EMS and Ambulance Crisis Across South Africa: Who’s Liable?

The state of ambulance and EMS services in South Africa

A combination of mismanagement, resource shortages and the use of outdated census figures in the procurement of resources have brought provincial ambulance services to their knees.

According to Minister of Health, Dr Aaron Motsoaledi, South Africa has a shortage of 2,000 ambulances.

Based on a recommended ratio of one ambulance per 10,000 people, at least 6,000 ambulances are required to serve the nation’s roughly 62 million people.

Yet, in a written reply to a parliamentary question, the Minister conceded that only 4,000 ambulances are currently operating across all nine provinces.

Most affected are the Western Cape, KwaZulu-Natal, Mpumalanga and the North West.  

Statistics provided to parliament in 2023 also point to a crisis-level shortage of ambulances. For example:

• North West needs 370 ambulances but is operating 72
• the Western Cape needs 580 ambulances but is operating 120
• Gauteng needs 2,542 ambulances but is running 1,600
• KwaZulu-Natal needs 1,174 ambulances but is running 432
• the Eastern Cape needs 670 ambulances but is running 448.

In 2023, a News24 article noted that SA’s “…dire shortage of ambulances is placing patients’ lives at risk”.

In the context of failing state care, the private sector is experiencing huge demand for emergency medical services, but it lacks the capacity to meet this demand.

Other problems affecting emergency medical services

The shortage of ambulances is not the only issue plaguing state-run emergency medical services.

Average response times are sluggish at best. More than half the callouts for ambulances in South Africa’s urban areas have an average waiting time of more than 30 minutes.

In rural areas, 67% of patients in need of ambulance services have to wait for an hour or more to get the care they deserve.

As reported by Health-E News in 2024, people living in remote areas like KwaZangashe in the Eastern Cape have to wait three days for an ambulance. That is if one arrives at all.

Slow response times are exacerbated by:

• shortages of basic medical supplies (like oxygen) in ambulances
• shortages of trained paramedics
• poorly trained emergency call centre staff
• long distances between hospitals
• difficulties accessing rural and township areas due to poor road conditions.

Ambulance and first responder delays have tragic results

Delays in getting a patient to a hospital can result in a worsened medical condition or death.

In October 2024, a teenager in Gqeberha died at her home following a six-hour wait for an ambulance.

According to the article in the Juta Medical Brief, the parents had been unable to call for help as the Department of Health’s phone lines had been cut off by Telkom due to non-payment.

As reported in The Witness in April 2024, a 35-year-old Greytown woman waited 10 hours for an ambulance. She later died in hospital.

At the time of the incident, only two state ambulances were available to service the Umzinyathi District, a vast area with an estimated population of more than 750,000 people.

In May 2023, the Mail & Guardian reported that a woman died in the Cape after it took an ambulance 24 hours to arrive.

Six months earlier, a man died after an eight-hour wait for an ambulance in Matatiele, Eastern Cape.

At the time, just one state ambulance was serving the entire Matatiele area, which spans 4,350 square kilometres and includes nearly 300 villages.

An earlier case in the Eastern Cape resulted in a young pregnant woman losing her baby. After a four-hour wait, the woman’s parents paid a neighbour to take her to hospital. The ambulance arrived eight hours after the original call.

Liability when an ambulance is delayed or doesn’t arrive

If an ambulance is delayed or doesn’t arrive due to provable negligence or poor service delivery by the state, you might be able to claim for damages.

A claim could be made against one or more of the following parties:

• the state, which is responsible for protecting South Africans’ constitutional right of access to healthcare (including emergency medical care)
• the hospital or entity that managed and despatched the ambulance
• the emergency medical technicians (EMTs) or paramedics on the ambulance, if their conduct could be considered negligent.

If you may have grounds for an ambulance or EMS negligence claim, you have the right to look at the records, charts and information related to your emergency transport in order to build your case.

Medical malpractice cases are complex and lengthy. It’s vital to make sure you have a strong case, along with sufficient legal representation and support.