Benefits: Emergency Services

Emergency IN AN EMERGENCY

You and your loved ones have access to emergency medical transportation (if authorised by ER24) 24 hours a day, 7 days per week, in South Africa, Lesotho, Swaziland, Zimbabwe, Botswana, Namibia, Mozambique and Angola. (Call +27 102 053 038 if outside the borders of South Africa.)

phone FOR MEDICAL ADVICE

ER24 also has an “Ask the Nurse” medical advice and information line. Although it is not possible to make an accurate diagnosis over the phone, this can help you decide whether you need an ambulance, see your doctor, or simply go to the pharmacy.

What to do in an emergency situation

You and your registered dependants will have access to emergency medical transportation in South Africa 24 hours a day, 7 days per week, provided that this is authorised by ER24 (the Scheme’s DSP for emergency medical services). Services offered by ER24 include:

  • 24-hour access to the ER24 Emergency Call Centre
  • Dispatch of emergency response
  • Medical transportation by ambulance or aircraft as deemed medically necessary
  • Authorised inter-hospital transfers

In addition to emergency transportation, you also have access to emergency medical advice and assistance. ER24’s operators will guide you through a medical crisis situation, provide emergency advice and arrange for you to receive the support you require – available at all times.

Remember that, in the case of an emergency where you (or your dependants) are admitted to hospital, you must notify the Scheme on the first working day after being admitted (see How does pre-authorisation before hospitalisation work? for more information).

The Nedgroup Medical Aid Scheme does offer cover for emergency medical assistance outside the borders of South Africa. The cover is limited to Lesotho, Swaziland, Zimbabwe, Botswana, Namibia, Mozambique and Angola.

What else do I need to know if I have to visit an emergency unit?

Medical emergencies are not something you can plan for. However, knowing what to expect in terms of the processes followed at an emergency unit is helpful, as it will allow you to concentrate on your or your loved ones’ well-being, should you be involved in a medical emergency.

The first thing you need to be aware of is that you may have to wait for medical attention, and that you should not become anxious about this. The reason for this potential wait is that, when patients arrive at the hospital emergency unit, every patient is assessed and given a score that indicates how severe their condition is. This process is called triage.

According to the triage system, a colour code is assigned to each patient based on this score (which is given according to a checklist of symptoms). Red indicates that very urgent medical intervention is required, while green indicates the least urgent attention required. The colour code therefore reflects how urgently the patient needs treatment. In practice this could mean that some patients who are already waiting for treatment might have to wait a little longer, and that persons arriving later than they have, may be treated first.

The triage system is used internationally to ensure that patients in danger receive immediate attention, rather than having emergency units that operate on a first-come, first-served basis.

A visit to the emergency unit that results in an admission will be covered under the authorisation provided by the Scheme and paid from the Hospital and Trauma Benefit.


Avoid having a claim for an ambulance rejected by understanding exactly when you should, and when you should not, arrange for an ambulance to take you to hospital. The most important differentiator in deciding whether an ambulance is appropriate or not, is whether the situation is a real emergency, or not. Read on to see the difference…

Ambulances should always be available for real emergencies. An ambulance should never be used as a transport mechanism when you could have travelled in a private vehicle.

Nedgroup Medical Aid Scheme and ER24 have embarked on a stringent programme to decrease the misuse of ambulances and to try to ensure that ambulance transports are reserved for patients who fit the definition for emergencies.

WHAT IS AN EMERGENCY?

The definition is as follows:
“An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.”

All ambulance cases will be audited to assess whether the patient was admitted into hospital and/or whether there was a need for specialised emergency care. If the patient was not admitted and did not require specialised care, the ambulance claim may be rejected and the member may be billed for the transportation.

WHEN SHOULD YOU CALL AN AMBULANCE OR VISIT THE EMERGENCY ROOMS, AND WHEN NOT?

To help members understand when calling an ambulance or visiting a hospital’s Emergency Rooms(ER) is advisable, and when it will probably just end up costing them money, ER24 has put together the following handy comparison of emergencies versus non-emergencies. If you are uncertain whether a situation is a real emergency, you can also call ER24’s helpline on 084 124 for advice.

 

EMERGENCY
CALL AN AMBULANCE / GO TO ER
NOT AN EMERGENCY
REFER TO YOUR PHARMACIST / GP
  • When a person has or is reasonably believed to have suffered an acute injury or illness requiring medical attention and/or medical transportation by ambulance
  • A doctor / registered nurse / paramedic has requested the urgent transport of a patient by ambulance
  • Acute life-threatening scenario
  • Patient’s life or usual activities would not be immediately threatened by referral to an alternative care facility for treatment at a later time.
  • Non-urgent health need outside of usual office hours
  • Alternative transport/ home remedy available
Persistent shortness of breath / Wheezing / Ongoing chest pain that worsens on breathing. Wheezing and difficulty of breathing associated with asthma (with no response to usual medications) Coughs, colds, flu, bronchitis, earache, sore throat – with or without fever, general weakness
Acute or persistent, severe chest pain, especially if it radiates to the arm or jaw and is accompanied by sweating, vomiting or shortness of breath. Ongoing, dull, nagging chest discomfort
Sudden, severe onset of abdominal pain (the kind that makes it impossible to walk and wakes one up in agony) Abdominal pain caused by menstruation, constipation and / or other minor abdominal complaints.
Difficulty speaking, confusion / altered mental state, weakness / paralysis, sudden loss of balance, especially with a history of high blood pressure / in the elderly, sudden loss of vision, seizures, unconsciousness Fainting, dizziness and headaches in an otherwise healthy person
Fever: >40°C, does NOT respond to Paracetamol, associated with all-over body rash, children under 2 months with fever >38.5°C Fever: <38.5°C, responds to use of Paracetamol, no rash
Ongoing, persistent diarrhoea & vomiting with dehydration (usually > 8 episodes/ day) Diarrhoea and / or vomiting, patient able to walk around
Trauma: Deep cuts that require stitches – especially on the face, bleeding that won’t stop, large open wounds, broken bones / dislocated joints, head injuries with loss of consciousness, eye injuries Trauma: Common sprains & strains, superficial cuts, bleeding stopped with pressure
Severe testicular discomfort Painful urination, blood in the urine
Burns: Large surface area, burns to the face or a large part of the hand, where the burn encircles the limb, electrical burns Burns: Minor burns and scalding, small surface area
Major allergic reaction: Breathing difficulties, swelling of lips / tongue or throat, dizziness or fainting, rash and itching over entire body Minor allergic reaction: watery eyes, runny nose, minor rash and itching
Poisoning – accidental or intentional
Back pain after trauma (such as falling), or after back surgery <3 months previously Back pain after heavy lifting, generalised back spasm
Suicidal thoughts expressed, sudden aggression / psychosis, previous history of psychiatric admission, possible relapse requiring emergency admission Depression/ emotional trauma

PLEASE NOTE

Treatment received in a hospital’s Emergency Room is not an admission to hospital and is regarded as treatment received out of hospital/everyday services. If approved by the Scheme, the claim is payable from your available Everyday Services Benefit.

Furthermore, if you are transported to hospital by an ER24 ambulance (even though approved), and on examination you are found to be fit enough to return home, you will be responsible for arranging your own transport home.

 

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