CALL 10177 IMMEDIATELY if you suspect a pulmonary embolism. PE can be fatal within minutes.
Recognise a Pulmonary Embolism — Act Without Delay
PE symptoms can develop suddenly. Call 10177 immediately if you experience:
- Sudden severe breathlessness — worse on exertion or even at rest
- Sharp chest pain that worsens when breathing in (pleuritic chest pain)
- Rapid heart rate (palpitations) with breathlessness
- Coughing up blood (haemoptysis)
- Feeling faint, dizzy, or collapsing — massive PE causes haemodynamic collapse
- Leg swelling + any of the above — suggests DVT with concurrent PE
Massive PE — where the clot is large enough to cause circulatory collapse, low blood pressure, and cardiac arrest — is immediately life-threatening. Every minute without treatment significantly increases mortality.
DVT — Urgent but Not Immediately Dangerous
DVT alone (without PE) is serious but not usually immediately life-threatening. However, it should be assessed urgently:
- Swollen, painful, warm, red leg (especially calf or thigh) — go to the ER or urgent care same day
- Do not delay — a DVT can propagate and embolise at any time
- Do not massage the leg — this can dislodge the clot
If you have a known DVT and develop any PE symptoms — call 10177 immediately.
Emergency Numbers
Ambulance (national): 10177 ER24: 084 124 Netcare 911: 082 911 Police: 10111
What Your Medical Aid Must Cover in a PE Emergency
| Situation | PMB Status | Notes |
|---|---|---|
| Acute PE — emergency ER assessment | Yes — PMB | CTPA (CT scan) to confirm diagnosis |
| Acute DVT — emergency assessment | Yes — PMB | Doppler ultrasound to confirm |
| Hospital admission for anticoagulation | Yes — PMB | |
| ICU admission (massive PE, haemodynamic instability) | Yes — PMB | |
| Thrombolysis (tissue plasminogen activator — massive PE) | Yes — PMB emergency | Life-saving in haemodynamic collapse |
| Surgical embolectomy (rare — massive PE, thrombolysis contraindicated) | Yes — PMB emergency | |
| Catheter-directed thrombolysis | Yes — PMB | Interventional radiology procedure |
| IVC filter insertion (anticoagulation contraindicated) | Yes — PMB | Interventional radiology |
At the ER — What to Say
On arrival, state immediately: "I have sudden breathlessness and chest pain — I think I may have a pulmonary embolism."
Give the triage nurse a brief clinical history: - When symptoms started - Any recent surgery, immobility, long-haul travel, or cancer treatment - Any known DVT or prior PE - Current medications (especially if on anticoagulants already)
Do not minimise PE symptoms — they are easy to attribute to anxiety or muscular chest pain. Be explicit.
If You Are on Anticoagulants and Experiencing Bleeding
Anticoagulant-related bleeding is a medical emergency: - Internal bleeding signs: Sudden severe headache, back pain, abdominal pain, black/tarry stools, vomiting blood, coughing blood, sudden vision change - Significant external bleeding (wound that won't stop, major laceration)
Call 10177 or go to the ER. Warfarin bleeding can be reversed with vitamin K and prothrombin complex concentrate (PCC); DOAC bleeding has specific reversal agents (idarucizumab for dabigatran, andexanet alfa for factor Xa inhibitors — availability varies in SA).
Tell the ER team exactly which anticoagulant you are on and the dose.
If Your Scheme Declines the Acute Admission
DVT and PE are PMB Diagnosis and Treatment Pairs. Refusal to fund an acute admission is a potential PMB breach.
- Request written reasons.
- Your treating physician should immediately submit a clinical motivation with the diagnosis, investigation results (CTPA/Doppler), and anticoagulation initiated.
- Internal appeal with clinical documentation.
- Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za — escalate without delay for an acute event.
Long-Term Crisis: DOAC or Warfarin Unaffordable
If you cannot afford ongoing anticoagulation:
- Do not stop anticoagulation without medical guidance — sudden cessation significantly increases re-thrombosis risk.
- Call your treating haematologist or GP immediately — explain the cost problem.
- Discuss whether warfarin (significantly cheaper) is appropriate for your profile.
- Ask your scheme about formulary access and whether DOAC can be funded under chronic medication benefit.
- Ask about generic DOAC availability in SA — some generics are entering the market and reducing costs.
Resources and Helplines
Emergency services: 10177 | ER24: 084 124 | Netcare 911: 082 911 SA Haematology Association (SAHA): saha.org.za Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →