Factors influencing the departure of South African advanced life support paramedics from pre-hospital operational practice

Objectives: South Africa has a lack of advanced life support (ALS) paramedics in full-time operational practice within the pre-hospital and inter-hospital fields. This is due at least in part to the departure of experienced ALS paramedics from operational practice. It is therefore important to identify and understand the factors that cause this departure in order to positively alter them. Methods: This study was a cross-sectional on-line survey conducted over 28 days. South African ALS paramedics were invited by e-mail to complete an on-line questionnaire consisting of 64 questions, including sections on demographics, reasons for leaving operational practice, current satisfaction levels and willingness to return to operations. Results: Of 318 registered ALS paramedics with valid e-mail addresses, a response rate of 52% (166) was observed. Top respondent groups were whites, critical care assistants and those operational in Gauteng. The top five reasons for leaving operational practice were related to remuneration, a lack of control of workplace dynamics, inadequate opportunities for promotion, poor organisational communication and poor benefits. The paramedics' current, or post-operational, satisfaction levels (in earning, time, stress and career development) were higher than when operational. Sixty-five percent of respondents were willing to consider returning to operational practice if the above issues were addressed. Conclusion: Whilst the job of an ALS paramedic is difficult and demanding, it was not operational factors that appeared to cause the majority of ALS paramedics to leave operational practice, but rather organisational and career-based factors. These factors should be addressed in order to improve job satisfaction, with the objective of retaining more operational paramedics for longer. © 2011 African Federation for Emergency Medicine.