Emergencies

From ParaWiki

As with all my content, this is my personal opinion, and I'm not an expert (in anything).

Even though our sport doesn't feel "extreme" (at least, not to us), it does come with a degree of risk. It's important to do what we can to be safer in the sky, but we also need to make sure that we don't burden ourselves, our friends, and families with a crippling financial burden due to medical emergencies.

It is important to understand the rules around difference between Medical Aid / Medical Schemes (in South Africa, but might be called National Health, Healthcare, Universal Health in other countries) and Medical Insurance (and other kinds of insurance).

Additionally, there are important differences between Search and rescue (casevac) costs and medical costs that you might incur.

Below is a flowchart that gives a visual overview of what I'll discuss (not just for South Africans, but for pilots visiting the country, too).

Emergencies-flowchart.png

First-aid kit

At the very least you should have one and at the very least it should include an emergency blanket. Not only does it make you extremely visible during recovery, it is one of the few things that weigh less than 15 grams and cost less than a dollar that might just save your life by keeping you warm.

Other smart things include: bandages and compression tape, 200-400 calories in energy gel packets, headache, and anti-nausea tablets. Keep it in a waterproof or zip-lock bag in your harness. The lightweight, rollable SAM splint (available in Europe and the US), a great way to stabilise most types of broken bones.

Other things, like always flying with extra water, food, warm clothes, and a charged (or solar charged) power bank could save your skin on cross country adventures.

Medical aid (South Africa)

You have medical aid coverage, if you are a member of a medical scheme in South Africa. Membership is usually restricted to citizens and residents. Medical schemes / medical aid are very different from medical insurance. Keep reading.

The following applies to to medical aid / medical schemes:

  • They are governed under the Medical Schemes Act
  • All medical schemes, no matter you "membership level" must provide Prescribed Minimum Benefits (PMBs), which include:
    • All emergencies (including paragliding accidents)
    • A set of 271 medical conditions (including fractures, sprains, broken bones, torn ligaments)
    • 27 chronic conditions
  • They exist to cover all members for expenses related to medical care (whether once-off or ongoing)
  • Medical aid contributions are tax deductible (explain it like you're five: you pay less tax / get money back from Sars)

If you are eligible to join a medical scheme and get medical aid in South Africa, do it. Now.

South Africa has world-class private medical services, which you can only access by being a member of a medical scheme or by paying lots of money (or having your loved ones do so). If you don't, you can't be denied emergency service at a state hospital either, but the waiting times, quality, and facilities of these can be drastically worse.

As above, medical schemes also cover you for chronic conditions, should you get diagnosed with them, but that's outside the scope of this article. (In other countries this might be called "healthcare" or "national health", different from insurance).

The Medical Schemes Act doesn't allow discrimination on the basis of the cause of an accident, the Insurance Act allows insurers to specify the events under which they will (and won't) pay out. I am unaware of any South African medical aid ever refusing to pay out for a paragliding accident. It would be unfortunate to sue them, but I can't envision a case where a judge would dismiss it (as they are required, by law, to cover emergencies and the 271 "prescribed minimum benefit" --PMB-- medical conditions which include sprains and fractures and the like).

Note that some clinics or professionals may charge more than the government-mandated PMB rate. Say, you need surgery and the PMB rate is R50,000, but you go to a clinic where they charge R55,000 for the procedure, you will either need to pay the remaining R5,000 out of pocket or you will need insurance (known as "gap cover"). You will need to confirm that your gap cover insurance will apply for paragliding, since it is legislated by the separate Insurance act, more below.

Medical insurance

Insurance policies (including health insurance) differ drastically from one provider to the next, and they're allowed to exclude coverage for certain things. They are also governed under different rules (for instance Medical insurance in South Africa isn't governed by the Medical Schemes Act, but by the Insurance Act).

Medical or travel insurance will usually pay out a once-off sum of money, when you are covered and eligible (often you'll need to make the payment to the medical provider, and get reimbursed for the expenses later).

