Early last Sunday morning, at around 6am, a man was found dead by ambulance officers in a suburb of Melbourne. As tragic as that was, it’s not a particularly unusual scenario for ambulance crews. Dealing with death is part of the job.
But what makes this case particularly tragic is the officers were responding to an emergency call made at around 2am. That’s a staggering four hours before the crew arrived. The call was made after neighbours had heard a man calling for help from inside a property they were unable to access. Adding to the heartbreak is that, after the call was made, the man’s cries for help continued for up to two hours.
Alarmingly, long waits for ambulances are no longer the rare occurrences they once might have been. This is the case not just in Victoria, but Australia wide. It suggests a serious breakdown in at least one part of the nation’s healthcare structure.
So what’s behind what has become a national ambulance service emergency?
The ambulance emergency
Ambulance Victoria said the Melbourne tragedy came in the middle of an extremely busy period for the health system. This was due to seasonal illness circulating around the community and health services workforce, Ambulance Victoria claimed.
This in turn contributed to high levels of sick leave among ambulance crews. The Victorian Ambulance Union said that meant only 90 ambulances were operating, instead of the 120 usually working night shifts. Ultimately this resulted in a shortfall across Victoria, the union said.
However, the Victorian case was not a typical one. Across Australia, the most common cause of lengthy delays in responding to calls is ‘ambulance ramping’. The term refers to paramedics having to wait at the hospital’s entrance because they’re unable to transfer their patient into the emergency department within an appropriate time frame.
In an article written for the Conversation, Flinders University’s Prof Jonathan Karnon and Andrew Partington explained the root cause succinctly. “Ramping is an indicator of hospital stress,” they wrote.
Why the increase in ramping?
Prof Karnon and Mr Partington said available data shows the problem has become worse over time. The bottlenecks occurring reflect an imbalance between the number of people presenting at emergency departments and the capacity to treat or transfer patients to a ward.
“Potential drivers of this imbalance are increased emergency department presentations and reduced availability of inpatient beds.” the authors wrote. “The latter may reflect increased demand for beds, including longer hospital stays.”
Other data suggests an increase in the number of more serious presentations in recent years. Inevitably, more serious presentations require longer to assess and treat, contributing to more ramping.
“Further, COVID and other viruses are likely to have contributed to increased hospital stress via workforce shortages,” the authors wrote. “This has possibly led to delays in seeing patients in the emergency department and in discharging patients from hospital.”
The ambulance solutions
Prof Karnon and Mr Partington have proposed a number of options which could help ease the crisis:
- Increased vaccination rates, which could reduce the impact of viruses.
- Increasing incentives to GPs to reduce costs to patients. This would address pressure on hospitals caused by increases in people delaying or avoiding seeing a GP due to cost.
- Designing, implementing and scaling up services that provide appropriate and cost-effective out-of-hospital care. This would free up hospital capacity.
- An increase in “hospital in the home” care
- Increasing Virtual Emergency Department services
Longer-term solutions would require better co-operation between state and territory governments and the federal government, the authors said. This would help “prevent and better manage chronic conditions, such as diabetes and heart disease, outside hospital. This includes boosting access to GPs and improving communication between GPs and hospitals.”
It seems, then, that prevention of tragedies similar to the one seen in Melbourne last weekend might be possible. It remains to be seen if and when the strategies that may facilitate this prevention are implemented.
Have you experienced a long wait for an ambulance? What effect did it have? Let us know via the comments section below.
