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Short-term fixes on the table to ease ramping crisis following death

UPDATED: An investigation report into the death of an Adelaide father from a suspected heart attack after waiting 42 minutes for an ambulance will be made public, authorities have vowed, as they search for short-term fixes to avoid another such tragedy.

Aug 10, 2022, updated Aug 10, 2022
Image: Tom Aldahn/InDaily

Image: Tom Aldahn/InDaily

Options being considered include putting more paramedics on overtime and introducing a GoodSAM app – to alert responders to someone nearby in cardiac arrest.

The paramedics’ union yesterday revealed a 47-year-old man died in a car park at Plympton on Monday night after calling triple zero for help with chest pain and waiting 42 minutes for an ambulance, during a day of extreme pressure and ramping.

Premier Peter Malinauskas said a “thorough investigation” would take place and today a government spokesperson said that review – to be conducted by SA Health chief medical officer Dr Michael Cusack – would be made public.

Bystander Josh Hamdorf told of the frantic efforts to save the man, including how he performed CPR until help arrived.

He said others attempted to use a defibrillator but the man had already been waiting more than half an hour and it was too late.

SA Ambulance Employees Association state secretary Leah Watkins today said she had held urgent talks with SA Ambulance Service officials to discuss immediate solutions to ease ramping.

She told InDaily options included putting more paramedics on overtime, which she said was more feasible now that new recruits had come on board.

She also said the SA Ambulance Service was working on rolling out a GoodSAM app – like Victoria has done – to enable quicker help to arrive.

“We need to be considering all options at this point,” she said.

The Ambulance Victoria website explains the GoodSAM app “connects responders to patients in those first critical minutes of cardiac arrest while paramedics are on the way”.

SA Best MLC Frank Pangallo said “the system is broken” and called for urgent action.

Pangallo wrote to Health Minister Chris Picton last week about a widowed pensioner relative who he says suffered a massive heart attack and waited two hours for an ambulance.

“The woman was barely conscious and the situation was distressing for all concerned, including the paramedics,” Pangallo wrote in his letter, seen by InDaily.

“The unacceptable delay could have had tragic consequences had it also not been for the excellent response by the emergency department at the Queen Elizabeth Hospital.

“The woman was rushed into surgery and required two stents to be inserted into blocked arteries. Surgeons told the family she was lucky to survive.”

He called on Picton to “address the ambulance response times blowouts to avoid yet another tragedy”.

“While I understand our hospital system and ambulance retrievals still are at breaking point, I feel the delay in this incident goes well beyond public expectations, particularly when it comes to dealing with high priority cases like cardiac arrests,” he wrote.

“It simply should not be allowed to happen.”

Pangallo will also introduce a Bill to parliament next month to make defibrillators mandatory in public buildings, larger businesses and public transport.

“They can save lives,” he said.

Opposition health spokesperson Ashton Hurn said Monday’s death was “a tragic incident and it’s not good enough for this poor man or his family, not good enough for first responders and not good enough for South Australians”.

“It’s also another disturbing reminder that the health system isn’t coping with the enormous pressure it’s under…,” she said.

“South Australians say they are terrified to call an ambulance because it might not show up – that’s an extraordinary state of affairs especially when Labor promised to fix ramping.”

Hurn said the Opposition would “look closely” at legislation put forward by Pangallo for the rollout of defibrillators across SA.

“All options must be on the table to save lives,” she said.

Central Adelaide Local Health Network chief executive Lesley Dwyer this morning said the system was under “extreme pressure” on Monday when paramedics were delayed reaching the 47-year-old man, with “large numbers of triple zero calls (and) the hospitals themselves had come off a weekend where we’d been extremely busy”.

“Two of the major metropolitan hospitals… the Flinders and Royal Adelaide… were really struggling to get the people into emergency departments in time, and free up ambulance services,” she told ABC Radio Adelaide.

“Although we were coming off the winter peak, you’ll appreciate that in the hospital system we’re dealing with the sickest people and therefore they will stay, so we still have around 300 people that are requiring care for COVID.”

Dwyer said flu and other winter illnesses were also adding to the pressure.

“We need to be doing all we can to free up EDs and that really relies on us being able to discharge more patients and to do lots of other things, and some of these things take more time, but others we just need to get on and do, and do them at scale,” she said.

“What we’re trying to do is create as much capacity as we can. But the discharging is key and making sure that it doesn’t matter what day of the week it is.

“We have to make sure that we can discharge people safely and sometimes on a weekend we do not have the range of support service within the community.”

The State Government has recently leased additional hospital beds from the private system to try to ease pressure and is working on election commitments to hire more doctors, nurses and paramedics.

Picton is on leave but a government spokesperson said in a statement: “We are taking immediate steps to help ease pressure on our hospitals, safely discharge more patients and improve ambulance response times.”

“More hospital beds available means patients in the ED have somewhere to go and our ambos aren’t stuck on the ramp,” the spokesperson said.

“That’s why we’re now bringing on 107 extra private beds for public patients, on top of more than 200 extra beds we’ve already opened since coming to Government.

“Other measures include the Regency Green site opening to get NDIS patients out of hospital and into community-based care, freeing up more beds.”

The spokesperson said 260 aged care patients had also been moved into aged care facilities since July 20, as part of a targeted campaign to reduce hospital bed-block.

“We share the desire to see increased availability of defibrillators across the state, and have committed to working through the details of this proposed Bill in conjunction with Mr Pangallo and SA Ambulance Service,” the spokesperson said.

In regard to the delayed ambulance case raised by Pangallo, the government spokesperson said: “The Minister has received and discussed the letter with Mr Pangallo, and shares his concerns over the unacceptable delay for his family relative.”

“The Minister asked SAAS to investigate the matter, and will provide an update to Mr Pangallo shortly,” the spokesperson said.

An SA Ambulance Service (SAAS) spokesperson said “we continue to work on response times so that our crews can get to our patients sooner”.

“Immediate measures being taken include increases in crewing to relieve pressure as a result of ramping and high workload,” the spokesperson said.

“SAAS continues to experience high demand for services, prioritising the most urgent cases so they can get help as quickly as possible.

“Where appropriate, those with less serious conditions should consider alternative care options before calling triple zero.

“This may include the local GP, HealthDirect, or for COVID-related enquires use the National COVID hotline.”

The spokesperson said a “significant number” of patients call triple zero “but after clinical assessment do not need an ambulance to attend, but may not have transport to get to their non-urgent care”.

“The use of taxis is likely to see these patients access their non-urgent care more rapidly and leaves our ambulances available for emergencies that require an immediate response,” the spokesperson said.

An SA Health spokesperson said: “SA Health recognises the health system is under pressure from the ongoing impact of winter illness, flu and COVID-19 and wants to reassure the community we are putting all our efforts into supporting flow in our emergency departments and easing pressure on our hospitals.”

“We have a range of measures in place, including prioritising the safe discharge of patients from acute wards to more suitable care in community-based settings, and to beds available through our partnership with the non-government sector,” the spokesperson said.

“We thank all of our hardworking staff for their ongoing commitment to providing the best care to our patients at this time.”

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