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Ambulance shortages amid more ramping and ED crowding


The parents of a 14-year-old who collapsed were forced to drive the boy to hospital themselves because there no ambulances available, while a crew had to be sent 80 kilometres from Port Augusta to a Whyalla patient suffering a seizure, according to the latest delays revealed by paramedics.

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In a third case, paramedics say a patient who had a fall after recent back surgery had to wait nearly an hour and a half on the floor for an ambulance to arrive, and was then ramped for nearly four hours outside the Royal Adelaide Hospital’s crowded emergency department.

The case notes have been provided to InDaily by the Ambulance Employees’ Association to highlight the ongoing personal toll of the state’s ramping crisis and lack of ambulance resources.

It comes as the union released a video on Twitter showing ramping at the Royal Adelaide Hospital – with a claimed 17 ambulances ramped at one time during yesterday’s peak.

It also comes as the nurses’ union reports that for the second time this month, the number of people waiting for a ward bed while stuck in emergency departments this morning again hit a record figure of 139 patients.

“Never before have we witnessed such appalling numbers of people waiting for a hospital bed, said Australian Nursing and Midwifery Federation state secretary Elizabeth Dabars.

“Never before have we witnessed such strain on our hospital system.”

Dabars said almost half of them – 65 patients – were waiting for anywhere between eight hours to more than 24 hours.

She said the previous record of 139 patients waiting for a bed was set on May 3.

It follows fears from frontline clinicians about looming job losses, as SA Health yesterday confirmed it had an “internal working document” outlining “various opportunities” for savings identified by firm KordaMentha but said “no decisions have been made”.

The nurses’ union has also issued a direct plea to SA Health chief executive Chris McGowan to address fatigue, as clinicians work double shifts across the system to try to keep up with demand.

AEA state secretary Phil Palmer said the latest ramping and delayed response cases were a reflection of a widespread problem.

The case notes report that just after 9am on Sunday a triple zero call was received in Whyalla for a 14-year-old boy who had collapsed.

It was initially triaged as the most serious emergency – Category 1 – meaning an ambulance should have arrived within eight minutes.

The case was then downgraded to Category 2 – requiring an ambulance within 16 minutes.

But the union says there were “no ambulances available to send”, so staff had to “inform the patient’s family over the phone that due to significant delays in (an) ambulance attending they should carry the patient to hospital themselves” – which the union says they did.

Later that day, also in Whyalla, the union says a triple zero call came in for a patient suffering a seizure who was “semi-responsive”.

“Again, there were no ambulances available to send,” the union’s notes say.

“When an ambulance became available 80 kilometres away in Port Augusta it was sent, arriving over an hour and 20 mins later, for what should have been a 16-minute response time.”

Palmer said “our regional areas continue to face increased demand for emergency ambulance services”.

“Many more ambos are needed across the state,” he said.

“These are not ‘surges’ – these are the risks that our community faces every day due to underfunding and under-resourcing by the Marshall Government.”

Paramedics and the State Government have been at loggerheads for years over workload and ramping.

The union has accepted “in principle” an offer from the Government of 74 more paramedics – including 24 for country areas – to cease industrial action and negotiate roster reform.

The deal will now go to the union’s 1600 members to be voted on next week.

The third example of delayed response times provided by the union occurred early yesterday morning when a patient who had back surgery had a fall at West Lakes.

The union says the patient was on the floor for an hour and 20 minutes until a crew arrived.

When the patient was taken to the Royal Adelaide Hospital, the union says the person was ramped, in significant pain, for nearly four hours before being allowed into the emergency department.

A large part of the ramping problem is caused by bed-block inside hospitals and emergency departments.

Doctors and nurses have been vocal in calling for more resources to help alleviate the pressure.

In its latest plea, the Australian Nursing and Midwifery Federation has written to SA Health chief executive Chris McGowan reminding him of his “duty of care” to staff and patients and urging him to act to help reduce widespread fatigue among clinicians.

“We have been receiving escalating reports by nursing and midwifery staff of excessive use of extra shifts, double shifts, overtime, and related missed/delayed care,” ANMF state secretary Elizabeth Dabars sates in her letter, seen by InDaily.

“These issues exist in both country and metropolitan areas.

“We have raised our concerns directly with all Local Health Networks regarding fatigue and fatigue management and the related strategies and solutions required to address this problem.

“In every instance, the strategies we have been assured will be implemented to rectify these issues have either not eventuated or have had limited impact.

“Members report they are fed up with working understaffed and coupled with the pressures of additional shifts, are experiencing burnout and fatigue. These conditions cannot continue.”

Dabars urges McGowan to take a number of immediate, medium and long-term actions, including to stop offering voluntary separation packages, employ those working on temporary and casual contracts as permanent employees and recruit extra graduates.

In a statement, an SA Health spokesperson said “our hospitals are staffed in line with the Nursing Midwifery Enterprise Agreement and we prioritise our workforce planning to ensure the wellbeing of our staff”.

“If a shift isn’t able to be covered through other means and a double shift is worked, we always provide the staff member with additional support and check-ins,” the spokesperson said.

“We thank our staff for always working hard to provide the best possible care for our patients.”

In a statement, a spokesperson for the SA Ambulance Service said “we agree that ambulances with patients ramped outside of hospitals is unacceptable” and “we are working to boost our response capacity within metropolitan Adelaide and in regional areas of priority”.

“SAAS can confirm that early Monday, crews were called to a patient at West Lakes who had fallen on the floor, requiring extrication support,” the spokesperson said.

“The case was triaged appropriately and the patient was later transported to the RAH by an ambulance crew who are well trained in managing such cases.”

The spokesperson said that Whyalla “experienced high demand for services” on Sunday, “with workload well above predictions”.

“We recognise the increasing demand for ambulance services in some regional areas,” the spokesperson said.

“We understand the distress to our patients and families, our staff, and our communities when an ambulance does not arrive as quickly as we would like.

“SAAS will always prioritise the response to the sickest of patients requiring lifesaving emergency treatment.”

The spokesperson added that it was “important to note that each patient has their own complex needs which can be reassessed as the response progresses, and as so, may experience priority upgrades or downgrades in response to a situation – these factors must be considered when reporting on ‘response times’”.

“The patient at West Lakes was initially triaged as a Priority 3 in an abundance of caution, and as the situation was established, the patient was quickly reprioritised as a Priority 5,” the spokesperson said.

“A SAAS crew arrived on scene in the relevant timeframe.”

In a statement, Health Minister Stephen Wade said “South Australia is not alone in experiencing high levels of emergency department presentations in recent months”.

“During the COVID-19 pandemic, hospitals throughout the nation have experienced increased pressure,” he said.

“Unfortunately, ramping and long waits for ambulances have been experienced in Queensland, Western Australia, Tasmania, New South Wales and Victoria.”

Wade said there was no denying that “more capacity” was needed in SA’s emergency departments.

“That’s exactly what we are delivering as part of our landmark $1 billion hospital build program, which will deliver an extra 141 treatment spaces across several EDs,” he said.

“The former Labor Government brought ramping to South Australia and allowed it to fester and become the norm for our hospitals.

“We are committed to stamping it out by getting on with delivering our building program to expand capacity and a range of initiatives to improve patient flow.

“Labor’s Transforming Health disaster saw hospitals downgraded across metropolitan Adelaide and a hospital closed entirely – that is the legacy they left South Australia.”

Wade said “we are pleased to be delivering 74 additional paramedics to our ranks, which will mean more than 250 additional ambulance service personnel have been employed in the first three years of government”.

“We are also pleased to be working with the union towards delivering much needed roster reform that will better align rosters with demand for service,” he said.

“All delays are regrettable, but we are determined to fix the problem by increasing capacity in our hospitals, delivering more ambulance officers and better health care for South Australians.”

He also said that “under the Marshall Liberal Government, there are more doctors, nurses and midwives employed in South Australia than ever before”.

“The independent Auditor Generals figures clearly show that there has been a net increase of more than 1000 health professionals since the 2018 election,” he said.

“Each year, the total number of health professionals has increased under the Marshall Government and we will continue to invest in our health system going forward.”

Opposition health spokesman Chris Picton said “the inadequate care” of the patients highlighted by paramedics “represents a total system failure of our health system”.

“The truth is, these shocking cases are the tip of the iceberg of the patient harm due to the negligent operation of the health system,” he said.

“It is shocking and telling that Stephen Wade would respond to these awful cases happening under his watch with political bluster rather than care and concern.

“Every day patients are being impacted by the escalating ramping crisis – in the city and around regional SA.

“It’s unacceptable that the Government has let this situation deteriorate so significantly that a collapsed person in a major regional centre had to wait for an ambulance to come from over an hour away.

“Stephen Wade needs to spend less time blaming a government from over three years ago, and more time listening to clinicians and patients about the impact of his cuts.

“What is even more startling is that when faced with evidence like this, the Government are still not ruling out embarking upon a second round of job cuts and refusing to release the cuts proposal that they have been given by KordaMentha.”

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