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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. and AV actively encourages everyone from schoolchildren to We continue to take patients with specific injuries to the most the elderly to learn this life-saving technique, having provided appropriate hospital – for example serious burns patients will training for more than 700,000 Victorians in recent years. go to the state’s burns centre at the Alfred, and critical trauma When paramedics arrive at a cardiac arrest and CPR has been patients to the Alfred, Royal Melbourne Hospital or Royal started by a member of the public, the victim has a Children’s Hospital. In the metropolitan region, suspected substantially greater chance of survival. stroke patients are taken directly to one of the seven recognised stroke care centres. The chances of survival are again increased by the highly skilled treatment we offer. Our paramedics use sophisticated This principle of taking patients to the most appropriate equipment and drugs that can mean the difference between life hospital for their condition applies statewide, and includes and death. using AV’s helicopters and planes to transport time-critical patients to the most appropriate centres. The most widely accepted measure of cardiac arrest performance for ambulance services is the percentage of People in rural Victoria have more access to specialist facilities patients presenting in a heart rhythm ‘shockable’ with a in the metropolitan area than ever before due to the increase in defibrillator (ventricular fibrillation/ventricular tachycardia) helicopter numbers during the year and the growth of Adult who survive. In recent years, AV has worked with hospitals and Retrieval Victoria (ARV), and its team of doctors. the Department of Human Services to measure these cardiac Focusing on the patient also presents AV with new opportunities arrest patient outcomes and the impact of our improved skills. to look at innovative ways of providing care in more remote communities, which is part of our strategy for the next five years.

A new service By the end of the year, a new badge was developed for AV. This badge will be used on paramedic uniforms, buildings and vehicles. The new badge will be phased in gradually as we replace or update our existing clothing and equipment. As a result, it is likely that MAS and RAV badges will be seen for some time to come.

6 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT AMBULANCE VICTORIA Chair REPORT A Remarkable year

2008-2009 has been a remarkable year in the long history of This past year was not just about merger. The normal day-to- ambulance services in Victoria. day ambulance service continued with demand continuing to In April 2008, when the Minister for Health, the Hon. Daniel increase in many areas. The 2008-2009 year also presented Andrews, MP, announced the merger of the three previous some of the most amazing challenges Victoria has ever seen. ambulance services – MAS, RAV and ADAS – all involved in Many of our staff and volunteers played significant roles both ambulance could see that this would lead to substantial change during and after the bushfires. This work occurred only days and wonderful opportunities. We now know that the first 12 after some of the most substantial demand ever on ambulance months of Ambulance Victoria (AV) has provided many occurred with the February heatwave. Both these dramatic challenges but has already resulted in many improvements events demonstrated the significant benefit to all Victorians throughout Victoria. that is now possible as we have one co-ordinated ambulance response statewide. Upon the announcement, a hard-working group of people led by DHS began work on the many details that needed to be The ability of AV to meet the needs of our wide and varied covered to have the new organisation up and running by 1 July community could not occur without the efforts of our staff and 2008. My thanks goes to that team, which meant that the volunteers. Their work – be they paramedics, paramedic Board and executive of AV were well placed to get on with students, volunteers or non-operational staff – ensures work of the new organisation from day one. high-quality services are received by our community. My thanks are also extended to the Boards and executive None of this, the ordinary or the extraordinary, could have members of MAS, RAV and ADAS who worked hard in the been achieved without the leadership of our CEO Greg Sassella final months of those organisations to ensure those services and the executive team. In a year of beginnings and challenges ran smoothly in the transition phase and that AV was building they have created an organisation that is well placed to upon the strong foundations of those organisations. continue the achievements and recognition that the three previous organisations enjoyed. The initial Board of AV included former Board members of MAS, RAV and ADAS and two new members. In addition, Reflecting upon the year that has passed, acknowledgement Leigh Hocking, the former Chair of RAV, participated in the must be made of the visionary decision made by the Victorian first 12 months of AV as the Minister’s Delegate to the new Government in deciding to create AV. The continued support of organisation. the Premier, Minister Andrews and DHS has seen not only the establishment of AV, but also new innovations such as the The Board members and Delegate worked hard in the first year Warrnambool-based helicopter and an increase in the number of AV and my thanks goes to each of them. Their passion and of paramedics in Victoria. vision for ambulance services has seen many achievements for AV, with the organisation not just meeting the minimum We now look forward to continuing the achievements of AV requirements of the merger but with many components of into the future and continuing to provide services to the people integration completed, as well as developing a new strategic of Victoria, especially members of AV, because – as the current plan for AV. advertising campaign says – it is no ordinary club!

Marika McMahon Chair

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 7 Chex i f E ecutive Officer REPORT A new service

On 1 July 2008, the state’s three ambulance services merged to Operational growth create Ambulance Victoria (AV). Since that day – and through AV’s first year of operation – our paramedics, managers and During the year we implemented a series of service support staff have performed in an outstanding manner. improvements, stemming from a Budget announcement by the State Government in April 2008. These initiatives were mostly The merger implemented on or ahead of schedule. Those improvements included the expansion of the state’s air There are good reasons to have one service, which can ambulance service through the addition of two new helicopters maximise the benefits of streamlined systems, be it buying – a helicopter fitted out for medical retrievals based at Essendon vehicles, standardising major incident capability or and a primary emergency response helicopter at Warrnambool. implementing a statewide ambulance dispatch system. The Essendon-based helicopter began service on 16 March 2009, The merger itself required a significant amount of work as AV and the Warrnambool helicopter was commissioned, tested and began to align its systems, from rosters and payroll to finance ready to commence service by 1 July 2009. and human resources. Much was achieved in 2008-2009, with These were delivered within the tight timelines required for the interim executive management team performing an the purchase, delivery, fit-out and commissioning of both outstanding job, which allowed AV to restructure the aircraft, the training of extra MICA flight paramedics to organisation and develop a five-year strategic plan. provide the 24-hour service, and, in Warrnambool, the on-time More remains to be done in the coming years, such as the construction of a new facility for the aircraft, crew and staged introduction of a single ambulance communications paramedic staff. centre in Ballarat to replace the existing five rural To cement a successful and eventful year for Air Ambulance communications centres, which the Government announced in Victoria (AAV), the new base at Essendon Airport was 2008-2009. This is one example of the important platforms completed, providing better patient facilities and a base for our that are being built to ensure AV gels as a dynamic, cohesive statewide air ambulance operations. AV now has five single service. helicopters, four pressurised aeroplanes and statewide As Chief Executive Officer, I have been pleased with the responsibility for medical retrieval through ARV. progress we have made in 2008-2009, and we are further down During the year we established a series of new paramedic that path than I had expected at the start of the financial year. teams in metropolitan and regional areas, to ensure we meet These changes have taken place during another busy year, in demand in growing areas of the state. A number of paramedics which we recruited a record number of graduate paramedics, destined for duty in the metropolitan region, as part of those introduced a significant number of new resources thanks to new teams, were redeployed to our rural region to assist in some welcome Government initiatives and significantly meeting demand challenges in that region – again highlighting increased property developments, particularly in rural Victoria. the benefit of a single state service for the community. These changes – and the successful merger – took place in a year The only key initiative not completed during the year was the with a series of unusual events, including the severe summer rollout of MICA single responder units. This issue became weather conditions, bushfires and swine flu, all of which put an involved in negotiations over pay and conditions as part of an additional strain on the organisation, and we improved Enterprise Bargaining Agreement and this initiative will performance levels against our performance indicators. proceed in 2009–2010.

8 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Demand growth Modes of delivery

Demand for emergency ambulances again increased during the AV continues to develop new ways to deliver effective care year to a record level, both in metropolitan and rural regions. across the state. Our increased fleet of five helicopters and four AV responded to 433,549 emergency road cases during the year, aeroplanes means rural Victorians have better access to a 1.3 per cent increase across the state. Including non- specialist medical care in Melbourne than ever before. emergency incidents, AV responded to a total of 714,362 ARV completed its first full year of operation, and during the incidents during the year. year its plans to expand its services were endorsed and Demand also increased at AAV, where our planes responded to supported by the State Government. During 2008-2009, ARV 4,770 incidents, an 8 per cent increase on the previous year. undertook 1,584 adult retrievals, where patients were Our helicopters were busier, responding to 1,759 incidents, up transported between hospitals – both by road and air – with from 1,650 the previous year. paramedic support and, in almost one-quarter of cases, flight paramedic and doctor support. In the metropolitan area, our Referral Service handled more than 33,000 low-priority calls to 000. As a result, 7.2 per cent Initiatives to provide high-quality pre-hospital care in remote of our 000 calls (more than 24,000 calls) were referred to and lightly populated areas of the state continued to grow and other health care options (such as a local GP or district nurse), develop. We piloted an exciting scheme for Ambulance and an emergency ambulance was not required to be Community Officers to study to become fully qualified dispatched. This means ambulances were more available for paramedics while remaining in their communities, with the responding to life-threatening emergencies, demand was ultimate aim of strengthening the ambulance presence in that reduced at hospital emergency departments and patients community and reducing the need to roster paramedics from received a service better meeting their needs. outside the area. We are developing and piloting other models that provide the best possible care for each community. Our Referral Service has proved increasingly valuable since it was set up in 2003, particularly during the heatwave and bushfire A particular highlight has been the outstanding success of the period, and is likely to expand further in the coming year. Remote Area Nurse (RAN) program, which was formalised in 2008-2009. Under the agreement, RAN’s at Victoria’s 14 Bush Our statewide response times improved on last year, with 82.5 Nursing Centres can be called on to be first responders or per cent of ambulances on Code 1 calls (lights and sirens) co-responders in a 000 emergency. This has already produced arriving within 15 minutes. some outstanding clinical successes. Despite the overall improvements in our response times, we did not meet the response time targets albeit by a very small margin. We will take measures to improve these response times further in the coming year by continuing with the initiatives described above.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 9 H ighlights

There were many other highlights in 2008-2009, including: • We again significantly increased resources in • Exceptional weather conditions in January and February occupational health and safety (OHS). This includes 2009 that caused four days of extreme heat, only days giving our workforce a better understanding of return- before we witnessed the worst bushfires in Australia’s to-work policies, avoiding manual handling and lifting history. These events put unprecedented pressure on the injuries, and dealing with fatigue, which is a significant state’s ambulance services and other emergency services, issue for paramedics who work variable shifts. We have with high levels of demand over a number of days. also increased our peer support program for AV staff and Thankfully, the significant initiatives and investments brought the administration of the Victorian Ambulance in recent years provided the systems, vehicles and Crisis Counselling Unit (VACU) in house in order to technology that delivered and maintained an effective provide easier access for all staff including paramedics. response across Victoria. Our emergency management • A commitment of more than $35 million was made to systems and our Referral Service proved invaluable in upgrade and replace AV branches, particularly in dealing with the crisis. And in the ‘recovery phase’, the regional Victoria. In many cases we are replacing days and weeks that followed the fires, AV worked existing buildings, and providing paramedics with closely with DHS. We were able to access doctors, state-of-the-art facilities. In rural projects we employ paramedics, vehicles, shelters, generators and establish local builders and tradesmen, where possible, to carry small medical centres to treat the affected populations, out these building works. again demonstrating our increased capabilities. Our staff • AV made a commitment to establish appropriate provided an outstanding service under extreme procedures and practices to monitor and reduce the conditions, and I would like to take this opportunity to organisation’s environmental footprint. We believe that recognise their work. as a large employer with regular community contact, we • AV recruited a record 334 paramedics. We streamlined have a responsibility to be an environmentally and the previous education systems to ensure all AV recruits socially responsible organisation. received the same high level of post-graduate induction. Our graduate recruits will spend a year in service across the state before becoming fully practising paramedics. • AV’s 70 auxiliaries, the dedicated volunteer committees that support local ambulance branches in regional Victoria, raised more than $640,000, demonstrating the remarkable community engagement and community commitment to local ambulance services. During the year I met many auxiliary members and gave AV’s commitment to support their role and their future, which I see as part of our core business.

10 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT F inancial result A challenging year

During the year, as part of the merger of financial systems, the Our paramedics performed exceptionally well during the year Auditor-General formally examined our financial position and ensuring their care to the community continued at the high systems and processes. Pleasingly, they did not identify any levels we’ve come to expect. The managerial and high-risk issues, with only a small number of moderate or administrative staff, in combination with operational staff, low-risk issues being identified. Each of these will be addressed delivered an exceptional outcome for the first year of AV. and resolved during the early part of the next financial year. I want to especially acknowledge the role of the interim We are conscious however, that the difficult economic climate executive management team, who provided me with support may impact on our future revenue. Our experience from and guidance during a very busy year. By the year’s end, the previous economic downturns is that our revenue from executive management restructure was complete, placing us in transport fees (non-payers) and the ambulance Memberships a sound position to continue ongoing work. Subscription Scheme (people who do not renew) is likely to be I also want to acknowledge the work and service of Keith affected. Young, the Executive General Manager of Metropolitan These two sources of revenue are more than one-third of AV’s Operations, who died unexpectedly in April 2009. Keith made total revenue base, so any decline may affect our finances in a significant contribution to the ambulance service in Victoria the long term. We have worked hard to manage these and is sadly missed by us all. challenges and improve our debt-recovery processes and On behalf of the executive management team I would like to continue to put a strong emphasis on our Membership thank the AV Board and the Chair, Marika McMahon, for their Subscription Scheme. It is pleasing to report that the scheme support and guidance through the year, which has been reported a record growth of more than 50,000 members in integral to the development of the service and to our 2008-2009 and now has almost one million memberships, achievements during the year. covering about 2.1 million Victorians.

Greg Sassella Chief Executive Officer

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 11 Where we are

12 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Notes: • Following the February 2009 bushfires resources were increased on a temporary basis at Whittlesea (extended to 24 hours) and Kinglake (a new 24-hour unit). • HEMS 1 and HEMS 5 operate from Essendon. • Four fixed-wing aircraft operate from Essendon. • A new helicopter (HEMS 4) entered service at Warrnambool at midnight on 30 June 2009. • AV has six regions: Barwon South West, Gippsland, Grampains, Hume, Loddon Mallee and Metropolitan.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 13 14 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT An effective service

In Ambulance Victoria’s 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.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 15 An effective service

Emergency performance

AV responded to 436,037 emergency incidents in 2008-2009. Low-priority calls may be transferred to the Referral Service, These included 120,625 road incidents in AV’s five rural regions, particularly when the patient’s condition indicates that an 312,924 incidents in the metropolitan region and 2,488 ambulance may not be necessary. emergency air incidents (1,759 by helicopter and 729 by plane). Established in 2003, the service operates 24 hours a day, with This represents an average of 1,194 emergency incidents per day. two call takers who are an experienced paramedic or nurse. Our statewide road response times improved compared with The aim is to ensure the caller gets the medical help that the previous year. We responded to Code 1 calls (lights and resolves their issue. This may mean a referral to more sirens) within 15 minutes in 82.5 per cent of cases. While this appropriate care – be it driving to a hospital, seeing a doctor or was an improvement on the previous year’s 81.9 per cent, it was self-treating the condition. The Referral Service also directs short of our statewide target of 85 per cent of cases. callers to other service providers, such as psychiatric case Overall, in areas with a population of more than 7,500, our managers, nurses and hospital outreach programs. In about response was 88.2 per cent within 15 minutes, an improvement 30 per cent of cases, an ambulance is still sent. on the previous year’s 87.5 per cent. Our target response time In 2008-2009, the Referral Service handled more than 33,000 is 90 per cent of calls within 15 minutes. emergency calls, with more than 24,000 referred to other We continue to take measures to improve our response times. health care options. This meant emergency ambulances were A key part of our strategy in the metropolitan region is AV’s not sent to 24,000 cases during the year and were still Referral Service. available to respond to emergencies. In the metropolitan region, calls to 000 are answered by an The Referral Service is set to expand further once a single operator from the Emergency Services Telecommunications statewide dispatch centre is established in Ballarat. Authority (ESTA), a state government body. These operators During the year, AV worked with DHS and health services follow protocols to establish the priority of the call based on the to improve at-hospital times in the metropolitan area. information given by the caller before dispatching an ambulance.

