One State, One Service

A B L VICTCE M ABL M U ANCE VICTORIA U 2008–2009 ANNUAL REPORT A N One state, one service. OR I A 2008–2009 ANNU Attached is a DVD on Ambulance Victoria’s Annual Report for 2008–2009. If it is missing please contact 03 9840 3372 for a replacement. A L R EPO R T Charges AV services are provided free to members of the Ambulance Service Victoria membership scheme, holders of Pensioner Concession Cards, Health Care Cards and eligible Department of Veterans Affairs Cards, except where payment is the responsibility of a third party such as the Victorian WorkCover Authority, Transport Accident Commission or public hospital. A charge is levied for attendance or transport of all other patients. In the metropolitan region, AV charges $270.76 for emergency attendance or $897.28 for emergency care and ambulance transport. In the rural regions, AV charges $260.49 for emergency attendance or a flagfall of $893.95 for emergency care and ambulance transport, plus $10.82 per minute and $1.06 per kilometre. Air ambulance service charges comprise $825.82 for the first flying hour and $13.78 for every additional minute for fixed wing services and $3,113.74 for the first flying hour and $51.90 for each Ambulance Victoria additional minute for ambulance helicopter services. Registered Office and Headquarters Publications and brochures 375 Manningham Road The AV website at www.ambulance.vic.gov.au contains Doncaster, Victoria 3108 information about AV and is regularly updated with the latest Postal Address in statistics, developments and media releases. AV also PO Box 2000 produces a range of publications and brochures which are Doncaster, Victoria 3108 available on request. Website www.ambulance.vic.gov.au Administration 03 9840 3500 Facsimile 03 9840 3583 Printed in Australia on an environmentally sustainable paper. Membership 1800 64 84 84 One state, one service. 2008–2009 Highlights A new service In an exceptional year by any standards, we have seen significant structural change, an unprecedented increase in staff and equipment, and paramedics treating a record number of patients. More on page 3. An effective service In our first year of operation – amid the merger activities, record staff recruitment and introduction of new services – we delivered outstanding patient care and improved our response times. Read details on page 16. A flexible service Our comprehensive planning and preparation for emergencies placed us in a strong position to respond in 2009 to an intense heatwave, terrible bushfires and an influenza pandemic. Read more on page 28. An innovative service From more effective treatment – especially in remote areas – to cutting-edge medical research and technology, we are continually finding innovative solutions. Full details on page 36. An accessible service We have a responsibility to educate the community on how to recognise a medical emergency and deal with it until paramedics arrive. We strive to ensure this education is accessible across all age groups and all communities. Read more on page 44. A well-managed service While a strong financial performance is important, so is supporting our front-line paramedics, the communities we work in and the environment. Full governance report on page 52. 2 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT A new service In an exceptional year by any standards, we have seen significant structural change, an unprecedented increase in staff and equipment, and paramedics treating a record number of patients. AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 3 The merger On 22 April 2008, the Victorian Premier, the Hon. John Brumby, In many instances – such as payroll – the MAS and RAV MP, and the Health Minister, the Hon. Daniel Andrews, MP, systems were very different, so separate systems were announced the merger of the state’s three ambulance services, maintained during the first year post-merger, while the Metropolitan Ambulance Service (MAS), Rural Ambulance preferred software system was chosen and then applied to both Victoria (RAV) and Alexandra District Ambulance Service services, ahead of implementing a statewide model. (ADAS). In other areas, such as our Quality & Education Services This created one statewide ambulance service, bringing Division, common practices and a previously close working Victoria into line with all other Australian states. relationship meant that aligning and merging aspects of our Submissions about the merger were invited, and 78 submissions training and quality management were significantly easier. were written and submitted. On 28 May 2008, five weeks after One of the first opportunities was to involve all new the initial announcement, the State Government confirmed the paramedics into a single induction program, which meant our merger would take place five weeks later, on 1 July 2008. graduate paramedics were exposed to the whole organisation. From the moment of the April announcement, an enormous We recruited a record 334 paramedics, and the programs were amount of work began. supported by staff from rural and metropolitan regions, who Initially, this