Risky sport, such as paragliding, is usually excluded from health insurance (and travel medical insurance) policies. Just because you have medical insurance or travel insurance or whatever insurance, doesn't mean that you are covered for paragliding.

Gap cover

If you have what is known as "gap cover" added to your Medical Aid in South Africa, it is a form of insurance, covered by the Insurance Act. If you were in a paragliding accident and, say, needed surgery, your medical aid should cover it (as regulated by the Medical Schemes Acts and how much and when it should pay out as per the PMB "prescribed minimum benefits").

Some clinics/care providers may charge an amount higher than the regulated PMB. So, as example: the PMB rate for back surgery might be set at R100,000 but your clinic may charge R105,000 for that procedure. Your medical aid will cover the PBM (R100,000) and insurance/gap cover could cover the remaining R5,000 --check your policy and get it in writing-- otherwise you'll have to pay it. Clinics generally charge the full PMB rate and sometimes in excess of the rate, but it is always useful to ask.

Life insurance

Life insurance is an insurance policy that pays out a sum of money to beneficiaries upon your death. There are many exclusions when life insurance won't pay out (like suicide and many high risk sport). You will need to confirm with your life insurance provider in writing if they will pay out during a paragliding fatality, and probably share the information with your family or the executor of your estate.

Insurance for foreigners visiting South Africa

Foreign paragliders traveling to South Africa will not normally be eligible to join a medical aid scheme. You should therefore get medical insurance that expressly covers you for paragliding in South Africa. These are the only three international insurance providers that I've found that cover paragliding (at the time of writing; confirm in writing from the provider if this is still the case).

  • IMG Signature Travel Medical Insurance (website)
  • World Nomads (coverage page)
  • Dog Tag Extreme (UK-based, currently suspended)

Note that these providers, at time of writing, only cover you for medical emergencies and not necessarily for:

  • competitive events (so if you're flying a competition, you may need something else, ask the comp organisers)
  • search and rescue (more on that further down)
  • repatriation to your home country

Insurance for South Africans abroad

You may be able to purchase insurance from the providers mentioned above (but do your research, since many insurance companies only accept residents from certain countries). As a South African, however, you might find it easier to deal with a South African insurance company when making payments, getting reimbursed (or, in a worst-case scenario, taking a South African company to court).

The only South African insurance provider I could find that expressly covers South Africans when travelling outside of South Africa (including paragliding) was the Travel Insurance with Sport cover, underwritten by Allianz. At the time of writing, if you don't add the extra "sport" coverage option, you won't be covered for paragliding.

More important things about insurance

Again, for the purposes of this article, the idea with medical insurance is that if you have an emergency (like a car or paragliding accident) where you need medical care, you'll either get reimbursed or otherwise be directly covered for that emergency, and not ongoing care.

If you, for instance travel abroad and find out you have a newly diagnosed chronic condition, like cancer, you are usually not covered with travel insurance, and you should fly back home (where you hopefully have domestic medical coverage in the form of a medical aid, healthcare, or national health, depending where you're from). Some travel insurance companies will pay for repatriation (an emergency flight back home, but not for medical care once you get back home), depending on the policy and emergency.

Few more important things about medical insurance:

  1. It is critical to have your insurance information readily available (in your harness, for instance, but also emailed to other responsible people) and to make sure that your co-pilots (or others who know where you are flying) can easily find it.
  2. The reason for the above, is that you or someone with your insurance information, should immediately contact the insurance provider after you've had an accident. They might have rules about which hospitals you can and can't go to, if they will reimburse for an ambulance or not, and even rules about not reimbursing for anything where they aren't notified in advance.
  3. If you are pre-paying and getting reimbursed (in the majority of cases this will be true, but some providers will directly settle with the clinic), ask for a final invoice or document with the sum of all the related costs in one document. You might see a physician and get medicine on day one, get x-rays done the next day, see a physiotherapist three days later, and so on. Sometimes insurance companies will argue that these are considered separate incidents, thereby reducing the total amount they will reimburse you for (or charge an excess/deductible for each of the three visits). I would also ask the administration or doctor to write, sign, and stamp a statement indicating that all costs are related to the same incident.
  4. If you have a choice: go to the largest clinic or hospital around. This relates to the above, where everything can be done and charged by one entity in one invoice.
  5. Always, always, always review your travel insurance policy and confirm in writing/the policy that you are i) covered for paragliding ii) covered for the type of paragliding you'll be doing (competitions / leisure) and iii) covered for the country you'll be visiting and obviously iv) that you are covered at all as a resident / permanent resident of your country.
  6. If you're, say, planning on taking a one-month holiday and you know you'll only be paragliding for three consecutive days, it might be cheaper to buy normal travel insurance for the entire trip (which should cover you for non-paragliding accidents) with one provider and get specific insurance that covers you for paragliding just for those other days.

Search and rescue

Let's say you have an incident where your glider got tangled up, you threw your reserve and landed by yourself in the middle of nowhere. The logical next thing would be to safely get out of that area, especially if you are injured, hanging from a tree, have limited food or water, find yourself in inhospitable terrain, or other nasty scenario.

This falls under search and rescue (also sometimes called casevac), separate from emergency medical care, insurance, or medical aid (even though you might also need medical attention). This applies more, but not exclusively, to cross country paragliding.

Mobile phone support

If you've landed in an area where there is mobile phone reception, you should be able to make a call, which is why you should always save the local search and rescue / emergency services on your phone.

If you were involved in or witnessed an emergency, you should also be able to locate your GPS coordinates on your phone. You can easily share your location in Telegram / WhatsApp to friends and the search and rescue team (if you have mobile data).

Also, download an app that shows smaller hiking trails (Google and Apple Maps don't) and download the map for the area/state where you're going to fly. These apps also display your exact GPS coordinates (in DMS or decimal format) and can give you estimates on how far you need to hike to get back to civilisation (including elevation change).

Experiment with the following (before you go out), available on iOS and Android:

  • Organic Maps
  • Maps.Me
  • Windy Maps
  • AllTrails
  • WikiLoc

Satellite phones

Since I paraglide (and trek, camp, and trail run) in areas with limited cell phone signal, I purchased a satellite device for peace of mind. It's an affordable way to stay in touch with my loved ones (a simple message like "Running a bit later than planned, but everything is OK") can make life significantly less stressful for everyone.

The main two hardware providers are SPOT and Garmin InReach. There are many different models: some with big colour screens and maps, others you can make actual phone calls on, others weigh only a few grams and you can only send and and receive text/email messages.

With my Garmin InReach Mini's $15/month subscription I can send an unlimited amount of three pre-programmed messages. My three messages are set as:

  • Starting to fly now.
  • Safely ended my flying for the day. All is fine.
  • Running late, but everything is OK.

In addition to those, I can receive messages (via someone sending me an SMS or email to my Garmin number) or send messages (which I can slowly type out on the device's up/down buttons, or pair it with my phone via Bluetooth and type it in an app). I get a sum of ten free ones per month, but beyond those it only costs a trivial amount to send or receive additional text or location messages. (I can also upgrade to the unlimited message plan -- currently $35/month).

You can also get weather forecasts sent from Garmin, but I found the quality to be inferior to the Windy and RASP forecasts. Rather ask a friend to SMS/email you a short forecast to your sattelite phone when you're in the middle of nowhere (or write a simple program to send your InReach/SPOT an email with the paragliding forecast for the next day).

SOS buttons

The big thing with SPOT and InReach, however, isn't necessarily communication but emergencies. They all have an SOS button/feature that connects you to the emergency services in the country / area you're in.

If you have an emergency, you should hit the SOS button. Period. That said, there are a few things to know:

  • When you press SOS, their teams will first try to contact you (via the device) and also a trusted contact (to find out if you may have accidentally pressed the button).
  • If they've confirmed this (or even if can't get a hold of you) they will contact their emergency and search and rescue partners in that country/area
  • Search and rescue will get you to the hospital, no matter what coverage/plan you have
  • Search and rescue services are free in some areas and countries, but they may be very expensive in others
  • Garmin acquired GEOS, which acts as insurance against search and rescue costs.
  • The GEOS SAR50 and SAR100 plans (which you can add when you first register your InReach device) cover you for search and rescue for things like hiking but not for paragliding
  • The SAR HR plan ($180/year) covers you for search and rescue for paragliding events

I'd encourage you to get the SAR HR plan (search and rescue can cost hundreds of thousands of dollars), but that said, in some countries search and rescue is free (including South Africa), or you might already have search and rescue coverage via another type of insurance; you'll need to find out.

On your InReach profile, you can set emergency notes. Here is what mine says:

Werner is a paraglider. SOS activation could mean a spinal injury. If SOS is activated in South Africa, contact Wilderness Rescue (+27219370300) to assist with search and rescue. Werner is a member of Genesis Medical Aid South Africa (+27861436374). ID number: xxxx; Medical aid number xxx; Allergies: none.

(When I travel outside of South Africa, I include a line like "Werner has medical insurance and casevac insurance underwritten by Such-and-such (+1555123456). Policy number: xxx)

Search and rescue in South Africa

Many people in South Africa are worried about hitting the SOS button or calling for help, because of the fear of the costs involved in a search and rescue operation. Don't be.

Search and rescue is free in South Africa.

The actual truth is that nothing is free, but that the state or municipality or other entity will dispatch a mecial or army helicopter and pay for it (in an emergency), and then may try to recover the costs from your medical aid scheme or insurance provider. They don't recover these costs from you.

If you're stuck high in a tree, don't cut your lines (if there's a risk of falling and injuring yourself), call for rescue. If you were forced to land on a part of a mountain and you can't safely walk out, call for rescue. If you (or your flying buddies) are injured, call for rescue.

The fastest way to get search and rescue started in the Western Cape, South Africa is WSAR / Wilderness Search and Rescue / +27219370300. (Note that the name "Wilderness" here doesn't mean the popular paragliding town of Wilderness...but they certainly will help with search and rescue in that town). They are based in the Western Cape, but can also assist with search and rescue coordination everywhere in the country.

The Aeronautical Rescue Coordination Centre (ARCC) is tasked with allocating state resources to respond to aviation accidents (including helicopters, microlights, light aircraft, passenger aircraft and yes: paragliding). If you are part of or witnessed an aviation accident that requires medical attention or emergency evacuation, call +27635054164 (24hr) / +27635055485 (standby).

I spoke to people from Wilderness Rescue. They had a few more important points to add:

  1. Save Wilderness Search & Rescue's number on your phone (and give it to all your flying buddies) +27219370300
  2. Save the ARCC's number on your phone (and give it to your flying buddies) +27635054164
  3. Always carry an emergency blanket. This helps you keep warm and is highly visible when people are looking for you.
  4. Initially you can keep your glider open on the slope (this is the signal that you're not OK, if you ever slope land and all is OK, bunch your glider so that other people know you're OK)
  5. They'll probably send an EMS or army helicopter if a normal ambulance can't reach you directly. Helicopters create an incredible amount of wind and your glider can be life threatening to you and to the helicopter/emergency team. Once contact has been made, bunch your glider up in your backpack, roll it in a ball and tie it down with the lines, or otherwise just get it out of the way.
  6. Be patient. Search and rescue usually takes many hours to coordinate. Have a sip of water, eat some of your snacks, stay warm, take care of wounds that need immediate attention.
  7. If you land on, say, the top of a building in a city, this is considered an "urban emergency". Wilderness Rescue will still be able to help coordinate, but they'll probably coordinate with the local ambulance. Any other mountain (including Lion's Head and Table Mountain) or rural emergency is considered "non-urban" and applies to them.
  8. Since there are a limited number of helicopters in the country, it may take significantly longer to coordinate a rescue in poorer and less-populated provinces (like the Northwest, Limpopo, the Eastern Cape etc.), contact ARCC.
  9. If you're a witness to an accident or incident, don't make life more difficult for them by also putting your life in danger. Land where it's safe and act as the liaison between the injured person and the rescue party.

The rescue team will do their thing: belay to you up in the tree and safely lower you down; hike and carry you out in some places; evacuate you in the helicopter in others. They'll have a medic in the search party and then get you to civilisation or an ambulance or hospital if needed (where all the rules about medical aid and medical insurance will kick in).

Search and rescue / casevac around the world

In addition to doing your research and making sure you're covered for medical expenses while paragliding abroad, you should make sure that the country you're visiting either has universal and free search and rescue available (and give that information to your flying buddies, family, and add it in your InReach emergency notes) or purchase search and rescue insurance that covers you for paragliding like the Garmin GEOS SAR HR annual plan mentioned above.

Obviously this relates more to adventurous, cross-country, volbiv, and solo paragliding adventures. If you're just soaring a gentle seaside slope, you probably don't need to go overboard with all of this.

Third-party insurance (South Africa)

In addition to the topics of medical insurance, travel insurance, medical aids, and search and rescue, we need to cover third-party insurance. This is when you're involved in a paragliding incident and you cause damage to others (property or persons).

It is illegal to fly in South Africa without valid SAHPA temporary (as a learner pilot permit or a foreign pilot permit) or annual membership (as a license holder). SAHPA's website states that you have third-party coverage, for things like flying into someone's car and cracking the windscreen, damage to a farmer's fence, or damage to government property like signs or telephone wires.

Their website returned broken links and very little other information related to this (see https://www.sahpa.co.za/about/insurance/). I've reached out to them for more information, but to date got no offical reply.

At the time of writing I have no information on the amount of coverage, the excess/deductible, when you'll have coverage, and when not. All that I know is that they say we have it and I know that it has paid out for legitimate claims. Unoficially, I've heard that Sahpa doesn't want to divulge the information, since it could open floodgates to some claims and administration.


South African law is very consumer friendly (and I can't see how you're legally allowed to withhold the information on an insurance policy). The Insurance Act 18 of 2017 states:

‘‘policy benefits’’ means—

(a) in respect of a registered insurer, one or more sums of money, other than an annuity, or services or other benefits;

(b) in respect of a licensed insurer, benefits to which a person is contractually entitled to under a non-life insurance policy arising from an insurer’s insurance obligations;

‘‘policyholder’’ in respect of a—

(a) registered insurer, means the person entitled to be provided with the policy benefits under a short-term policy;

I am aware of the fact that this might be a sensitive topic for an understaffed, volunteer-driven, non-profit to handle, but I feel strongly that accurate and shared information will only reduce uncertainty and benefit the paragliding community. Lastly, here is a useful quote from the Sahpa Basic License Training Manual:

SAHPA provides third party aviation public liability insurance for the protection of the members. Public liability insurance pays for damage or injury to another person's property or body, not that of the pilot. Students are covered by this insurance should they cause damage to something or somebody, somehow. There is an excess payment required. Check with the SAHPA office or on their website for specific details. All members and temporary members are included. Tandem passengers are not covered by the third party public liability insurance except if they are SAHPA members. Foot-launched powered paragliding and powered hang gliding are covered by this third party liability insurance, but the trike versions are not.

In summary: reach out to Sahpa if you had an accident whereby someone else's property was damaged. I know for a fact that they've paid out, but again the excess/deductible, amounts, exclusions are still unclear at this time.