Total AV road incidents Percentage of Code 1 responses within 15 minutes: all regions

800,000 Year Number 100 Year % target 85% 700,000 2008-2009 714,362 2008-2009 82.5 2007-2008 702,235 80 2007-2008 81.9 600,000 2006-2007 674,391 2006-2007 84.8 500,000 2005-2006 630,844 60 2005-2006 87.1 2004-2005 87.7 400,000 2004-2005 577,572

300,000 40

200,000 20 100,000

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

16 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Cardiac arrests

Because of pressures on hospital emergency departments, When 000 receives an emergency call for a suspected cardiac there can be delays before paramedics are able to unload arrest in the metropolitan region – in which the time to a patient and transfer the patient into the hospital’s care. defibrillation is critical – the Metropolitan Fire and Emergency This was particularly apparent during the influenza Services Board (MFB) is also sent if the call is within the outbreak late in the financial year. MFB’s coverage area. When ambulances are waiting at hospitals and not available The first to arrive treats the patient, and this initiative, begun in to respond to emergency calls, it affects our response times. 2000, has proved highly effective. Under this arrangement, the During the year, we followed protocols established last MFB officers are trained at Monash University, then receive financial year around the time it takes to transfer a patient, training updates and clinical audit and support from AV. increased the presence of paramedic team managers at We also continued a pilot program in partnership with the hospitals and held regular meetings with DHS and health Country Fire Authority (CFA) involving simultaneous dispatch of services. Despite this, at-hospital times continue to be an CFA volunteers to suspected cardiac arrests. The program began issue that affects our response times. in February 2008, with volunteers from the CFA stations at Berwick, Edithvale, Mornington, South Morang and Whittlesea. The volunteers have been trained in the use of automated external defibrillators and, like the MFB program, the aim is to reduce the time to defibrillation for cardiac arrest victims and improve the chances of survival. Since its inception, the volunteers have been sent to more than 200 cases and have achieved excellent results, with a number of patients resuscitated. It is hoped that this pilot program will be extended to CFA career firefighters in the metropolitan region in the coming year.

Total patient transports Total air transports

600,000 Year Number 6,000 Year Number 2008-2009 593,398 2008-2009 5,993 5,000 500,000 2007-2008 586,603 2007-2008 5,434 2006-2007 564,917 2006-2007 5,706 400,000 4,000 2005-2006 533,507 2005-2006 5,899 2004-2005 485,999 2004-2005 5,467 300,000 3,000

200,000 2,000 Helicopter Fixed wing

100,000 1,000

2005 2006 2007 2008 2009 2005 2006 2007 2008 2009

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 17 Expanding services Communications

In April 2008, the State Government announced significant In 2008-2009 we completed the implementation of a new radio new resources for AV. These included 20 extra ambulance communications network in the rural regions, replacing the teams in the metropolitan region. VHF radio network that had operated around the state. These teams were successfully put in place during the year. The new radios use Telstra’s Statewide Mobile Radio (SMR) These teams included 12 peak-period units and eight 24-hour network and we have a guaranteed capacity. The SMR network teams. Two existing peak-period units were converted to provides higher quality transmissions and improved coverage. 24-hour operation. This system is different to the system installed in the A planned restructure of MICA paramedic road response in metropolitan region. However, we are fitting all metropolitan the metropolitan region, including the expansion of MICA ambulances with SMR network radios to allow interoperability single response units, was deferred until 2009-2010. and have an arrangement with Telstra that allows us to turn In the rural regions, AV implemented a 24-hour roster in Colac, these radios on when required, should metropolitan filling five vacancies, with extra staff put on in Gisborne (four ambulances need to move into other regions. SMR capability paramedics), Kilmore (four paramedics), Woodend (three proved useful in metropolitan region vehicles during the Black paramedics) and Kyneton (four paramedics). Saturday bushfires in February 2009. All vacancies were filled at Anglesea, Apollo Bay, Timboon and A significant benefit of the SMR network is that paramedics Mirboo South, where paramedics will work with ACOs, and anywhere in the state can now talk to one central rural five positions were filled in Alexandra. communications centre. The previous system limited the ability for paramedics to talk to a communication centre For the first time, AV had the flexibility of moving crews into beyond their region, meaning there was a need for five rural areas with shortages, creating a significant benefit to communications centres to dispatch emergency calls. some communities. During the year, a structured program of short-term transfers was put in place for some rural branches, This means AV can now proceed with a centralised call taking to ensure permanent coverage. and dispatch system. In the metropolitan region, AV expanded the Team Manager During the year the Government announced AV’s five Pilot program, which gives paramedic team managers more communications centres in the rural regions would be time off-road to develop and improve performance of their merged into one to provide more consistent and reliable teams. In rural regions, an evaluation was made of a similar service for callers. pilot program that began in the previous financial year. The new centre will be part of the ESTA facility in Ballarat, and will progressively replace the existing operation centres in Bendigo, Geelong, Ballarat, Wangaratta and Morwell. This provides for a significant improvement in safety, service and security, with identical technology, policies and procedures in place wherever an ambulance is dispatched. Ambulances will be individually located by GPS, standardised questioning will be adopted and a more robust system will be in place. The new communications centre will bring regional Victoria into line with the whole-of-government approach to emergency service telecommunications, with one body managing emergency communications across the state.

18 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT New recruits

In 2008-2009, AV recruited its largest ever paramedic intake. New paramedics We employed 334 new operational staff made up of: • 167 university graduates July 2008 to September 2008 7 paramedics • 109 Victoria University 2nd year students 6 October 2008 26 paramedics • 29 qualified paramedics 3 November 2008 49 paramedics • 3 MICA paramedics 1 December 2008 56 paramedics • 26 Div 1 Nurses completing a Fast Track program. 26 January 2009 47 paramedics These new recruits will help shape AV over the coming years. 23 March 2009 48 paramedics Today’s paramedic workforce averages 37.5 years old with 20 April 2009 4 paramedics women now making up 38.2 per cent of the workforce. 18 May 2009 39 paramedics All new paramedic recruits are university educated, graduates 15 June 2009 58 paramedics of courses recognised by AV offered at 11 universities across Australia and New Zealand. This number has increased from Total 334 paramedics eight courses recognised in 2007-2008. The university recruits begin work with a structured development program, which provides on-the-job training under Equivalent full time staff 2008–2009 the guidance and supervision of our Operations and Quality & Operational staff 2,059 Education Services divisions. This comprises a four-week induction program, followed by a minimum 12-months Operational MICA paramedics 403 internship to develop to qualified ambulance paramedic level. Operational management and support 276 For the undergraduates, the program goes for 24 months to allow Management and administration 321 for concurrent completion of their university degree. Our Total 3,059 relationships with universities are strong, particularly with the four Victorian universities that offer paramedic courses and those in New South Wales and South Australia. These cooperative relationships have allowed us to recruit the third-year students, offer a Graduate Entry course and provide the sponsored degree program for five regional volunteers. We provide continual feedback on the recruits’ knowledge, as well as industry feedback on the changes and improvements we make to our activities. All our paramedics provide medical care using the most up-to-date knowledge. Our aim is to constantly update skills, knowledge and qualifications and achieve world’s best practice based on clinical evidence, refining areas that need improvement.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 19 Ambulance Community Officers Emergency volunteers

ACOs are employed on a casual basis to work mainly in AV continued to support community volunteers throughout small communities where it is not practicable to maintain Victoria who are trained to safely provide basic early life support. a permanent paramedic crew. They are paid for all work Members of these Community Emergency Response Teams they undertake. (CERTs) are part of AV’s integrated emergency response, and are ACOs are trained to deal with health emergencies such as located in less populated and more remote areas of the state. stroke, breathing difficulties and chest pain, and provide a Studies have shown that these teams reduce response times, range of treatment such as basic life support, pain relief, and provide clinically appropriate care, create a positive impact on a managing spinal injury and fractures. community’s wellbeing and increase personal and community As well as providing pre-hospital emergency care and medical resilience and confidence. transport for their local community, they provide support to Volunteers are provided with regular training, uniforms, paramedics in their neighbouring areas. AV has about 500 equipment and a vehicle, and respond to incidents in their area. ACOs who are often active in their local communities in CERT members called to an emergency incident during the year promoting health care. arrived before an ambulance in more than 80 per cent of cases, illustrating the value to patients of the ‘first responder’ program. Audits of cases attended by volunteers showed they met clinical practice standards in more than 98 per cent of cases. At 30 June 2009, there were 28 teams with a total of 505 volunteers. During the year, volunteers attended more than 3,000 emergency cases. Volunteer conferences were conducted in Lakes Entrance, Halls Gap, Hume Resort and Swan Hill during the year. All were well attended and successful. AV also provided leadership training for women, which was well received. Critical incident peer training was provided to enable all teams to have their own peer support. CERT volunteers have the same crisis support mechanisms as paramedics to provide important psychological support.

CERT team locations in Victoria

20 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Building the future VACIS AV has more than 220 branches, with 125 branches in the rural regions, including three seasonal branches and 95 branches in Our paramedics collect comprehensive information about the the metropolitan region, including air ambulance. condition of the patients they attend and the treatment provided. This data is entered into portable computers running an AV- A comprehensive rebuilding and refurbishing program for AV’s developed electronic patient care record system known as VACIS. branches was announced during the year, with $35 million allocated to the rural regions. This world-leading system ensures AV captures substantial amounts of clinical data. This allows us to: The plan is to rebuild 20 rural branches and perform major refurbishment at nine more. • Better train paramedics This includes new ambulance branches in Horsham, Wodonga, • Review clinical standards Halls Gap, Yarrawonga, Kyabram, Omeo and funding to buy • Conduct pre-hospital research the existing Kilmore branch. • Audit dispatch priority codes Most branches will be built at new sites, including Alexandra, • Design services for the future. Apollo Bay, Belmont, Daylesford, Hamilton, Horsham, During the year the rollout of VACIS in the rural regions was Kyabram, Lismore, Neerim South, Omeo, Warrnambool, completed. We also implemented a system that pre-populates Wodonga and Yarrawonga. information for each entry – such as the time of a call and The new branches include the Air Ambulance base and hangar location, which saves paramedics from keying in this basic at Warrnambool, home for a primary emergency response information. helicopter that is also capable of search and rescue duties. During the year, VACIS was adopted by the New South Wales Ambulance Service, meaning VACIS will be used by paramedics in four states. Collating national information on pre-hospital medical treatment and reporting this information in a coordinated way will prove valuable for ambulance service planning, treatment and research, and for the wider health industry.

Continuous training During the year we held a series of regional conferences, such as this one in the Grampians, to provide training and support for our ACOs and CERT members. The conferences include workshops and keynote addresses, and allow ambulance staff to enhance their skills and build working partnerships.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 21 Non-emergency transport

AV provides non-emergency transport of patients in the In the metropolitan region during the year, 145,699 patients metropolitan and rural regions. were transported, a 2 per cent increase on the previous year. In the metropolitan region, we provide stretcher transport 24 This service has been contracted out since 1993. Contractors hours a day, 365 days a year. All stretcher vehicles are crewed are bound by the Non-Emergency Patient Transport by two people, either a qualified ambulance attendant and a Regulations, which provides a licensing system in Victoria, qualified patient transport officer (for patients actively under which providers must hold a licence and meet minimum monitored en route) or two patient transport officers (for standards around crewing, vehicles, qualifications, low-acuity patients). documentation and health and safety. Examples of patients taken by a non-emergency stretcher We also provide clinic cars for patients who do not need transport would be those admitted to hospital from home, clinical care or monitoring en route. Some may be frail or need discharged from hospital to home, transferred between assistance, and the crew member ensures the patient gets to hospitals, or taken to and from a nursing home, rehabilitation their destination. and/or specialist medical appointments. Most of the work is taking patients to and from renal dialysis. Most stretcher transport bookings and dispatches are Other key users are patients having cancer treatment and those coordinated through the Emergency Services having medical rehabilitation. Telecommunications Authority, the same organisation that During the year 74,511 patients were transported in clinic cars, coordinates 000 calls for emergency ambulances. Some jobs a 6.6 per cent increase on the previous financial year. are organised by hospitals. In the rural regions we continued to provide non-emergency Non-emergency transport needs to be authorised by a doctor. medical transport services. During the year we expanded People cannot call directly and we do not accept bookings by crewing resources in the rural regions to upgrade the skill members of the public. levels provided. We also reviewed our arrangements for A patient may think they need an ambulance, but the doctor non-emergency transport, which is likely to lead to changes in needs to consider whether the person can travel by other means the coming year. – including by taxi or with family members, for example. We rely on doctors to use their judgment when requesting non-emergency transport.

A new arrival In late June 2009, more than 800 people turned up to officially welcome the Warrnambool-based helicopter, including (from left) Team Manager Anthony de Wit, Health Minister, the Hon. Daniel Andrews, MP, and AV Chief Executive Officer Greg Sassella.

