end of life care needs. Br Paramed J 2020;5(3):8-14. https://doi.or g/10.29045/14784726.2020.12.5.3.8
34. Swetenham K, Grantham H, Glaetzer K. Breaking down the silos: Collaboration delivering an efficient and effective response to palliative care emergencies. Prog Palliat Care 2014;22(4):212-218. https://doi.org/10.1179/1743291X13Y.0000000076
35. Morgan K. Inequality and crime. Rev Econom Statistics 2000;82(4):530-539. https://doi. org/10.1162/003465300559028
36. Demombynes G, Özler B. Crime and local inequality in South Africa. J Dev Econ 2005;76(2):265- 292. https://doi.org/10.1016/j.jdeveco.2003.12.015
37. Vargas J. The impact of socioeconomic factors on crime rates. Addict Criminol 2023;6(4):161.
https://doi.org/10.35841/aara-6.4.161
38. Western Cape Government. EMS assaults. Cape Town: Western Cape Government, 2023. https://
www.westerncape.gov.za/news/department-condemns-senseless-assaults-ems-crews; 2023 (accessed
22 May 2024).
39. CarronP,DamiF,DiawaraF,etal.Palliativecareandprehospitalemergencymedicine:Analysisofa
case series. Medicine 2014;93(25):1-3. https://doi.org/10.1097/MD.0000000000000128
40. Penchansky R, Thomas JW. The concept of access: Definition and relationship to consumer
satisfaction. Med Care 1981;19(2):127-140. https://doi.org/10.1097/00005650-198102000-00001
41. Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health inequality in South Africa: Evidence from general household surveys. Int J Equity Health 2011;10(48):1-10. https://doi.
org/10.1186/1475-9276-10-48
Downloads
Published
Issue
Section
License
Copyright (c) 2025 C Gage, B Spies, K Crombie, T Slingsby, L Gwyther, W Stassen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
