On referral system the CEO informed the Committee that Ermelo Hospital refers to Witbank hospital and Rob Ferreira hospital. The hospital faces challenges with referral of orthopaedic cases due to receiving hospitals not having beds. Msukaligwa sub-district does not have a district hospital and therefore all patients from the 11 PHC facilities are referred to this hospital. The EMS station at Ermelo hospital, like all other EMS stations is centrally controlled in Secunda which sometimes causes delays in transporting of patients to upper levels of care.