Thinus Stander remembers his first stroke patient so vividly that decades later he could tell you the address if you asked. He was a newly qualified ALS paramedic in Cape Town when they were called out to a patient who was having a haemorrhagic stroke. “I was out of my depth,” Thinus remembers. “I felt helpless and alone.”
In August this year, in a different part of the country, Thinus accompanied the final journey of another stroke patient he will never forget. This time it was no stranger – Nazir Sadack had been a hero to a community left reeling from the loss. There wasn’t a paramedic up or down the north coast of KwaZulu-Natal (KZN) who hadn’t known or worked beside this big-hearted rescuer, crimefighter and volunteer.
“This is my town,” says Thinus about Ballito where IPSS Medical Rescue is headquartered. It is a holiday town located at the gateway to the Dolphin Coast, as this stretch of coastline is also known for the schools of bottlenose dolphins that frolick in the waves of the Indian Ocean.
IPSS may be a privately owned service but it is rooted in the community whose footprint starts here and stretches northward to Mtunzini and inland to uMnambithi.
And as Thinus points out, if your patient is also your neighbour, your uncle or, as in this case, the local hero, you simply cannot be anything other than the best.
‘They prenotify us’
Thinus is the clinical governance manager of IPSS Medical Rescue, which is on track to become the first EMS in KZN (and the second in South Africa) to win an EMS Angels diamond award for prehospital stroke care. It is an offshoot of IPSS Security, a private provider of industrial and large client protection that noticed a need for emergency medical services in an underserved rural-industrial area. In the course of 13 years it has grown from a single response vehicle to a fleet of 13 ambulances and three ALS response vehicles, and gained a reputation for impressive response times, evidence-based practices, deploying high-tech solutions for challenging circumstances, and old-school pride.
When Angels consultant Maxeen Murugan first started working with Thinus and IPSS operations manager Keith Pillay, she found that they already complied with EMS awards criteria in almost every respect. “When you mention IPSS to big or small hospitals, the first thing they say is ‘they prenotify us’,” Maxeen says. As well as making prenotification consistent and “seamless”, their handover documents were impeccable and their stroke protocol was on point. It was simply a matter of uploading their data to RES-Q in order to line them up for an EMS Angels Award.
Data-driven improvement is stitched into the IPSS culture. Data collection is done in real time and if data analysis reveals certain trends or patterns, corporate hurdles are easily cleared so policy changes can be implemented quickly. This level of agility is exciting for employees, says Thinus, who adds that they’re “picky” recruiters who prioritize teachability when adding to a team that feels like a family.
A scientist by nature
The technology that supports IPSS performance has its roots in concern for employee and vehicle safety, which is crucial given South Africa’s crime rate. Data shows on average 66 vehicles are hijacked on South African roads per day. Vehicle tracking technology using GPS satellites that allows round-the-clock tracking and controlling of vehicles also helps IPSS optimize their dispatch system and deliver outstanding response times.
Yes the work can be dangeous, Thinus says, especially in situations where their uniforms are mistaken of those of law enforcement, but their biggest safety feature is a community that has their back.
One gets the impression that Thinus is not entirely averse to a bit of danger either. He grew up wanting to be a doctor and completed a BSc in psychology and physiology in the hopes that it would lead to medical school, but student debt put paid to the dream. In paramedicine, however, he found an outlet for both his interest in medicine and his taste for adventure, and the right set of challenges for someone who stays calm under pressure.
He completed the B.Tech degree in emergency medicine at the Cape Town University of Technology, and eventually found his way to KZN nine years ago, moving across the country for love.
What does he like about the work? “Everything,” he says.
“I like the ability to make a difference in someone’s life, anonymously, without taking the credit.” The anonymity acts like a shield, protecting him from the heartsore and ugliness that sometimes comes with the territory. It’s important not to get drawn into emotions.
“I try all I can and then I walk away,” he says. “I’m a scientist by nature and I find comfort in science. It’s a protective mechanism.”
But walking away doesn’t mean feedback isn’t important. “We do follow up once there is emotional clarity,” Thinus says, adding that the small town atmosphere and strong community ties mean you will learn of the outcome one way or another. “Feedback is mostly important for education – for considering what we might have done, or should have done.”
‘That ignites my passion’
At an age when many paramedics have retired from the field, Thinus has dealt with a wide range of situations and witnessed “unfathomable” trauma. The reason why he is passionate about stroke and cardiac cases, is that science has made good outcomes possible.
“The latest treatments can make a big difference,” he says. “Within minutes you can go from being in severe jeopardy to a full recovery. That ignites my passion – the fact that you can make a massive difference.”
The aftermath of an event such as stroke is often the ideal time for letting the message about prevention and symptom recognition sink in, he says. Teaching the community about how to protect their health and what to do in a crisis is simply part of their work.
There is a more subtle form of teaching that takes place in the interaction with hospitals. It starts with trust. Prenotification and competent handovers build trust, and so does sticking around in casualty for the benefit of a critical patient. Then you don’t try to influence practice at a corporate level. Instead, you talk to the nurse and through her get to know the network.
“Change is hard, especially in medicine,” Thinus says. But you don’t always have to wait for a policy change before you take a stroke patient directly to the CT scan. With the right approach, “we can change practice before we change policy.”