involved essential aspects for a new service, highlighted the similarities in practice, equipment and systems such as appointing an interim executive group and a new to the participants. Board. Once the merger took place, a significant amount The induction program also highlighted the small differences that of work began in earnest. could be quickly overcome, such as a single process for uniform Under the new executive structure, the senior executive orders, a common safety vest for all operational staff and chemical, became responsible for merger projects within their division. biological and radiological training for all new recruits. There were more than 40 separate projects, covering human Within three months, Ambulance Victoria (AV) developed resources, finance, information systems, payroll, rosters, risk a Statement of Priorities, which was endorsed by the Health management – and many others. Decisions were made about Minister. By the end of the financial year AV had developed how to align equipment, policies and processes and, ultimately, a five-year strategic plan. ensure all regions operated under one system. The enormous amount of work behind the scenes was coupled with a substantial amount of energy implementing a raft of welcome Government budget decisions – an extra $185.7 million over four years. The resources introduced during the year included two new helicopters (one officially came into service on 1 July 2009), new teams and paramedics both in rural and metropolitan areas. These extra resources were implemented by the due dates. 4 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT At the same time, our paramedics responded to a record AV’s central strategy number of emergency calls across the state – and our overall response time performance improved. AV’s central strategy is based around the patient and their At the end of 2008-2009, Greg Sassella was appointed as medical outcomes. Focusing on what happens from the Chief Executive Officer, having worked as interim CEO patient’s perspective clarifies the challenges we face as an through the first year of the merger. organisation and drives significant decisions. By this time a new organisational structure was in place, While AV measures the activities and the efficiencies of what with a permanent executive team establishing the roles and we do – such as the number of emergency calls and our responsibilities in the management structure. response times – we need to understand what actually happens AV was assisted by external business consultants to advise on to the patient because of our attendance or intervention. various aspects of the merger, which was of great benefit. As a result we have key indicators to measure the impact AV’s new structure has several key design considerations, on a patient’s quality of life and the quality of their clinical including: outcome, which allows us to understand the significance • Retaining the strengths and knowledge of the of the interventions we provide. previous organisations We also closely monitor our interventions by collecting • No metro-rural divide comprehensive computerised data on each patient, and by working in partnership with hospitals to conduct important • A strong operations presence in the executive medical research. Doing this we can learn which interventions • Improved consistency in processes, roles and systems produce better patient outcomes, and these become our • A statewide service delivery model standards of care. • Strong, centralised support functions, such as HR, IT A key measurement for AV is the outcome for patients who and finance, supporting a decentralised service. suffer a cardiac arrest, which occurs when someone’s heart Merger activities will continue for some time as we continue to stops pumping and the person stops breathing. They are align our systems and practices using our existing budget. clinically dead (whereas in a heart attack, the heart continues These changes may take some time to complete, however we to beat). will ultimately build a stronger, more efficient and more effective ambulance service in Victoria. And then there was one In the early 1980s, Victoria had 16 different ambulance services. In 1987, a series of mergers cut the number of services to seven. Then in 1999, the merger of rural services reduced the number to three. And on 1 July 2009, those three services became one. AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 5 A cardiac arrest requires urgent action. Cardio-pulmonary Outcomes have improved significantly over the last five years. resuscitation (CPR) is the main first-aid technique, compressing In 2003-2004, 39 per cent of VF/VT patients arrived at the chest and breathing into the victim’s airway, to keep hospital alive and 14 per cent survived to go home. In the year oxygenated blood flowing to the brain and other vital organs. to June 2009, 51.2 per cent of patients arrived at hospital with The public uptake of CPR in recent years has saved many lives vital signs, and 23 per cent of patients survived to discharge.

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