Ramped up about

Assures Tasmanians that patient care drives ambulance services

Neil Kirby

AS Ambulance Tasmania chief executive, my top priority is to ensure that when someone needs an ambulance, they get one.

I understand the frustration of anyone who waits longer than they need for an ambulance or for admission into hospital.

One factor that can delay both these things is ramping of ambulances at hospitals.

Ramping is when an ambulance is queued until the emergency department is able to receive the patient.

Having ambulances at an emergency department bay does not necessarily mean they are ramped.

It takes time for paramedics to hand over a patient to emergency department staff to ensure continuity of care. Paramedics do not simply drop off a patient on a stretcher and drive to the next job. They ensure emergency department staff have all the relevant information about a patient’s condition and the circumstances under which they called an ambulance.

In many cases, paramedics will have been speaking to the patient since they began treatment, and may need to relay information as to the person’s physical or mental state in the lead-up to their requirement for medical intervention.

In the event the patient was with other people, paramedics may have information from witnesses as to how a person suffered an injury or illness. All this needs to be passed on because it may be important to the treatment and diagnosis.

A proper handover of a patient can take up to 30 minutes, and the Australasian College for Emergency Medicine even recommends handovers of up to 30 minutes. An ambulance waiting for its crew to conduct a thorough handover is in no way ramped.

At a point in time, there may be several ambulances at the emergency department while crews are conducting handovers, but in a relatively short period of time they will be back on the road.

Ramping occurs. It is not a new phenomenon and has been happened at hospital emergency departments in Tasmania for decades, consistent with increased demand for emergency treatment.

In terms of impact on ambulances across Tasmania, last financial year, less than 1 per cent of ambulance hours was lost due to ramping, and that does not include volunteer ambulance hours or staff working on-call.

The southern region recorded the highest level of ramping during the same period, with just 1.38 per cent of ambulance hours lost.

To put that in context, a person using 000 to call an ambulance for a trivial or nonemergency situation can waste much more time in one call.

Managing those demand pressures is part of modern medical systems, which is why patients are triaged and those in most need of medical intervention receive it first. That’s how lives are saved.

Ambulances also get ramped when the emergency department is managing its demand pressures through its triage system.

There may be sicker patients needing earlier intervention. Staff could be dealing with a patient whose condition has suddenly and unexpectedly become critical.

All these situations can create unanticipated, but unavoidable delays.

Ambulance Tasmania can receive many calls in a short period of time, with multiple ambulances arriving at hospital at the same time. Again, the triage system applies, meaning some patients get seen before others.

Of course, access to inpatient beds is important in maintaining patient flow, and opening new hospital beds will put downward pressure on ramping. I assure patients that our paramedics provide continuous care until the hospital staff take over.

In the event a patient arrives in an ambulance, paramedics continue to monitor and care for their patient until the appropriate medical care is available in the emergency department.

In co-operation with the Tasmanian Health Service, in periods of high demand, Ambulance Tasmania has asked staff to provide additional support to crews waiting to transfer patients into emergency.

Ambulance Tasmania and the THS are committed to the health and safety of patients.

I would prefer ramping was not an issue, but we are working to address it with improved procedures, additional beds, and new ambulance crews coming online this year, with more paramedics in recruitment.

Anything we can do to maximise our response to critically ill patients is critical.

Ramping happens, it is not ideal, but ambulances outside an emergency department may simply be doing their job — delivering people to hospital in a timely manner with proper medical oversight.

It takes time for paramedics to hand over a patient

Neil Kirby is chief executive of Ambulance Tasmania.