22 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Mildura HEMS 3 (Bendigo Fixed Wing Helicopter base) New helicopters Swan Hill It was a busy year for Air Ambulance Victoria

(AAV), highlighted by the arrival of two new Wodonga helicopters and the opening of new facilities at Wangaratta Essendon and Warrnambool. Shepparton Horsham Bendigo In April 2008, the State Government announced Mansfield Omeo funds would be available to operate two new helicopters – one based at Essendon with the Ballarat main aim of providing medical retrieval Hamilton Melbourne Bairnsdale

(transporting critically ill patients from Sale Geelong Portland mostly rural hospitals to specialist care in Colac Morwell Warrnambool Melbourne) and a primary response HEMS 4 helicopter based at Warrnambool. (Warrnambool HEMS 2 Helicopter base) HEMS 1 (Latrobe Valley Both helicopters, Bell 412-EPs, were imported to (Essendon Helicopter base) Australia and fitted out in Brisbane to our Helicopter base) requirements, including specialist communications HEMS 5 and medical equipment. Each helicopter had about 150 major modifications from a ‘standard’ helicopter. The aircraft were painted with AV livery and flown to Melbourne for testing and training, Where we Fly before being deployed. Indicative map of approximately one hour’s flying time, as at 1 July 2009 The first helicopter to enter service was HEMS 5 (standing for Helicopter Emergency Medical Victoria Police continues to provide pilots and observers for Service), the retrieval helicopter based at Essendon. It began HEMS 1, a relationship that is working well and will continue. service on 16 March 2009, and for the three-and-a-half months Canadian Helicopter Corporation provides the aircraft, pilots, to the end of the financial year flew to 136 incidents. maintenance and crew for HEMS 2 and HEMS 3, and The Warrnambool-based helicopter, known as HEMS 4, was Australian Helicopters provides aircraft, pilots, crew and officially welcomed to its new base on 26 June 2009 in a maintenance for HEMS 4 and HEMS 5. ceremony attended by the Health Minister, the Hon. Daniel We also continue to liaise closely with the Australian Maritime Andrews, MP. HEMS 4 will be used for emergency medical Safety Authority, Southern Peninsula Rescue Service, Victoria cases and will have the capacity to be involved in search and Police, other agencies and the state’s hospitals. rescue operations, as do all AV helicopters. During the year, AAV moved into new $18 million purpose- The ceremony was well attended by the local community, who built premises we share with Victoria Police at Essendon toured the hangar, crew and paramedic facilities, which allow Airport. The move co-located AV’s four planes and two for staff to sleep on-site to facilitate 24-hour coverage. HEMS 4 helicopters for the first time – previously they had been at officially entered service on 1 July 2009. different sites more than one kilometre apart at the airport. These two additional helicopters increase our fleet to five The move also brought together all paramedics, pilots, crew helicopters – along with HEMS 1 (Essendon), HEMS 2 (LaTrobe and maintenance staff, providing hangars, maintenance Valley) and HEMS 3 (Bendigo) – and substantially increase the facilities, training space and a four-bed medical facility. The emergency response we can provide in metropolitan and state-of-the-art offices also accommodates staff from ARV, and regional Victoria, consequently providing better access to provides shelter for patients being loaded and unloaded. metropolitan specialty hospitals for rural patients. During the year we also trained extra MICA flight paramedics to staff the additional helicopters.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 23 Our workload Aeroplanes

In 2008-2009, our workload increased, with our helicopters We operate four aeroplanes from our Essendon base and can transporting 1,387 patients, 147 more than the year before. We reach most of Victoria within an hour. In 2008-2009, we flew were called to 1,759 incidents, 109 more than the previous year. 4,606 patients, 412 more than the previous year. We go on emergency flights only when our speed offers an The planes mainly flew patients from regional Victoria to advantage. While our flight times are relatively short, it can Melbourne, providing access to specialist medical and hospital take minutes to get airborne, and on arrival at a scene we need facilities. to find a safe place to land, then get to the patient. In difficult This service includes transporting people for regular areas this can add crucial minutes. treatments such as oncology and dialysis. We also fly patients This means we rarely fly a mission within 40 kilometres of with acute medical conditions requiring surgery, transfer Melbourne’s central business district because there is simply injured patients from regional hospitals to specialist care and no clinical advantage. We will not get there quicker than a retrieve critically ill patients from regional hospitals to highly trained MICA paramedic in a road ambulance. specialist care, such as cardiac care and intensive care. The We continue to work hard to cut the number of cancelled calls planes are vital in assisting medical teams involved in patient – calls we are on the way to (or arrive at) where patients do not retrieval, including the Newborn Emergency Transport Service need our services. When we are on these calls, we are unable to (NETS). respond to other emergencies. We believe an acceptable The aircraft are pressurised and can take several patients on cancellation ratio is 20 per cent. the same flight to maximise efficiency. The aircraft provide a Most helicopter work is pre-hospital emergencies, which are vital link between metropolitan services and communities in often trauma cases, with the balance mostly inter-hospital regional Victoria. transfers (with a small amount of search and rescue, and The service reaches many towns within Victoria while also transporting remote patients). HEMS 1 has the most pre- servicing southern New South Wales, northern Tasmania and hospital work, at about 70 per cent of its caseload. some parts of South Australia. We can also repatriate patients Our work can have seasonal aspects, such as rescuing injured from other states back to Victoria for ongoing care. skiers from mountain ridges in winter and plucking people from the water in summer. The cost of taking an emergency flight is covered for those with ambulance membership or people who have other insurance, such as those covered in a road accident by the Transport Accident Commission. Otherwise it can be expensive, with a single trip costing thousands of dollars.

24 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Adult retrieval

In 2008-2009, Adult Retrieval Victoria (ARV) enjoyed its first full year of operation as part of AV. ARV uses doctors, paramedics and MICA paramedics to move critically ill patients from hospitals – often in regional Victoria – to hospitals with critical care facilities, mainly in the metropolitan area. Patients are transported by road ambulance, plane and helicopter. ARV also provides telephone advice on the clinical care of critically ill patients (mostly to smaller hospitals), coordinates critical care beds in the hospital systems and manages the state’s trauma advice line. During the year, ARV coordinated 1,584 adult retrievals. Of those, 617 were by road, with 457 using a paramedic only, 160 used a doctor and paramedic, and 967 retrievals were by air, 794 using only a paramedic and 173 using a doctor and paramedic. As a key part of the year, ARV undertook extensive negotiations with stakeholders to review and improve the system of adult retrieval (mostly moving critically ill patients between hospitals, by air and road), culminating in a service improvement plan that was approved by AV and DHS. This sets a platform for ARV to expand its activity and staff numbers in 2009-2010. ARV became a unit of AV on 26 November 2007, replacing the Victorian Adult Emergency Retrieval and Coordination Service (VAERCS), a service run from Melbourne’s St Vincent’s Hospital. The integration into AV came after a review by DHS, which identified the opportunity for further improvements in the state’s adult retrieval service, which began in Victoria in 1986.

New airbase Our new Air Ambulance Victoria headquarters at Essendon Airport brings together our planes, helicopters and the coordination centre for all AV flights across the state.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 25 26 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 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.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 27 A flexible service

Emergency response Business as usual

The September 2001 attacks on the United States and the 2002 A central focus of our emergency planning is business bombings in Bali changed the thinking in Australia about continuity. terrorism and major disasters. When a major incident occurs, the aim is to isolate that In 2006, the Commonwealth Games in Melbourne led to an incident from our day-to-day business. Under this model, the investment in equipment and resources, including a dedicated incident is managed in isolation – with its own management emergency management control centre in South Melbourne. structure, resources and communications - while the ongoing The AV Emergency Management Unit has become the centre for dispatch of emergency ambulances continues uninterrupted AV’s planning and preparation for – and response to – major from AV’s control rooms. incidents. We also ensure that the organisers of large community If this did not happen, numerous emergency ambulances could events have considered health aspects in their planning. be sent to a scene, potentially leaving large areas uncovered for During the year we continued to hold emergency exercises to other medical emergencies. ensure our skills are up to date. This extensive program Importantly, we are not simply focused on disasters, such as a enables us to test and refine our response plans, operations and terrorist attack, but on events that can have a significant communications, and to ensure we work effectively with our impact on our daily business. emergency services partners. We consider scenarios such as chemical leaks and the Under Victoria’s State Health Emergency Response Plan, which evacuation of nursing homes, where large numbers of low- focuses on pre-hospital response in mass casualty emergencies, acuity patients are involved, potentially putting a large drain AV is the lead health agency at an incident, with an ambulance on resources. officer appointed as the Health Commander. These incidents Each time there is an actual incident that has potential to affect can include natural disasters, accidents and pandemics. our business continuity – such as an incident that may have We continued Health Commander training to ensure our senior many seriously injured people – the emergency operations operational managers are equipped to manage serious incidents. centre is notified. During the year we spoke at national and interstate In 2008-2009, the emergency response plan was activated 441 conferences, sharing ideas with other emergency services about times in the metropolitan region based on 000 call the best ways to prepare. information, with 10 events reaching the highest ‘red-level We also created a new, statewide AV emergency response plan, incident’. Notable events in this category were a dance party as a result of extensive consultation across all AV regions and with a large number of substance-affected people; a HAZMAT departments. It is expected that this plan will be published and incident in Rosebud West with 10 patients transported; and a implemented ahead of the next bushfire season. HAZMAT event in Reservoir with 19 patients transported. Our ability to manage major incidents has increased dramatically and we are at the forefront of emergency management planning for pre-hospital care. We regularly work with Federal and State Government agencies on mass casualty management.

28 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Major events Additional preparedness

Part of our strategy of isolating major incidents from day-to- We have CBR (Chemical, Biological and Radiological) response day business is to ensure major public events that draw large capacity that rates alongside the highest standard crowds are allocated adequate paramedic resources. Under internationally. Victorian arrangements, the organisers of these events meet During the year, CBR training was incorporated into the basic AV representatives to discuss preparations and pay for training and orientation for new graduate paramedics, and 296 paramedics assigned to their event. students qualified at Level C. The Emergency Management Unit was involved in 118 such By 30 June 2009, AV had 728 paramedics in metropolitan and public events in 2008-2009, with AV’s rural regions managing rural regions qualified to Level C, which involves suits with a number of events locally. respirators, and allows paramedics to enter and work in The metropolitan region’s events included major AFL games affected areas. An additional 99 paramedics were qualified to and finals, big music events, the Melbourne Marathon, major the higher Level B and Level A standards. horse races such as the Cox Plate and Melbourne Cup, During the year we redeployed the metropolitan region’s Level Australian Masters Golf, New Year’s Eve in the CBD, C personal protective equipment into five strategic caches to Australian Open Tennis, Moomba Birdman Rally, ING cover the central business district and key industrial areas, as Australian Grand Prix and ANZAC Day. well as having equipment available to the air ambulance and at Outside the metropolitan area events included motor racing at the Emergency Management Unit’s headquarters. Phillip Island, the Pyramid Rock Festival at Phillip Island, Falls Festival at Lorne, Southern 80 Ski Race at Echuca, and Air Shows Down Under at Avalon.

In Melbourne In the metropolitan region we attend more than 850 emergency calls each day. When there is an event with many casualties, we activate our Emergency Operations Centre and isolate that incident, so we can continue to conduct ‘business as usual’ and respond in a timely manner to the other emergency calls.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 29 Urban search and rescue Summer heatwave

AV’s Urban Search and Rescue (USAR) unit was set up in the On 27 January 2009, Melbourne’s temperature climbed to late 1990s. During the year we created three caches of medical 36 degrees Celsius, marking the first day of a short, intense equipment for use in multi-agency disaster responses, thanks heatwave. The top temperatures on the following three days in to a $300,000 Federal Government grant. Melbourne were extreme, at 43.4, 44.4 and 45.1 degrees. The portable medical kits will be used by the USAR paramedic Higher temperatures were reached in regional Victoria. on each eight-person rescue team, which is made up of Temperatures stayed high at night – on three consecutive members from AV, the state’s fire services, police, State nights the lowest temperature in Melbourne was 22.5 degrees. Emergency Service and Army. Weather forecasts had predicted the heatwave and AV The kits contain appropriate quantities of specialist medical responded, activating its Emergency Operations Centre and equipment. rostering extra staff and extra managers. Training was cancelled, and extra emergency crews were rostered. We USAR paramedics perform a central role in rescue operations, increased the number of communications staff on duty, such as a building collapse and confined space rescue. All are increased hospital liaison and ensured more non-emergency fully qualified rescue operators (which includes a three-week contractors were available. course), and their primary role is as the team medic. We also conducted a comprehensive pre-emptive media If a patient is found, they then coordinate the rescue team and campaign, encouraging people to stay cool and hydrated, and assume responsibility for treating the patient. look after vulnerable neighbours and friends. AV has 21 trained USAR paramedics who can be deployed in This was done because the extreme temperatures, with little Victoria, interstate or overseas. All are experienced MICA relief at night, had implications particularly for the chronically paramedics with single responder experience. ill and the elderly. With a likely increase in use of air- AV created three small medical caches, rather than one large conditioners, there was the potential for power blackouts due cache, to provide more flexibility in the event of a widespread to supply shortages, exacerbating some medical conditions. incident or if a Victorian USAR team was sent interstate or The heatwave put severe pressure on AV across the state, with a overseas. 50 per cent increase in the daily demand. For patients, the The equipment includes specialist gear such as battery-operated outcomes were not good – there was a fourfold increase in patient heating blankets, which can be used for warming cardiac arrest patients, and survival rates fell. There was a hypothermic patients and warming intravenous fluids. significant increase in non-emergency work, which continued Paramedics also have access to an Ezy-IO, a device like an for days afterwards. electric surgical drill that is used to insert a needle into human In the metropolitan region, communications were overloaded bone. Used by MICA paramedics on AV helicopters, it allows a by the record demand, and the Referral Service, an ambulance patient to receive fluids and pain relief via their bone marrow, initiative that began in 2003, played a significant role in usually when there is no easy access to the patient’s veins. dealing with callers. The USAR team also has an I-Stat machine, which is used in major hospital emergency departments to monitor the blood chemistry of a patient, valuable for treating a trapped patient. During the year, USAR paramedics were assigned to work as part of the recovery effort following the devastating Black Saturday bushfires.

30 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Black Saturday

Experienced paramedics and nurses were able to talk to One week after the heatwave ended, on 7 February 2009, Victoria patients with low-acuity conditions and either refer them to prepared for another extreme weather day, with a forecast of high other medical options, such as a GP or district nurse, or give winds and temperatures of more than 46 degrees. them clinical advice over the phone. At some stages, up to 70 AV again activated the Emergency Operations Centre, and low-acuity cases were waiting for an ambulance, and the vast rostered additional managers and resources, including more majority were happy to wait when the circumstances were emergency ambulances, paramedics, non-emergency explained. contractors and ensured resources were available for staff The busiest day was Friday 30 January, when paramedics welfare. statewide responded to 1,976 emergency calls. AV planned for an acute heat event with a high risk of fire, In the metropolitan area – where the temperature hit 44.4 although it was not possible to predict the size of any fires, degrees at 3 pm – there was a record of 1,456 emergency or their locations. dispatches, 71 per cent more than the daily average. This During the afternoon, it became evident there were a large included 159 patients classified as suffering from heat number of concurrent fires, which were spreading quickly. exposure. There was immediate demand for evacuations of buildings This exceeded a record set the previous day, when there was a such as nursing homes, and reports of large numbers of 52 per cent increase on average daily demand, including 157 patients trapped or burned. The fires were in all AV regions patients affected by heat. in the state. While the event put a strain on our ability to respond, such an The Referral Service again proved its exceptional value, event would have put a serious strain on any ambulance service in offering high-level clinical advice to people in fire areas who the world. Our preparation, including extra resources, meant we were unable to escape and who could not be reached by were able to respond effectively to the unprecedented demand. ambulance (some areas were too dangerous to enter or inaccessible due to fires and fallen trees).

Outstanding achievement Kinglake CERT responded to emergency calls on Black Saturday and worked in the aftermath of the fires to support their community. The team was recognised in the inaugural Minister for Health Volunteer Awards, winning the award for most outstanding team achievement.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 31 Ambulance teams were dispatched, comprising six ambulances AV set up small medical centres using paramedics – and, in supported by a bulk supply vehicle, with a senior paramedic as cooperation with DHS, doctors and nurses – to treat Health Commander. populations immediately after the fires, providing a significant During Black Saturday and in its immediate aftermath, AV and valuable resource, again demonstrating our unique performed about 75 emergency transports, including 26 capabilities and the value of our emergency management patients with acute burns. Hundreds of other patients were preparations. assessed and treated on site, including many fire fighters who The operation was coordinated from the Emergency suffered minor burns and other injuries. Operations Centre, which switched to ‘code red’ on Black The fires devastated communities, claiming 173 lives and Saturday and became the centre of AV’s bushfire response, destroying thousands of homes. operating on a 24-hour basis for eight days. In the days that followed, AV assisted the DHS in what was The centre fulfilled its main aim – taking the crisis workload described as the ‘recovery phase’. from AV’s regular communications centres and allowing ‘normal business’ to continue unaffected. Thanks to the capability the organisation has built in recent years, we were able to move into that phase very quickly because we could access welfare shelter tents, paramedics, medical supplies and vehicles.

AV’s loss Marysville was one of the hardest-hit towns on Black Saturday, and one of those who died in the fires was Ambulance Community Officer (ACO) Kevin Bradwell. Kevin joined the Alexandra and District Ambulance Service in 1999 and was known for his dedicated and enthusiastic work, particularly in improving facilities and equipment. He worked extensively as a volunteer for St John Ambulance and retrained as an ACO in 2008. Kevin, 52, was married with four children. Other AV members had property damaged by the fires, and many lost friends. The Kinglake CERT’s training facilities were destroyed.

32 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Influenza pandemic

AV developed an influenza pandemic plan in 2004. The plan The disease was not as severe as many people expected, and did had three key principles: staff protection, demand management not have the high case-fatality rate that many predicted would and business continuity. come with an influenza virus that crossed the species barrier On 26 April 2009, AV learned about the new strain of and evolved into a pandemic. As a result, we did not need to influenza identified in North America, and preparations began activate all aspects of our influenza pandemic plan. for a local outbreak. The pandemic, did, however, create increased demand, with A key aspect of AV’s plan was communication with staff, and about 2 per cent of AV’s 000 emergency calls related to swine we released regular communication bulletins updating staff flu in the two months after the disease was identified. In the on the latest information about the disease and the personal metropolitan region there was a noticeable increase in demand precautions they needed to take. for patients with flu-like symptoms. The first Australian case of the H1N1 (swine flu) influenza strain We were fortunate that the pandemic was mild and merely was diagnosed in Melbourne’s northern suburbs on 20 May. stressed ambulance services. The outbreak taught us many lessons, such as how to communicate with staff and the need Following this diagnosis, large numbers of patients with seasonal for continued education in the use of personal protective influenza, and an increasing proportion with swine flu, began equipment. Learning from these lessons will stand us in good presenting to paramedics, GPs and hospitals across Melbourne. stead for future medical emergencies that affect Victoria. Changes were made to call-taking scripts to help identify potential cases, and paramedics were notified when they were sent to a potential case, allowing them to use personal protective equipment and follow AV procedures.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 33 34 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT An innovative service

F rom more effective treatment – especially in remote areas – to cutting-edge medical research and technology, Ambulance Victoria is continually finding innovative solutions.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 35 An innovative service

Treating patients H ighly trained nurses

In Victoria’s more remote regions the nearest paramedics can During the year, AV was recognised with a Victorian Safer be many kilometres away and it can take some time for an Communities Award for its role in training and equipping ambulance to arrive. Remote Area Nurses (RANs) at Victoria’s 14 Bush Nursing Over the years, AV has developed a series of measures to Centres, who can be called on to be first responders or strengthen the emergency medical response in these co-responders in a 000 emergency. communities, including the training and deployment of ACOs The nurses operate from Bush Nursing Centres, which are and CERTs. small, non-bed-based incorporated primary health services that This has provided a faster response in medical emergencies, provide essential primary health and nursing services to with ACOs and CERT members providing early intervention isolated small and remote communities. and support for patients. The RANs’ scope of practice is comparable to that of an Strengthening these communities by providing them with a Advanced Life Support paramedic, with special legislation level of self-reliance is important not only for the people who enabling the nurses to administer a range of medications in an live there, but also for the cohesiveness of the communities emergency without a doctor’s order. themselves. With training by AV in emergency work – which involves In the coming years, establishing appropriate models of care for annual accreditation – the nurses are able to respond to a range individual communities will be a central element of what we do. of emergencies, and use their high-level skills to perform emergency interventions in the field, such as administering intravenous analgesics and fluids both in adults and children. About 50 nurses are trained in emergency work, and they are backed up by an ambulance at every call-out. The RANs are provided with training and equipment, including items such as overalls, wet-weather gear, reflective vests and radios, which are especially important in remote areas with poor mobile telephone coverage. Each nurse has access to a car stocked with medical equipment, which allows them to effectively respond to emergencies.

Bush Nursing Centre locations in Victoria

36 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT ACO training

The RAN emergency role has been incorporated into the State ACOs work mostly in remote or lightly populated areas and and Regional Health Emergency Response Plans, allowing for provide pre-hospital emergency care and transport for their an effective, coordinated health and medical response in the local communities, and support for paramedics in surrounding event of a pre-hospital mass casualty incident. areas. They are trained by AV, employed on a casual basis and In one case during the year, a RAN was first to arrive at a car paid for the work they do. accident with five patients. One patient had a broken pelvis, During the year we began a pilot program with six ACOs to another had serious chest injuries and needed evacuation by train them to become fully-qualified paramedics, in a bid to helicopter. The RAN provided intravenous analgesic and IV bolster paramedic numbers in remote areas. fluid to the patient with the broken pelvis and was onsite for Under the program the ACOs are employed full-time by AV as 20 minutes before the first ambulance arrived. (A complication student paramedics. The new program includes clinical skills, in the case was that all five patients spoke only Russian, so an bio-science and finalising study toward a Certificate IV so the interpreter was required via the nurse’s mobile phone). ACOs can embark on their degrees, studying part-time through In another case, in a remote part of Eastern Victoria, a RAN distance education at Flinders University while continuing to responded to an emergency case of suspected anaphylaxis, a work from their rural bases. life-threatening condition. On arrival, the patient was found to The ACOs – five men and one woman – are from Victoria’s have a minor illness that did not require emergency treatment. south-west and Barwon areas. Their initial training included a This allowed AV to cancel a helicopter, which had been 12-week bridging course conducted in Hamilton. activated, as well as a MICA road unit, which was more than Our experience is that many new graduate paramedics do not an hour’s drive away, meaning these valuable services were want to work in remote areas so, by targeting people already available for other emergency cases. embedded in their communities, AV hopes these ACOs will The program was initiated about four years ago with DHS stay on once qualified, providing a wider spread of paramedics funding, and allows local communities to have access to very across the state. skilled and effective practitioners who are often the only medical professional available in the area.

Medical response Whether it be a Skidoo in Victoria’s ski fields or our bicycle response unit in a crowded urban event, AV’s paramedics have adopted innovative ways of quickly reaching patients. During the year we updated and modified a golf buggy, or patient retrieval vehicle, which was successfully used at the spring racing carnival in Melbourne. This vehicle provides easier access through crowds than an ambulance, and is modified to transport one patient, with a paramedic able to sit beside them and give treatment. The buggy carries the same level of equipment found on an ambulance.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 37 A unique community Best practice

Mallacoota, in the far east of the state, is one of Victoria’s most AV’s Clinical Practice Guidelines (CPGs), which outline the remote towns. For most of the year its population is about 950 steps to take in treating different conditions, were overhauled which, over summer, jumps to almost 10,000. during the year. AV is running a program in Mallacoota called the Paramedic The dramatic transformation followed extensive research and Community Support Coordinator (PCSC) to support the testing, and has produced a more user-friendly system that is town’s ACOs and general practitioners and help provide likely to reduce risks, improve safeguards and be easier to sustainable health care. remember. Under the model, the PCSC provides regular training for the The first CPGs were written for MICA paramedics in the area’s 13 ACOs, who handle about 300 jobs a year, which can 1970s, and for all paramedics in the 1990s. In 1999, DHS include transporting patients for many hours to hospitals in handed over ongoing responsibility for CPGs to the ambulance New South Wales or Victoria. services. The higher training for ACOs has in turn reduced pressure on The guidelines, informally known as the Paramedic’s Bible, were the town’s GPs, who previously were the only medical resource distributed across the state as a book. capable of simple tasks, such as maintaining airways or However, AV plans to make the information in the new drawing up drugs, and were regularly asked to help deal with guidelines available in electronic form, making them more emergency cases. portable. This innovation is the first step in providing The PCSC has also adopted an educational role in the wider comprehensive information to paramedics, such as hyperlinks community and works closely with the Mallacoota auxiliary. to drug treatments and specialist advice, which in future is We are continually evaluating the success of this model, likely to be delivered to technology such as mobile phones. which is also in use in Omeo, and it may be developed and modified further and expanded to other rural communities to improve the sustainability of their health care.

38 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Better patient care

Our groundbreaking pre-hospital research often leads to Cardiologists are immediately contacted and the ECG images improvements in the care we provide patients. quickly examined to facilitate early activation of the cardiology During the year, for example, we expanded the use by MICA team. paramedics of a 12-lead electrocardiogram (ECG) – which On arrival at the hospital, patients are taken straight to reads the electrical activity in the heart – to patients with a the catheter laboratory for the blockage to be cleared and suspected heart attack. a stent inserted. This followed a successful research trial last year that The trial cut the average time from arriving at hospital to dramatically cut the time it took for patients to be treated in having a stent inserted from 106 minutes to 57 minutes. hospital, resulting in substantially better patient outcomes. Research shows that for every 30 minutes you reduce the wait, A heart attack can be caused by a narrowing of the artery in there is 7.5 per cent less chance of dying or having a serious the heart, or the blockage of the artery supplying blood to the cardiac event in the next 12 months. heart muscle. This is a time-critical condition. The longer the The potential savings to the health system – fewer patients heart attack continues, the more damage can be done to the needing admission to hospital, long periods of recovery and heart muscle. potentially a lifetime on medication – are substantial. Hospital treatment for this condition is to unblock the artery During the year we expanded the use of 12-lead ECGs for this and allow blood to flow freely again, often by inserting a stent purpose across the metropolitan region and into the Geelong in a process known as coronary angioplasty. region. We are looking to expand this further in the coming year. Previously, paramedics took the patient to a hospital We also adopted as standard practice the results of another emergency department, where the heart attack would be trial in which we provided rapid sequence intubation (RSI) to confirmed, and then the patient would be taken to the catheter trauma patients with severe head injuries (details in the next laboratory for the removal of the clot and insertion of a stent. section). This trial showed that patients treated with RSI had By conducting a 12-lead ECG in the field, paramedics can send better outcomes. the ‘image’ of the heart’s activity from the field directly to medical specialists at the hospital.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 39 Research

During 2008-2009, AV participated in 33 research studies, Research highlights of the year included: 24 of which are continuing. Improving pre-hospital trauma care through enhanced Pre-hospital research encompasses a wide range of activities, monitoring and evaluation. This study was funded by the ranging from the analysis of routinely collected data to Victorian Trauma Foundation and aimed to evaluate the randomised clinical trials. clinical effectiveness of the Adult Pre-hospital Major Trauma AV promotes and participates in high quality research within a Criteria, and if necessary, refine them. Two key goals were (i) rigorous research governance framework, with the aim of maximise the identification of major trauma patients (achieve improving patient care. AV is committed to a collaborative high sensitivity), and (ii) minimise the identification of approach to research, and works closely with a range of other non-major trauma patients (achieve high specificity). The service providers and research institutions. evaluation revealed that there were physiological, anatomical AV also has ongoing involvement in three quality assurance and mechanistic elements of the major trauma criteria that registries: were identifying many non-major trauma patients as potential major trauma. The evaluation identified that the guidelines • The Victorian Ambulance Cardiac Arrest Registry required changing and statistical modelling was used to (VACAR), which is managed by AV and collects data on identify possible modifications. The recommended model has a all cardiac arrest patients attended by ambulance across sensitivity of 93.6% and specificity of 82.7%, and has been the state. endorsed by the Victorian State Trauma Committee. • A registry coordinated by Turning Point Drug and A trial of pre-hospital rapid sequence intubation (RSI) in Alcohol Centre, which collects data on all non-fatal patients with severe head injury. The study was funded by the drug-related AV attendances in Melbourne. Victorian Trauma Foundation and the National Health and • The Victorian State Trauma Outcomes Registry Medical Research Council and is the first pre-hospital (VSTORM), which is managed by Monash University randomised controlled trial of RSI in the world. The study and collects data on all major trauma patients in aimed to determine whether paramedic intubation improves Victoria in order to monitor the performance of the outcomes compared with intubation by a physician at hospital. state's trauma system. A total of 312 patients with severe traumatic brain injury were enrolled from Melbourne, Geelong, Ballarat and Bendigo between 2004 and 2008. Researchers found that pre-hospital RSI was associated with more favourable neurological outcomes after six months.

40 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Air Pollution and Out-of-hospital cardiac arrests in Melbourne. S. Zalstein, P. Danne, D. Taylor, P. Cameron, S. McLellan, Researchers used VACAR data from 2003-2006 to investigate M. Fitzgerald, T. Kossmann, I. Patrick, T. Walker, J. Crameri, the association between particulate matter air pollution and M. Bailey and G. Magilton. The Victorian Major Trauma 8,434 adult out-of-hospital cardiac arrests (OHCAs) with Transfer Study. In Press. Injury; 2009. cardiac aetiology, in Melbourne. The results support an P. Cameron, B. J. Gabbe, D. J. Cooper, T. Walker, R. Judson association between an increased risk of OHCA and and J. McNeil. A statewide system of trauma care in Victoria: concentrations of daily average particulate matter less effect on patient survival. Medical Journal of Australia 2008; than 2.5 micrometers in aerodynamic diameter (PM2.5). 189 (10): 546-550. Research Fellows. Two AV Research Fellows are continuing D. Kerr, A. M. Kelly, P. Dietze, D. Jolley and B. Barger. clinical research in high priority areas. One Research Fellow is Randomised controlled trial comparing the effectiveness and researching cardiac arrest treatment and outcomes via VACAR. safety of intranasal and intramuscular naloxone for the The other Research Fellow is continuing research related to treatment of heroin overdose. In Press. Addiction; 2009. improving paramedic care of trauma patients. E. W. Chan, S. E. Taylor, J. L. Marriott and B. Barger. Publications for the year include: Medications brought into the Emergency Department by ambulance significantly improves the accuracy of E. W. Chan, S. E. Taylor, J. Marriott and B. Barger. Exploration prescribing on hospital admission. In Press. Medical Journal of attitudes and barriers to bringing patient’s own medications of Australia; 2009. to the Emergency Department: A survey of paramedics. Journal of Emergency Primary Health Care; 2008;6(4) I. Patrick, S. Burgess, K. Cantwell, P. Cameron, M. Fitzgerald, C. Jones, L. Niggemeyer and D. Pascoe. Prehospital Management of Tension Pneumothorax: Has It Improved? Final Report to the Traffic Accident Commission; 2009. P. A. Jennings, P. Cameron and S. Bernard. Measuring acute pain in the prehospital setting. Emergency Medicine Journal 2009;26:552-555.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 41 42 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT An accessible service

Ambulance Victoria has 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.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 43 An accessible service

Community education In schools

Part of AV’s charter is to educate the community in what to do Our schools program continues to be extremely popular. in the event of a medical emergency. Our programs are During the year, we began a pilot program in rural regions, designed to access a wide range of people, from school children where we have received an enormously positive response. to the elderly. We also focus on disadvantaged and isolated Every school we visit in Victoria asks us to return and we have groups, who may have missed out in the past. a booking system with a healthy waiting list. We regard this community education as the glue between In lower primary, the program titled Sprinter and Friends operational staff and the community. We aim to encourage the – named after the Sprinter model ambulances – introduces the community to identify and manage medical emergencies and, characters Pete and Pam the paramedics. The aims are to at the same time, we educate paramedics about the importance introduce the idea of the ambulance, when to call for an of building the capacity within a community to improve ambulance and to allay any fears. patient outcomes. This education provides lifelong skills and For older primary school children, the program is called results in whole-of-community capacity building. Emergency … Deal with It. This introduces children to This partnership between the community and AV addresses the resuscitation, and hazardous behaviours and environments elements in the ‘chain of survival’ – early access, early CPR, they may encounter. early defibrillation, early advanced care – producing In secondary schools the program is called ADAPT – Ambulance significantly better patient outcomes. Drug and Alcohol Program for Teenagers – and addresses risk- We conduct regular evaluations of our programs, which taking behaviours around partying, one of the main reasons repeatedly demonstrate their high value. teenagers witness an emergency or end up in a hospital emergency department. All three programs were piloted outside the metropolitan area in 2008-2009 to see if they met the needs and expectations of regional Victorians. Our two primary programs were taught in schools in the Loddon-Mallee, Barwon-South West and Gippsland regions, and our secondary school program ran in schools in Gippsland.

Stronger ties Our commitment continues to strengthening ties with the state’s Aboriginal communities. During the year this included providing education programs in schools that are tailored for Aboriginal communities.

44 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Culturally aware

In 2008-2009, our paramedics taught more than 16,000 New arrivals to Australia often have little experience of a primary and secondary school children. service such as AV. They may confuse us with the police or fire Children are given take-home packs, so that messages get into brigade, and some communities are fearful of our presence. the home, reaching parents and extended families. Some Each year we seek access to culturally and linguistically information is translated into other languages. The packs also diverse communities to provide general presentations about provide information on ambulance membership, first aid and our role, and how people can react when they need us. other frequently asked questions. Key aims are to reduce fear, explain appropriate use (that we Former paramedics and education officers teach in primary do not provide first aid, but deal with medical emergencies) schools on a casual basis, while in secondary schools and an overall picture of what we do. paramedics work on their rostered days off. Before they visit Face-to-face contact is vital, and many paramedics provide schools, paramedics are taught presentation skills appropriate their time on rostered days off – often using an interpreter for children. As part of our regional pilot program, local provided by the group – to explain our role. paramedics were trained to deliver the programs. This is proving a successful program for both paramedics and Teachers are given an extensive resource pack and in many the communities involved, and allows us to better know the schools, the AV programs are absorbed into school curriculum, communities we serve. with the extensive resource packs providing materials useful During the year, we continued to circulate education materials in subjects such as English, geography and mathematics. for teachers that were developed with the Adult Migrant We also taught these school-based programs to children at Education Scheme, as part of a statewide scheme. expos, such as community agricultural shows, health Specific programs were delivered across the state including promotion expos and other large community events. This gave Melbourne, Shepparton, Swan Hill and Mildura. much wider reach during the year and we significantly increased the number of children who learned from these We also attend cultural events, such as the Antipodes Festival, valuable programs. La Plaza del Mercado, Vibe Alive and the Police Islamic Day. We also attend events such as career days and events that We expect the programs to be increasingly delivered across involve important partner groups for AV, such as the National Victoria in the coming year. Stroke Foundation. We have developed partnerships with organisations such as the Asthma Foundation and National Heart Foundation, which allow us to share educational and research material and promote each other’s messages in the community.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 45 Aboriginal liaison

Our relationship with the Aboriginal community was We also commissioned artwork by Aboriginal artist Mandy strengthened during the year through the ongoing work of Nicholson, which has been used widely on AV’s education AV’s Aboriginal Project Officer and Education Officer Zane materials, including those promoting CPR and when to contact Alford. the ambulance in an emergency. Traditionally, there has been little interaction between The artwork was chosen to make these materials more Aboriginal groups and ambulance services in Victoria. accessible and appealing, with the aim of having culturally Research has revealed Aboriginal people are reluctant to call familiar artwork associated with the willingness and effort of an ambulance because of cost, lack of trust and knowledge AV to improve health outcomes for Aboriginal communities. about the ambulance, and issues around cultural respect. The response has been strong and positive, and has encouraged Similarly, paramedics have often had mistaken beliefs and a paramedics and the community to discuss the key messages in lack of understanding about Aboriginal traditions and culture. the educational material. This education of paramedics expanded during the year, with a During the year, the artwork was put on to a retired series of programs extending to ACOs and volunteer members ambulance, which has since been used to spread AV’s health of CERT teams. and education messages throughout Victoria. The ambulance A reference group of key Aboriginal leaders provides advice and has proved to be a big drawcard at key Aboriginal cultural advocacy to assist with engagement with different communities. events that AV has attended, such as Vibe Alive in Mildura. Highlights for the year include education programs for school aged children in the Loddon-Mallee and Grampians regions, which has been tailored for Aboriginal communities. These programs have been delivered by education coordinators and education officers, including Zane Alford and local paramedics.

Bunjil the eagle Bunjil the Eagle is the creator of all things, including the Wurundjeri people of Melbourne, says Wurundjeri artist Mandy Nicholson, who drew the image for AV. The image has been widely used on AV educational materials..

46 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT

Public access defibrillators 4 Steps For Life

AV has been installing and maintaining defibrillators in public The older you get, the more likely you are to have a cardiac areas since 2002. arrest – and at the same time, those over 50 are the least likely These machines are used to shock the heart in the event of a to do a first aid course. cardiac arrest, and can be used by someone with no experience. This year we continued with the DHS-funded 4 Steps For Life With more people performing CPR due to courses such as DVD/video-based self-education package, which has proved 4 Steps for Life, the defibrillators provide the next step in highly successful. Primarily aimed at over-50s, the package helping people survive. goes step-by-step through what to do when someone has a Defibrillators are installed at 18 sites in the metropolitan cardiac arrest. region and six sites in rural regions. These are: The package is given to individuals, who take it back to their Healesville Sanctuary community and explain how it works. AV also sells a personal Federation Square pack version of 4 Steps for Life, including the same information National Gallery Victoria – Federation Square but with enough contents for two people. National Gallery Victoria – St Kilda Road Formal evaluations show the program is effective and well Wyndham Leisure & Events Centre supported, with about 700,000 Victorians having completed Melbourne Zoo the program. We also frequently received anecdotes about Werribee Zoo someone who took the course, responded in an emergency, and Croydon Leisure Centre & Croydon Memorial Pool saved a life. Kew Recreation Centre The program has been translated into 10 languages and AV Ringwood Aquatic Centre employs casual promotion officers who promote it in culturally Ashburton Pool and Recreation Centre and linguistically diverse communities. Shrine of Remembrance Flinders Street Station F irst aid Melbourne Central Station Melbourne Airport AV continues to sell first aid kits and promote the purchase Parliament Station of defibrillators, especially to places such as golf clubs, Flagstaff Station community organisations, and private businesses. These Southern Cross Station devices are relatively inexpensive, and save lives. Sovereign Hill During the year AV withdrew from the commercial business Otway Flyer of providing accredited first aid courses, as there are many Phillip Island other well-credentialed organisations – such as St John Mildura Airport Ambulance – that provide a high-quality service. We believe Avalon Airport. we are better to focus our energy on educating the community During the year, the defibrillators were deployed a number of through unique, targeted programs rather than be one of times. One highlight was a Sri Lankan national who had a cardiac several players in an already well-served market. arrest at Melbourne Airport as he was about to leave Australia. The defibrillator was successfully used and, after a period in a Melbourne hospital, the man recovered and flew home.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 47 Auxiliaries

AV’s 70 auxiliaries are dedicated volunteer committees Auxiliaries once again played a critical role in engaging the that support local ambulance branches in the rural regions. rural community and are looking forward to working with AV The state’s ambulance auxiliaries date back to 1918 and today on advocating key education messages. Auxiliaries have an have more than 800 members. opportunity to help educate community members on issues Auxiliaries play a critical role in providing local community such as AV’s schools program, ambulance membership and the support for ambulance services as well as raising funds so 4 Steps for Life program. This is an excellent continuation of the branches can buy extra equipment or improve facilities. role of auxiliaries and will assist in improving patient outcomes in their communities. During the year, the Board and executive made it clear that auxiliaries are a central part of AV and that the contribution AV has continued to support and encourage auxiliaries, which of auxiliaries and their members is highly regarded. was highlighted at two auxiliary conferences. The conferences were held in Lakes Entrance in August 2008 and in Echuca in Auxiliaries are well known in their communities for May 2009. These conferences were well supported. conducting a diverse range of activities, from running opportunity shops to organising large events such as community markets, dances and balls, as well as undertaking general fundraising. Auxiliaries raised $644,830 in 2008-2009 for ambulance building upgrades, improved facilities and enhanced equipment for community members and our paramedics. The benefits from the funds raised by auxiliaries remain in the local communities where they were generated.

Auxiliary locations in Victoria

48 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Community heroes

The 9th annual Community Hero Awards were held at Queens Hall, Parliament House in November 2008 with 16 people receiving the prestigious award. For the first time award recipients came from across the state – recognised for their selfless actions at medical emergencies including cardiac arrests, car accidents, electrocution, traumatic injuries and breathing problems. The awards are given to ordinary members of the public who act in a heroic manner, regardless of whether it was for a friend, family member or a stranger. This year’s award recipients were chosen from more than 100 nominations made by paramedics in the preceding year. The aim of the awards is to promote first aid, and to promote community involvement in assisting paramedics and patients.

Isabelle Grigoriants One of the year’s Community Hero Award recipients was Isabelle Grigoriants, 6. She was staying overnight with her 66-year-old grandmother when she was woken by her grandmother’s abnormal breathing at 5.30am. After trying to wake her grandmother without success, Isabelle called 000. When paramedics arrived she translated their questions into Russian because her grandmother did not understand English. She directed paramedics to her grandmother’s medication, was able to contact her parents and give paramedics a brief patient history. MICA paramedic Nanto Cielens nominated Isabelle for remaining very calm and helpful during the incident.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 49 50 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT A well-managed service

A strong financial performance is important for Ambulance Victoria – and so is supporting our front-line paramedics, the communities we work in and the environment.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 51 A well-managed service

H ealth, safety and welfare Early intervention

Health, safety and welfare issues across AV are addressed jointly Research indicates that early intervention improves the by the Health Safety & Welfare (metro region) and the Health & chances of a successful, sustainable and timely return to work. Safety Strategy & Services (rural regions) Departments. During the year, rehabilitation advisors were employed by AV More than 20 staff provide expert advice in occupational health to contact employees (initially in the metropolitan region) who and safety, injury prevention, early intervention, health and had sustained injuries at work to provide rehabilitation and fitness, WorkCover, peer support and welfare. return-to-work support, irrespective of the lodgement of a WorkCover claim. During the year, the two departments worked together to integrate systems and processes that focus on continuous quality improvement to meet AV’s commitment of ensuring a safe and F atigue management healthy working environment for all staff. Fatigue is a complex area and is recognised by AV as a health and safety matter. It is important that we assess fatigue in the unique Back to Basics operational environment that exists in AV and then develop systems and processes that adequately manage the issue. During the year AV commenced the roll-out of the Back to Basics program aimed at reducing manual handling injuries among During the year we began developing an effective fatigue paramedics. The program focuses on a dynamic risk management system with the assistance of leading experts in assessment process to select the appropriate techniques, and this field. available manual handling equipment to reduce the risks when A number of fatigue management workshops for managers handling patients. were held during the year to build awareness of fatigue, AV’s induction program has also been modified to include an management of sleep, sleep availability and strategies for introduction to the Back to Basics program. These sessions are addressing fatigue management. aimed at providing new staff with an understanding of the Back to Basics techniques and principles. Peer Support WorkSafe initiative Peer support is made up of experienced paramedics who support AV staff, volunteers and immediate family members AV has been working in collaboration with WorkSafe on an following their involvement in a critical incident – such as the initiative to assist and support AV to achieve high performance death of a child, a fatal accident or a suicide, as well as other to prevent and manage workplace injuries. A number of key work, personal or family related matters. They also act as a elements in the systems and processes of AV emerged that link between staff and the Victorian Ambulance Counselling reflect the model of good performance. Unit (VACU). As part of this program, 30 per cent of AV’s employees returned Peer Support has two vehicles which are out most days. About surveys, reflecting a strong attitude to and engagement with 90 peers are positioned across the regions ready to talk both OHS and injury management operations and performance through incidents with their colleagues. across the organisation. We are now set to implement a range These services were tested during the year, particularly in of recommendations made as part of this program. response to the Black Saturday bushfires when there was a need for comprehensive psychological support to those directly and indirectly affected. As a result, more than 600 peer and 60 counselling contacts were made during this period. One centralised AV phone number is now available for Peer Support services, as well as the VACU 24-hour counselling line, emergency services chaplain, WorkCover and police statements/court assistance.

52 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Counselling services H ealth support

The Victorian Ambulance Counselling Unit was established During the year we provided health services across AV, as a pilot program in 1986 after the Russell Street bombing. including a specialist phone line that offers medical advice to The program began by providing a 24-hour counselling service paramedics following biological and chemical exposure. This staffed by three psychologists. service was invaluable in assisting AV with the initial response Funded by AV and DHS, the unit expanded in the following and subsequent management of H1N1 influenza, including the year to provide a Critical Incident Stress Management provision of information surrounding personal (hand and Program, which included a peer program component. respiratory) hygiene. During the year, VACU provided a range of services to AV, As part of our commitment to employee health and safety and its staff and their immediate families, with a 24-hour patient welfare, AV continued to offer influenza vaccinations to counselling line staffed by experienced psychologists that all staff. More than 1,000 staff were vaccinated during the operates 365 days a year. 2008-2009 financial year. VACU can put callers in touch with one of its 31 contracted, Summary of occupational health private psychologists, 22 of whom are in regional Victoria. and safety performance There is an entitlement to six face-to-face counselling sessions each financial year, and up to 10 if necessary. Referral to other Issue 2008-2009 agencies and resources can also be provided. Number of fatalities 0 VACU has experts in a range of fields, including critical Risk management system compliance 93% incident stress management, anxiety, depression, eating disorders, alcohol or drug addiction, post-traumatic stress, Lost time injury frequency rate 90.2 relationship problems and anger management. Average number of standard claims per 100 FTE (full time equivalent) staff 9.2

Average cost per standard WorkCover claim $30,982 Number of hazards/incident reports lodged 3,041 Percentage of standard WorkCover claims with a return to work plan initiated 100% Percentage of employees immunised against influenza 38% Average number of OHS related training hours per staff member 1.9 Percentage of Health & Safety Representatives (HSR) positions filled 94%

New chaplain In May 2009, Dave Thompson, a church minister with extensive experience as an outreach worker, was appointed as AV’s new chaplain. He follows in the footsteps of Ron Manley, who left the role after two-and-a-half years to become Minister at the Uniting Church in Wangaratta. Dave, married with two children, previously worked for nine years managing programs in a psychiatric disability rehabilitation service known as the Richmond Fellowship of Victoria (now called MIND).

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 53 Clinical risk management Medical standards

Across all health services there is an increasing understanding During the year, we maintained the two medical standards of the significance of identifying medical errors and committees that existed before the merger. These committees minimising the risk of patient harm. provided advice and recommendations on clinical standards Reviewing and identifying cases where there is harm to a and clinical practice, with a focus on continuous quality patient or potential for harm is an integral part of AV quality improvement and evidence-based standards and practice. improvement activities. At the end of 2008-2009, the work of the two committees was AV has established a series of evidence-based clinical quality aligned and a new AV Medical Advisory Committee was indicators that allow for maintaining and enhancing standards appointed. AV acknowledges the work of the committee to ensure patients receive the best possible treatment. members who provided their expertise during the year. In 2008-2009, AV reviewed 52,310 cases (seven per cent of F ormer RAV Medical Standards Committee total workload) in the following areas: A/Prof Tony Walker – Executive General Manager Quality • All high-risk low-frequency events, including drug- and Education Services (Chair) assisted intubations Dave Garner – Manager Clinical Operations (Exec Officer) • Re-attendances to patients (at the same address) within A/Prof Mark Fitzgerald – Medical Adviser 24 hours Dr John Edington – Medical Adviser • All cases where patients die in AV’s care Lauren Tanzen – Ambulance Paramedic Representative • Care and outcome of cardiac arrest patients Dr Norm Castle OAM – Rural Doctors’ Association of Victoria Remote Area Nurse Representative • Management of traumatic and cardiac pain in adults Lisa Hutchins – A/Prof Stephen Bernard – Medical Adviser • Time at scene and hospital destination for potential Mark Cooke – Regional General Manager major trauma patients Dr David Eddey – Medical Adviser • Non-emergency cases where emergency ambulance Kevin Masci – Executive Manager, Operational Quality assistance is required and Improvement • Random audit of the Referral Service. A/Prof Daryl Pedlar – Medical Adviser Additionally paramedics self-report cases where there is Paul Jennings – Manager Clinical Effectiveness and Research concern of potential or actual harm. Auston Balon-Rotheram – MICA Paramedic Representative Through the assessment of these cases, 62 system issues were F ormer MAS Medical Standards Committee identified and strategies put in place to prevent recurrence. Executive Manager, Operational Quality These strategies include individual education, continuing Kevin Masci – & Improvement (Chair ) education for all staff, equipment or consumable changes, and Dr Andrew Bacon – Medical Adviser changes to workflow or practical procedures, all of which is A/Prof Stephen Bernard – Medical Adviser monitored for effectiveness. Prof George Braitberg – Emergency Specialist DHS has established the Victorian Health Information Dr Marcus Kennedy – Adult Retrieval Victoria Management System. This is a collaborative project between Prof John McNeil – Research Specialist the department, Victorian health services and other key Prof Thomas Kossman / Dr Annette Holian – Trauma surgeon stakeholder groups, to determine an optimal solution for Dr Jeffrey Rosenfield – Neurosurgeon collection and review of statewide clinical incident data, A/Prof Tony Walker – Executive General Manager Quality and consumer feedback and OHS incident data to identify trends Education Services and share relevant information to better target quality Bill Barger – Act Operations Manager – Operational Quality improvements. AV has been selected as one of the six lead & Improvement implementation agencies for 2009-2010. Keith Young – Executive General Manager Operations Kerry Power/Ian Jarvie, Acting Manager Clinical Standards & Audit, OQI (Secretariat) Elia Petzierides – Ambulance Paramedic Representative Andrew Burns – MICA Paramedic Representative

54 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Environmental commitment

AV Medical Advisory Committee AV recognises that our everyday activities have direct and indirect impacts on the environment. AV is committed to being Prof George Braitberg – Emergency Specialist an environmentally and socially responsible organisation and A/Prof Leeanne Grigg – Cardiology Specialist is committed to complying with all relevant government A/Prof Stephen Bernard – Medical Adviser environmental management policies, practices, regulation and Bill Barger – AV Clinical Operations legislation. A/Prof Tony Walker – AV General Manager, Regional Operations Dr Andrew Bacon – Medical Adviser To achieve our aims, we committed during the year to establish appropriate procedures and practices to monitor and reduce Dr David Eddey – Medical Adviser AV’s environmental footprint, including: Dr John Edington – Medical Adviser Dr Marcus Kennedy – Adult Retrieval Victoria • Reducing the energy, water and resource usage of all A/Prof Mark Fitzgerald – Medical Adviser aspects of AV’s business A/Prof Russell Gruen – Trauma Specialist • Adopting the principles of the waste management Kevin Masci – AV Executive Manager, OQI – QES hierarchy – avoidance, reduction, reuse and recycle Paul Holman – AV Operations Manager, SERD • Ensuring all new capital works programs incorporate Prof Jeffrey Rosenfeld – Neurotrauma Specialist comprehensive environmental sustainability principles Prof John McNeil – Research Specialist • Implementing an environmental purchasing policy. Dave Garner – AV Manager Clinical Development – QES We have also committed to empower our staff to minimise our Justin North-Coombes – Ambulance Paramedics Representative environmental impacts, through education and participation. Gavin Smith – MICA Paramedic Representative We expect to report more on the development of these practices in the 2009-2010 annual report.

A smarter branch The new Whittlesea branch officially opened in January 2009. It features numerous safety and environmental options, including a single switch that allows paramedics to turn off all non-essential electricity when they leave the branch.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 55 Vehicle fleet Ambulance membership

As part of our environmental commitment, we have committed A significant amount of Ambulance Victoria’s annual revenue to increasing the efficiency of AV’s vehicle fleet, without comes from the ambulance membership scheme. compromising emergency operations and service delivery. The ambulance service is not free, and without membership or This includes replacing our ambulance general purpose vehicles specific health insurance cover, people who need an ambulance with Mercedes Sprinters, which have a Euro-4 compliant engine, can face hefty fees – especially if using an air ambulance. which creates fewer carbon emissions. In the metropolitan Membership is $60 a year for singles and $120 a year for a region, the number of these vehicles has grown from 10 per cent family and covers ambulance services Australia-wide. We have of our fleet in 2007-2008, to about 40 per cent by the end of the worked hard to keep our costs low – with one increase in five 2008-2009 year. In the rural regions, the replacement is greater, years – so we can keep the cost of membership as accessible as with more than 80 per cent of the fleet complete. possible for people who want to protect themselves. During the year we acquired a second Complex Patient Membership increased by more than 50,000 in 2008-2009, Ambulance Vehicle (CPAV) in the metropolitan area, allowing with a total membership of 990,572 on 30 June 2009. These for better transport of bariatric and seriously ill patients. memberships cover about 2.1 million Victorians when dependants on family memberships are included. This makes AV Vehicles 2008-09 AV’s membership scheme bigger than the entire private health industry in Victoria. Ambulance General Purpose 519 During the year, AV also began examining how best to use the Patient Transport Vehicles 47 membership database – which can reach almost half the state’s Operational Support Vehicles 274 population – to introduce new products and services to help Special Operations Vehicles 11 members before, during and after a medical emergency, and better Total 851 prepare people in case they encounter an emergency situation.

New campaign During the year we launched a new membership campaign ‘No Ordinary Club’, featuring real paramedics in dramatised emergency situations. The aim of the advertisements was to show that while people may belong to other clubs and associations, AV is different - it can save your life. Rather than repeating the ‘fear campaigns’ of recent years, the latest thought-provoking title was designed to be more positive and more collegiate, highlighting how important and essential the service is.

56 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Risk & Business Service Improvement System Continuity Management AV has a strong commitment to quality management principles In August 2008, the Board approved an interim Risk and the associated benefits for improving customer confidence Management Framework to support AV’s risk management and business performance through continual improvement. practices during the period of integration. A review of this Since 2002, the metropolitan region of AV has been continuously framework was completed during the year, with the aim of certified to ISO 9001:2000 (Quality Management Systems) and simplifying the risk processes to meet the organisation’s AS/NZS 4801:2001 (Occupational Health and Safety culture and new structure, and to enable risk to be handled at Management Systems). In January 2009, certification to ISO more appropriate levels within the organisation. The resulting 9001:2000 was extended to the rest of the organisation, new framework has been aligned with the International resulting in all of AV being certified to this international Standard for Risk Management ISO 31000, which will standard. Certification to both standards is subject to a supersede the current Australian Standard for Risk requirement to undergo annual surveillance audits by an Management ANS/NZ 4360, in September 2009. external accredited body. The assessment and certification In accordance with the new framework and previous risk process provides management with an independent expert practices, the 2008-2009 Organisational Risk Register was review, not only of compliance with the standards but also of reconsidered to ensure the existing 43 risks were relevant and areas within the business that can be improved. being managed at the appropriate level. This review resulted in External audits were conducted in September 2008 26 risks being either removed from the register, as they had (metropolitan) and December 2008 (rural). The reports been fully mitigated against, or placed on divisional registers concluded that ‘the management system audited continues to where they can be treated more efficiently. The remaining 17 be a robust framework for AV metropolitan…’ and that ‘the risks have been rolled over to the 2009-2010 Organisational management review process through its relevant meetings at Risk Register. all levels of the organisation is a strength which ensures that It was also identified that the previous MAS and RAV Business all objectives of the organisation are measured at differing Continuity Management (BCM) arrangements were intervals and levels’. insufficient to support the newly merged organisation. As a A key element of the Service Improvement System is to result, a new BCM Framework was developed that reflects the measure overall satisfaction of the ambulance service from the current and future operational and administrative functions community, health sector and users of our services. In 2009, for AV. This framework is based on the current Australian and satisfaction surveys were conducted with the general public, international standards as well as industry accepted practices. health sector and patients with the following results: The ongoing focus for BCM will include the roll-out of the framework in AV to develop appropriate business continuity 2009 AV survey results Percentage satisfied plans and strategies, and the development of an education, Public 87%* exercise and testing regime to support the framework. Patients 97% Health Sector 78%#

Note: * This figure would be 94% if those respondents who answered ‘Don’t Know’ or ‘Neither/nor’ were excluded # This figure would be 80% if those respondents who answered ‘Not Applicable/Don’t Know’ were excluded

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 57 Staff Recognition 2008-2009

Ambulance Service Medal Staff Events and Service Awards The Ambulance Service Medal in the 2009 Australia Day In 2008-2009, a large number of staff in the metropolitan and honours was presented to the following AV staff: rural regions qualified for recognition through the Ambulance • Alan Eade Victoria Service Medals, highlighting the long-term commitment of staff to their careers with AV. Paramedics were • Austin Gapper also recognised for their continuous diligent service through • Hector Stagg. the National Medal/Clasp. Alan Eade has demonstrated a high level of professionalism, The formation of AV has shown that different mechanisms dedication and involvement within the ambulance service. In existed for the presentation of awards and medals. To enable a particular, Alan has made a significant contribution to the consistent approach to be developed statewide, the understanding and treatment of party drug use in the pre- metropolitan annual family staff event, which included a hospital setting, both within Victoria and other states. Over formal medal presentation, was deferred until 2010. the years, Alan has attended various forums, workshops and For 2008-2009, AV is pleased to recognise the following medal briefings, and has delivered numerous lectures; he has been recipients within the metropolitan and rural regions. part of the Australian Drug Foundation advisory group, and has given advice and recommendations to many professional bodies. Alan has also provided exceptional public education to many health and community groups. Austin Gapper has provided an outstanding contribution to the development and provision of ambulance services in South Eastern Victoria. In particular, this has been through the provision of leadership in the development of career and volunteer ambulance staff and the strengthening of relationships with the community and other health emergency service organisations in areas such as emergency management and training and development. Hector Stagg has made an outstanding contribution to the development and provision of ambulance services in the remote rural community of Ensay-Tambo Valley. Particularly, this has been through the provision of leadership, fundraising and ambulance response, which has required the investment of significant personal time and effort on a voluntary basis for the past 25 years.

58 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Metropolitan Medal Recipients

Ntiaa on l Medal Stanley Burtt** Jeremy Healy Simon Reynolds Craig Cain Fiona Cartmel** Lara Heliotis Matthew Riddle** Anthony Coffey Kate Cantwell** Jonathan Hinton** Stephen Riley* Russell Craven Jan Chambers Daine Hochfield** Debbie Riseley Maree Goodman Catherine Chandler* Jason Hunter Mark Rogers Angus Taylor Robert Chase* Giovanna Jeffrey Victor Rogers Russell Twigg Bryan Chesson Anthony Jelleff* Shaun Ryan Glenice Winter Nigel Church* Gavan Jenkin Alan Smith** Wendi Civetta Cheryl Jessop Brian Steer 1st Clasp to the Matthew Johnson* Keli Sutherland National Medal Louise Clancy Mark Jones** Ross Tagell* Bruce Anders James Coates Kate Kamateros Robert Voss* Antony Armour Shaun Columbine* Steven Kerekes** Philip Wade** Ronald Eke Kevin Commins Shaun Kinna* Damian Warrillow Hansen Lu Jenny Daniels Yvette Knox* Kate Waterman Graham Mummery Andrew Coffey** Michael Leigh Kevin White David Reinhard Jennifer Davidson Trena Lidgett** Kenneth Whittle* Stephen Wood William Davis* George Dinas Nigel Longman** Michelle Winterton* 2lnd C asp to the Paul Dodd* Mark Maclean** Andrew Wyatt National Medal Lucas Drew* Christopher Macpherson Luke Youla William Van Den Akker Brent Driscoll** Gregory Margetts* 15 years of service A ncmbula e Victoria Andrew Erskine* David Mati* Stephen Bird Service Medals Lucas Finlay* Jason McAliece** Stephen Burgess* 10 years of service Thomas Finneran* Matthew McCrohan Anita Davis Trevor Abbott** Chester Fogarty Jane McKeown Maree Goodman* Bruce Anders Joanne Frankel Pamela McLure Leanne Lewis Cathryn Anderson* Paul Furniss Jennifer Merolli Steven Mati* Calum Atkinson Wayne Gardam* Robert Mits* Julie McKinnon Michael Atkinson** Michael Gdak Robert Morley Susan Smith Matthew Baker* Peter Geha Stephen Mulhollard** Andrew Woollard* Gregory Gibson* Sarah Neale Barry Bates 20 years of service Gareth Becker* Anne Gillett-Duns Julie O’Brien* Trevor Abbott Noel Bird* Steven Grove** Lindsay O’Brien** Colin Barry* Amanda Bond* Kristine Gough Lee Owens David Bedford-Lee Lisa Bourke* Vicki Gurry Glen Pattrick* Dale Bence* Timothy Bramwell* Timothy Ham* Julie Payne* Stewart Blackburn Nicholas Bridge* Mark Hamer** Mark Pitruzzello Phillip Brake William Brooks* Sharon Haslam David Poland* Michael Burgess* Steven Brough Louise Hay Richard Prisgrove** Wayne Butterfield* Ian Buckland Barry Hayes** Marcus Ramanauskas* Alison Campbell Joanna Burbidge Craig Hazelwood Steven Randall

National Medal An Australian Award recognising 15 years continuous diligent service in an emergency and/or defence service. 1st clasp to the National Medal Recognises an additional 10 years of diligent service; that is, a total of 25 years of diligent service. 2nd Clasp to the National Medal Recognises an additional 20 years of diligent service; that is, a total of 35 years of diligent service. * Denotes recognised for Safe Driving Award also ** Denotes recognised for Safe Driving Award only

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 59 Metropolitan Medal Recipients continued Stewart Carroll Philip Nestor Glenys Van De Wildekamp** Wayne Brooks* Timothy Clancy Cherrie Ninness Edward Watkins* John Coetzer* Frank Cummane Mark Nowak* Brendan Webster* Dennis Fraser-Jones* Geoffrey Davis Craig Ogier* Jonathan Wright* Colin McLeod* Simon Doust* Anthony Ovcak* 25 years of service Malcolm McLeod Michael Dunn Alan Penaluna* Antony Armour* Stephen Murphy* Anthony Elliott* Graeme Petrie* Jonathan Byrne Graeme Parker* Alan Gailey* Rosalinda Polivka Ronald Eke* John Pattison Eric Giles* Ian Ramsdale* Roderick Hurlbut* Robert Ray* Peter Godwin Dianne Rock* Gregory Iles* Paul Robertson* David Greich* Kevin Rogers* Peter Kent* Donald Tippett* Bruce Harrison Raymond Rogers Hansen Lu* Rodney Wadsley* Brian Hicks* Mark Sanders Ronald McLeod Michael Whalan* Peter Hoffman* Phillip Schumacher Alexander Medancic Andrew Wilson Istvan Huska* Andrew Sexton* Graham Mummery* 35 years of service Ashley Jackson Alan Smith Brendan Noone Paul Chase* Ian Jarvie Phillip Smith Barry Sidebottom David Dandy Michael Keating Mark Somers* Peter Stewart* Ian Gedge Con Kokkinopoulos* Shane Spalding* Neil Tabrah* Philip Hogan Robert Macdonald David Steentjes Stephen Walsh* Trevor Mitchell Phillip Matthews* Bruce Sutherland* Stephen Wood* Reginald Yates* Timothy Maywald* Geoffrey Tassell 30 years of service 40 years of service Lisa McColl* David Tate Warren McDonald* Ricky Thomas Kenneth Bailey* Terry Murie David Neal David Trevan Mark Barbis

National Medal An Australian Award recognising 15 years continuous diligent service in an emergency and/or defence service. 1st clasp to the National Medal Recognises an additional 10 years of diligent service; that is, a total of 25 years of diligent service. 2nd Clasp to the National Medal Recognises an additional 20 years of diligent service; that is, a total of 35 years of diligent service. * Denotes recognised for Safe Driving Award also ** Denotes recognised for Safe Driving Award only

60 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Barwon South West Medal Recipients

Ntiaa on l Medal Neville Hettick* 20 years of service 30 years of service Allison Shawyer Rene Kershaw Terry Baker** Clive Hawkes* 1st Clasp to the Maree May Geoffrey Carter** Neville Hettick* National Medal Ian McPhail** Dennis Currell* Kenneth Jepson Laurence Blick Trevor Mee Samuel Hadden** Michael Loats Benjamin Wright Anna Nash* Neville Hettick* Ian McPhail** Russell Pitcher* Ian McPhail** Trevor Niklaus* 2lnd C asp to the Brian Ritchie* Bruce Rae* National Medal Geoffrey Solomon Lyle Spokes* Connal Schurmann Bruce Timms 35 years of service Ian Turrill** Ian Turrill* A ncmbula e Victoria Benjamin Wright** Ronaldus Baars 15 years of service Service Medals Stephen Alexander 25 years of service 10 years of service Ronald Davidson William Atkinson Jennifer Allen Neville Hettick Laurence Blick Sally Cannon* David King Neville Hettick Suzanne Copland* Joy Lambourn Anthony O’Sullivan Graham Devereux* Andrew Mann Colin Rogers Susan Furness Connal Schurmann

Gippsland Medal Recipients

Ntiaa on l Medal Kim Mihai* Peter McMillan* 25 years of service Murray McDonald Jennifer Moncur* Alexander Mihai* John Bayley* A ncmbula e Victoria Tom Reakes* Kim Mihai* Laurie Best** Service Medals Duncan Roney* Tom Reakes* Gordon Bowman 10 years of service Edwin Swann** Deb Rielly Leslie Collins* Andrew Williams* Duncan Roney Daniel Anderson* Peter Collins Laurie Best** 15 years of service Terry Staker** Austin Gapper* Gordon Bowman** Mark Allen* Edwin Swann* Bernard Goss* Peter Collins Laurie Best** Neil Trease** Terry Houge* Brenda Crutchfield* Gordon Bowman** 20 years of service Peter McMillan* Simon Crutchfield* Peter Collins Laurie Best** Terry Staker* Paul Dickison* Mark Cox* Gordon Bowman** Edwin Swann* Ken Gardam* Paul Dickison** Ross Breaden Gregory Taylor Robert Geerling* Wolfgang Drobeck* Peter Collins 30 years of service Jaclyn Harrap* Ken Gardam* Barry Davidson* David Booth* Paul James* Garry Hodson Paul Dickison** Gordon Bowman Warren Kenney* Michelle Howard* Ken Gardam* Bill Meade John Kleverlaan* Warren Kenney Warren Kenney Brian Mellor Robert Martiniano* Glen Laity* Peter McMillan* Peter Pildre* Murray McDonald* Robin Lowe Brian Mellor** Terry Staker Paul McMahon* Robert Martiniano* Terry Staker* Alexander Mihai* Murray McDonald** Edwin Swann**

National Medal An Australian Award recognising 15 years continuous diligent service in an emergency and/or defence service. 1st clasp to the National Medal Recognises an additional 10 years of diligent service; that is, a total of 25 years of diligent service. 2nd Clasp to the National Medal Recognises an additional 20 years of diligent service; that is, a total of 35 years of diligent service. * Denotes recognised for Safe Driving Award also ** Denotes recognised for Safe Driving Award only

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 61 Grampians Medal Recipients

Ntiaa on l Medal Trevor Lehmann** Peter McIntosh John Seater Tom McLean Daryl Mair* Catherine Neyland John Serfozo* 1st Clasp to the Peter McIntosh** John Seater Greg Tingate** National Medal Jane McPhee** Patrick Torpey Ken Wilkins* Barry Nicholls Stephen Newton** Mal Watts Garry Wright Catherine Neyland* Ron Williams 2lnd C asp to the 25 years of service Barry Nicholls** Garry Wright National Medal Neil Blizzard Peter Poulton* Denis Rowe 20 years of service Phillip Gribble Luciano Sartori** Terence Batson* Andrew Gunn A ncmbula e Victoria John Seater Service Medals David Boyd** Herb Jenkins Tony Stevens* Daryl Burdett** Ian Jones 10 years of service Anthony Sutherland* Malcolm Callaway* Trevor Lehmann Stephen Austin** Greg Tingate** Brian Campbell** Tony McKinnon Richard Barker* Paul Turner** Gary Curnow* Garry Wright Terence Batson* Brendan Walker* Maurice Ellis* 30 years of service David Boyd** Mal Watts* David Halsall** Leigh Amos* Julie Fallon* Chris Woolnough* Ian Harvey Paul Fletcher* Garry Wright David Boyd* Grant Hocking* Ian Caddy* Peter Frayne* 15 years of service Fred Hutchins* Greg Hallam* Brian Campbell* Terence Batson Ian Jones* Lindsay Cooke David Halsall* David Halsall Sandy Kahn Ian Harvey John Eden Bret Harding John Lawson** Trevor Fewster* Fred Hutchins* Ian Harvey Trevor Lehmann* Ross Hutchison Mal Hunting* Mark Hosking Melissa Mann* Wally Mayski Ian Jones** Fred Hutchins Tom McLean* Richard Jones* Sergio Monteduro** Ross Hutchinson Roger Murray* Russell Reid* John Kelly** Graham McGrath Barry Nicholls* John Lawson** Peter Zadow

Hume Medal Recipients

Ntiaa on l Medal 2lnd C asp to the 15 years of service 25 years of service Greg Kay National Medal Greg Kay Grant Parker Clinton Lee Michael Crothers Peter Lock Peter Lock A ncmbula e Victoria 20 years of service 1st Clasp to the Service Medals Scott Burns* National Medal 10 years of service Tom Gladstone* Grant Parker Clinton Lee Winton Hare* Jim Reeves*

National Medal An Australian Award recognising 15 years continuous diligent service in an emergency and/or defence service. 1st clasp to the National Medal Recognises an additional 10 years of diligent service; that is, a total of 25 years of diligent service. 2nd Clasp to the National Medal Recognises an additional 20 years of diligent service; that is, a total of 35 years of diligent service. * Denotes recognised for Safe Driving Award also ** Denotes recognised for Safe Driving Award only

62 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Loddon Mallee Medal Recipients

Ntiaa on l Medal David Chandler** Wesley Ewart 25 years of service Michael Allan Wesley Ewart* Daryl Fish Geoffrey Astall John Brereton Christopher Fleming Francis Gadsden Thomas Athorn David Chandler Raymond Foley* Kenneth Jenkins Keith Bailey Joan Cook Darren Hartwig* Christopher Jewson Bruce Dorrington Raymond Earle Timothy Hobson* Joanne Kerr Michael Gleeson Timothy Hobson Frank Hofmann Peter Keil David Guild Kenneth Jenkins Kenneth Jenkins Glenn Palmer Neil Harrop Christopher Jewson** Andrew McDonell 20 years of service Peter Kelly David Rowlings Hugh Kennedy* Leigh Murray Peter Keil* Michael Allan* Dale Richards 1st Clasp to the Brian Patterson** Geoffrey Astall* National Medal Brendan Smith Mark Robertson* Keith Bailey Thomas Athorn Geoffrey Smith Paul Carr* 30 years of service Leslie Wiles Brendan Smith** Paul Cracknell* Maxwell Brooker* A ncmbula e Victoria 15 years of service Raymond Earle* Neil Harrop* Service Medals Timothy Hobson* Malcolm Zadow* Michael Allan* Dennis Homfray* 10 years of service Geoffrey Astall** 40 years of service Christopher Jewson* Michael Allan* Keith Bailey Ian Nagle** Glenn Palmer* Geoffrey Astall** Mark Burns Brian Pike* Keith Bailey Paul Carr Geoffrey Quennell* Mark Burns* Christopher Casey Brendan Smith* Paul Carr** David Chandler Stephen Williams* Christopher Casey** Raymond Earle*

National Medal An Australian Award recognising 15 years continuous diligent service in an emergency and/or defence service. 1st clasp to the National Medal Recognises an additional 10 years of diligent service; that is, a total of 25 years of diligent service. 2nd Clasp to the National Medal Recognises an additional 20 years of diligent service; that is, a total of 35 years of diligent service. * Denotes recognised for Safe Driving Award also ** Denotes recognised for Safe Driving Award only

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 63 Governance

Ambulance Service Victoria – operating as Ambulance Victoria Declarations of pecuniary interest (AV) – was established on 1 July 2008 to provide statewide ambulance services by amalgamating the former organisations All Board members and senior managers are required to lodge of Metropolitan Ambulance Services (MAS), Rural Ambulance and update declarations of pecuniary interest in respect of Victoria (RAV) and Alexandra District Ambulance Service their responsibilities to AV. (ADAS). The newly formed AV is bound by the Ambulance Services Act 1986, as were the former MAS, RAV and ADAS services to: Committees • respond rapidly to requests for help in a medical emergency The Board operates four board committees to support its functions along with one advisory committee. • provide specialised medical skills to maintain life and to reduce injuries in emergency situations and while The Corporate Governance and Remuneration Committee transporting patients advises the Board on governance policies and procedures that enable the AV Board to meet its policy and legislative • provide specialised transport facilities to move people accountabilities and fulfil its role and responsibilities. It also requiring emergency medical treatment oversees the development and monitors the implementation of • provide services for which specialised medical or sound human resource management, employment and transport skills are necessary employee relations policies. • foster public education in first aid. Membership: Ms Jan Moffatt (Chair), Ms Marika McMahon, AV reports to the Minister for Health, the Hon. Daniel Andrews, Ms Rosie Buchanan (until 14 April 2009) and Mr Kevin Boote MP, through DHS. (from 18 May 2009) Appointed by the Governor-in-Council on the recommendation The Finance Committee facilitates the achievement of the of the Minister, the Board is responsible for the provision of AV Strategic Plan through the formulation of sound financial comprehensive and efficient ambulance services to the people policy advice and strategy, oversights financial management of Victoria. systems to ensure policy and legislative compliance, While organisational management is vested in the Chief minimises risk and ensures long-term viability of AV through Executive Officer and the executive team, the Board is organisation-wide risk assessment and management accountable to the State Government and Minister for Health, culture, and oversees the development and management through DHS, for the overall performance of AV. The primary of the annual budget. focus of the Board is the establishment of the strategic Membership: Ms Jean Sutherland (Chair), Ms Marika direction, governance and policies, together with monitoring McMahon, Mr John Frame and Ms Rhonda Whitfield. the performance and operating efficiency of AV. The Board operates in accordance with its Policies for Board Governance and the By-Laws AV, ensuring AV meets its statutory obligations and, in doing so, meets appropriate standards of accountability and propriety.

64 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT The Audit Committee reports to and assists the Board in Community Advisory Committee fulfilling its accountabilities and responsibilities in relation to The role of the Community Advisory Committee is to improve AV financial reporting, internal control structure, risk AV’s understanding of consumers’ and the community’s needs, management systems, and internal and external audit expectations and experience of the care provided by AV and to functions. In doing so, it is the responsibility of the committee provide input into AV’s strategic and operational development, to maintain free and open communication between the delivery and evaluation of services. committee, internal auditors, external auditors and AV management. The establishment of AV has provided the opportunity to reconsider the avenues for partnerships, consultation and In discharging its responsibilities, the committee is empowered references between AV and the wider community and as part of to investigate any matter brought to its attention with full access AV’s strategic development, work has been undertaken to to all books, records, facilities and personnel of AV (through the develop a new AV Community Advisory Committee that aligns CEO), and has the authority to engage independent, expert with the direction of the organisation. advisers as it determines necessary to carry out its duties. The committee has the right to seek explanations and additional The involvement of members of the former MAS Community information from AV management. Advisory Committee and the former RAV Community Reference Group was suspended from 1 July 2008 until this Membership: Mr John Frame (Chair), Ms Marika McMahon, process has been completed. It is anticipated that the future Ms Jean Sutherland and Ms Jan Moffatt. direction and membership of the new AV Community Advisory The Quality Committee ensures the development, Committee will be finalised by October 2009. implementation and effectiveness of the AV Quality Membership : Ms Alison Teese (Chair), Mr Kevin Boote and Management System and promotes the development of an Ms Rhonda Whitfield. organisation-wide culture to achieve the systematic management of quality improvement. The committee’s purpose is to: • ensure the development of a Quality Management System for AV • monitor the implementation and effectiveness of the AV Quality Management System • promote the development of an organisation-wide culture to achieve the systematic management of quality improvement • ensure the development of appropriate and contemporary policies, strategies, standards and guidelines, relating to clinical care, paramedic training/education and clinical research projects • monitor the clinical performance and clinical risk management processes of AV and identify key areas that require attention or reform • facilitate and encourage clinical research within AV and on a collaborative basis with other agencies both locally and nationally. Membership: Ms Marika McMahon (Chair), Ms Rhonda Whitfield, Mr George Braitberg, Mr Kevin Boote and Ms Alison Teese.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 65 The Executive Group

Chex i f E ecutive Officer Excutivee General Excutivee General Excutivee General Manager, Metropolitan Manager, Regional Manager, Regional Greg Sassella Operations Operations (East) Operations (West) Responsible to the Board Mark Rogers Garry Cook Greg Leach for the overall management Acting Executive and performance of AV. Responsible for emergency Responsible for emergency General Manager ambulances, location of ambulances, location of from 27 April 2009 teams, design of service teams, design of service Keith Young delivery, resources and delivery, resources and until 26 April 2009 response time performance response time performance for the Gippsland and Hume for the Barwon South West, Responsible for emergency Regions. Loddon Mallee and ambulances and the state’s Grampians Regions. air ambulance services, including communications systems, staff, locations of teams, design of service delivery, resources and response time performance, and Adult Retrieval Victoria.

70 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Excutivee General Excutivee General Excutivee General Manager, Quality & Manager, Strategic Manager, Finance & Education Services Planning Corporate Services Tony Walker Alex Currell Rosalinda Polivka Responsible for service Responsible for strategic Responsible for AV financial quality, professional planning and data analysis. performance, commercial standards, operational staff services, legal, purchasing, training and clinical risk and project management, standards, and the clinical property services, fleet performance of AV and its administration, business service providers. services, memberships, AVFA, and marketing.

Excutivee General Excutivee General Excutivee General Manager, Information Manager, Community & Manager, Integration Systems Human Services Theresa Smith Cameron Crampton Susan Smith from 8 October 2008 Responsible for IT and Responsible for recruitment, Jon Holloway communications payroll administration, until 13 September 2008 infrastructure, information employee relations, management, technical occupational health and Responsible for identification services, records safety, WorkCover, of operational requirements management, Freedom of administration training and business processes to Information and Privacy. programs, internal and enable AV to function and external communication, and immediate tasks that must community education. be undertaken by the Board and CEO of AV to ensure business continuity.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 71 72 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 73 74 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Financial Report for the year ended 30 June 2009

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 75 76 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 77 78 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Operating Statement for the year ended 30 June 2009

NOTE 2009 $’000 INCOME Revenue from Operating Activities 2a 454,716 Revenue from Non-Operating Activities 2a 5,832 Other Income 2b 2,815 TOTAL INCOME 463,363

EXPENSE Employee Benefits Expense 3 (307,155) Contract Payments and Services 3 (88,119) Supplies and Services 3 (43,162) Maintenance Expense 3 (17,676) Bad and Doubtful Debts 3 (12,063) Other Expenses 3 (10,156) TOTAL EXPENSE (478,331) NET RESULT BEFORE CAPITAL & SPECIFIC ITEMS (14,968)

Capital Purpose Income 2a 40,333 Specific Income -Proceeds on Disposal of Assets 2g 3,459 Impairment of Financial Assets 3 (2,364) Depreciation and Amortisation 3,4 (21,285) Specific Expenses 3 (5,853) 14,290 NET RESULT FOR THE YEAR (678)

This statement should be read in conjunction with the accompanying notes.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 79 Ambulance Victoria Balance Sheet as at 30 June 2009

NOTE 2009 $’000 CURRENT ASSETS Cash and Cash Equivalents 5 71,334 Receivables 6 5,241 Fees Receivable 7 15,402 Other Financial Assets 8 1,898 Inventories 9 2,564 Prepayments 4,741 Non-Current Assets Classified as Held for Sale 10 508 Total Current Assets 101,688

NON-CURRENT ASSETS Receivables 6 7,132 Other Financial Assets 8 7,589 Property, Plant and Equipment 11 226,745 Intangible Assets 12 4,788 Total Non-Current Assets 246,254 TOTAL ASSETS 347,942

CURRENT LIABILITIES Payables 13 24,014 Employee Benefits 14 89,785 Prepaid Income 15 46,944 Total Current Liabilities 160,743

NON-CURRENT LIABILITIES Employee Benefits 14 10,615 Prepaid Income 15 11,890 Total Non-Current Liabilities 22,505 TOTAL LIABILITIES 183,248 NET ASSETS 164,694

EQUITY Reserves 16a 7,672 Contributed Capital 16b 157,700 Accumulated Surplus /(Deficit) 16c (678) TOTAL EQUITY 164,694

This statement should be read in conjunction with the accompanying notes.

80 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Statement of Changes of Equity for the year ended 30 June 2009

NOTE 2009 $’000 Total equity transferred as contributed capital at beginning of financial year 16b 157,700 Gain on Asset Revaluation 16a 7,154 Available-for-Sale Revaluation Reserve: Gain taken to equity 16a 518 NET INCOME RECOGNISED DIRECTLY IN EQUITY 7,672

Net Result for the Year 16c (678) TOTAL RECOGNISED INCOME AND EXPENSE FOR THE YEAR 6,994

TOTAL EQUITY AT THE END OF THE FINANCIAL YEAR 164,694

This statement should be read in conjunction with the accompanying notes.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 81 Ambulance Victoria Cash Flow Statement for the year ended 30 June 2009

NOTE 2009 $’000 CASH FLOWS FROM OPERATING ACTIVITIES Operating Grants from Government 275,559 Capital Grants from Government 40,774 Transport Fees Received 91,338 Membership Fees Received 87,153 Interest Received 6,093 Donations and Bequests Received 765 GST Received from/(Paid to) ATO 17,263 Other Receipts Received 9,193 Employee Benefits Paid (305,205) Payments for Supplies and Services (191,155) Net Cash Inflow From Operating Activities 17 31,778

CASH FLOWS FROM INVESTING ACTIVITIES Purchase of Property, Plant and Equipment (49,961) Proceeds from Sale of Property, Plant and Equipment 3,460 Proceeds from Sale of Investments 43,629 Net Cash Outflow From Investing Activities (2,872)

NET INCREASE IN CASH HELD 28,906 Cash and Cash Equivalents at Beginning of Year 42,428 Cash and Cash Equivalents at End of Year 5 71,334

This Statement should be read in conjunction with the accompanying notes.

82 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

C oNTENTS

Notes Page 1 Statement of Significant Accounting Policies 84 2 Income 93 2a Revenue 93 2b Other Income 93 2c Government Grants 94 2d Indirect Contributions by Department of Health 94 2e Transport Fees 94 2f Memberships 95 2g Net Gain/(Loss) on Disposal of Non-Current Assets 95 3 Expenses from Ordinary Activities 96 4 Depreciation and Amortisation 97 5 Cash and Cash Equivalents 97 6 Receivables 97 7 Fees Receivable 98 8 Other Financial Assets 99 9 Inventories 99 10 Non-Current Assets Classified as Held for Sale 99 11 Property, Plant and Equipment 99 12 Intangible Assets 101 13 Payables 101 14 Employee Benefits 102 15 Prepaid Income 102 16 Equity 103 17 Reconciliation of Net Result for the Year to Net Cash Inflow/(Outflow) 105 from Operating Activities 18 Financial Instruments 106 19 Commitments for Expenditure 110 20 Contingent Assets and Contingent Liabilities 110 21 a Responsible Persons Disclosures 111 21 b Executive Officer Disclosures 112 22 Events Occurring after the Balance Sheet Date 112 23 Economic Dependency 112

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 83 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies

(a) Statement of Compliance This general purpose Financial Report which has been prepared on an accrual basis in accordance with the Financial Management Act 1994, applicable Australian Accounting Standards (AAS), which includes the Australian equivalents to International Financial Reporting Standards and Australian Accounting Interpretations. (b) Basis of Preparation Ambulance Victoria (AV) was created under Section 23 of the Ambulance Services Act 1986 on 1 July 2008 and represents the amalgamation of Victoria’s three ambulance services -Metropolitan Ambulance Service, Rural Ambulance Victoria and Alexandra and District Ambulance Service. Consequently, comparative amounts have not been included. The Financial Report is prepared in accordance with the historical cost convention, except for the revaluation of certain non-current assets and financial instruments, as noted. Cost is based on the fair value of the consideration given in exchange for assets. In the application of AASs, management is required to make judgements, estimates and assumptions about carrying values of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and various other factors that are believed to be reasonable under the circumstances, the results of which form the basis of making the judgements. Actual results may differ from these estimates. The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision, and future periods if the revision affects both current and future periods. Accounting policies are selected and applied in a manner which ensures that the resulting financial information satisfies the concepts of relevance and reliability, thereby ensuring that the substance of the underlying transactions or other events is reported. The accounting policies set out below have been applied in preparing the financial report for the year ended 30 June 2009. (c) Reporting Entity The Financial Report includes all the controlled activities of AV. AV is a not-for-profit entity and therefore applies the additional Aus paragraphs applicable to “not-for-profit” entities under the AASs. (d) Rounding Of Amounts All amounts shown in the Financial Report are expressed to the nearest $1,000 unless otherwise stated. (e) Cash and Cash Equivalents Cash and cash equivalents comprise cash on hand and cash at bank, deposits at call and highly liquid investments with an original maturity of 3 months or less, which are readily convertible to known amounts of cash and are subject to insignificant risk of changes in value. (f) Receivables Trade debtors are carried at nominal amounts due and are due for settlement within 30 days from the date of recognition. Collectability of debts is reviewed on an ongoing basis, and debts, which are known to be uncollectible, are written off. A provision for doubtful debts is raised where doubt of collection exists. Bad debts are written off when identified. (g) Inventories Inventories include goods and other property held either for sale or for distribution at no or nominal cost in the ordinary course of business operations. Inventories held for distribution are measured at cost, adjusted for any loss of service potential. Bases used in assessing loss of service potential for inventories held for distribution include current replacement cost and technical or functional obsolescence. Technical obsolescence occurs when an item still functions for some or all of the tasks it was originally acquired to do, but no longer matches existing technologies. Functional obsolescence occurs when an item no longer functions the way it did when it was first acquired. Cost is determined principally by the weighted average cost method and includes expenditure incurred in acquiring the inventories and bringing them to their existing condition.

84 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

(h) Other Financial Assets Other financial assets are recognised and derecognised on trade date where purchase or sale of an investment is under a contract whose terms require delivery of the investment within the timeframe established by the market concerned, and are initially measured at fair value, net of transaction costs. AV classifies its other financial assets between current and non-current assets based on the purpose for which the assets were acquired, and AV’s intended use. Those assets deemed to be non-current are not intended to be settled within 12 months. Management determines the classification of its financial instruments on initial recognition, based on the purpose for which the assets were acquired, and AV’s intended use. AV assesses at each balance sheet date whether a financial asset or group of financial assets is impaired. Loans and receivables Trade Receivables, loans and other receivables are recorded at amortised cost, using the effective interest method, less impairment. The effective interest method is a method of calculating the amortised cost of a financial asset and of allocating interest income over the relevant period. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, or, where appropriate, a shorter period. Available-for-sale financial assets Other financial assets held by AV are classified as being available-for-sale and are stated at fair value. Gains and losses arising from changes in fair value are recognised directly in equity until the investment is disposed of or is determined to be impaired, at which time the cumulative gain or loss previously recognised in equity is included in profit or loss for the period. Fair value is determined in the manner described in Note 18. (i) Intangible Assets Intangible assets represent identifiable non-monetary assets without physical substance such as computer software, licences and development costs. Intangible assets are initially recognised at cost. Subsequently, intangible assets with finite useful lives are carried at cost less accumulated amortisation and accumulated impairment losses. Costs incurred subsequent to initial acquisition are capitalised when it is expected that additional future economic benefits will flow to AV. Amortisation is allocated to intangible assets with finite useful lives on a systematic (typically straight-line) basis over the asset’s useful life. Amortisation begins when the asset is available for use, that is, when it is in the location and condition necessary for it to be capable of operating in the manner intended by management. The amortisation period and the amortisation method for an intangible asset with a finite useful life are reviewed at least at the end of each annual reporting period. In addition, an assessment is made at each reporting date to determine whether there are indicators that the intangible asset concerned is impaired. If so, the assets concerned are tested as to whether their carrying value exceeds their recoverable amount. Any excess of the carrying amount over the recoverable amount is recognised as an impairment loss. Intangible assets with finite useful lives are amortised over a 2-10 year period. (j) Property, Plant and Equipment Freehold and Crown Land is measured at fair value with regard to the property’s highest and best use after due consideration is made for any legal or constructive restrictions imposed on the asset, public announcements or commitments made in relation to the intended use of the asset. Theoretical opportunities that may be available in relation to the assets are not taken into account until it is virtually certain that any restrictions will no longer apply. Land and Buildings are recognised initially at cost and subsequently measured at fair value less accumulated depreciation and impairment. Plant, equipment and vehicles are initially recognised at cost and subsequently measured at fair value.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 85 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

(k) Revaluations of Non-current Physical Assets Non-current physical assets measured at fair value are revalued in accordance with FRD 103D. This revaluation process normally occurs every five years, based upon the asset’s Government Purpose Classification, but may occur more frequently if fair value assessments indicate material changes in value. Revaluation increments or decrements arise from differences between an asset’s carrying value and fair value. Revaluation increments are credited directly to the asset revaluation reserve, except that, to the extent that an increment reverses a revaluation decrement in respect of that class of asset previously recognised as an expense in net result, the increment is recognised as income in the net result. Revaluation decrements are recognised immediately as expenses in the net result, except that, to the extent that a credit balance exists in the asset revaluation reserve in respect of the same class of assets, they are debited directly to the asset revaluation reserve. Revaluation increases and revaluation decreases relating to individual assets within an asset class are offset against one another within that class but are not offset in respect of assets in different classes. Revaluation reserves are not transferred to accumulated funds on derecognition of the relevant asset. In accordance with FRD 103D AV’s non-current physical assets were subjected to a detailed valuation in the current financial year. (I) Non Current Assets Classified as Held for Sale Non-current assets classified as held for sale are measured at the lower of carrying amount and fair value less costs to sell, and are not subject to depreciation. Non-current assets are classified as held for sale if their carrying amount will be recovered through a sale transaction rather than through continuing use. This condition is regarded as met only when the sale is highly probable and the asset’s sale is expected to be completed within one year from the date of classification. (m) Depreciation and Amortisation Assets with a cost in excess of $1,000 are capitalised and depreciation has been provided on depreciable assets so as to allocate their cost or valuation over their estimated useful lives using the straight-line method. Estimates of the remaining useful lives and depreciation method for all assets are reviewed at least annually. This depreciation charge is not funded by the Department of Health, but AV participates in the Department’s capital works program. The following table indicates the expected useful lives of non-current assets on which the depreciation charges are based. 2008-09 Buildings 10 to 52 years Building Components: • Structure Shell Building Fabric 51 years • Site Engineering Service and Central Plan 27 years • Fit Out 21 years • Trunk Reticulated Building Systems 22 years Leasehold Improvements 2 to 50 years Plant & Equipment 1 to 13 years Intangibles 2 to 10 years Office Furniture & Equipment 4 to 18 years Motor Vehicles 2 to 10 years

(n) Net Gain/(Loss) on Non-Financial Assets Net gain/(loss) on non-financial assets includes realised and unrealised gains and losses from revaluations, impairments and disposals of all physical assets and intangible assets. Disposal of Non-Financial Assets Any gain or loss on the sale of non-financial assets is recognised at the date that control of the asset is passed to the buyer and is determined after deducting from the proceeds the carrying value of the asset at that time.

86 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

Impairment of Non-Financial Assets Intangible assets with indefinite useful lives (and intangible assets not yet available for use) are tested annually for impairment (i.e. as to whether their carrying value exceeds their recoverable amount, and so require write-downs) and whenever there is an indication that the asset may be impaired. All other assets are assessed annually for indications of impairment. If there is an indication of impairment, the assets concerned are tested as to whether their carrying value exceeds their possible recoverable amount. Where an asset’s carrying value exceeds its recoverable amount, the difference is written off as an expense except to the extent that the write-down can be debited to an asset revaluation reserve amount applicable to that class of asset. It is deemed that, in the event of the loss of an asset, the future economic benefits arising from the use of the asset will be replaced unless a specific decision to the contrary has been made. The recoverable amount for most assets is measured at the higher of depreciated replacement cost and fair value less costs to sell. Recoverable amount for assets held primarily to generate net cash inflows is measured at the higher of the present value of future cash flows expected to be obtained from the asset and fair value less costs to sell. (o) Net Gain/(Loss) on Financial Instruments Net gain/(loss) on financial instruments includes realised and unrealised gains and losses from revaluations of financial instruments that are designated at fair value through profit or loss or held-for-trading, impairment and reversal of impairment for financial instruments at amortised cost, and disposals of financial assets. Revaluations of Financial Instruments at Fair Value The revaluation gain/(loss) on financial instruments at fair value excludes dividends or interest earned on financial assets, which is reported as part of income from transactions. Impairment of Financial Assets Bad and doubtful debts are assessed on a regular basis. Those bad debts considered as written off are classified as an expense. Financial assets have been assessed for impairment in accordance with Australian Accounting Standards. Where a financial asset’s fair value at balance date has reduced by 20 percent or more than its cost price; or where its fair value has been less than its cost price for a period of 12 or more months, the financial instrument is treated as impaired. In order to determine an appropriate fair value as at 30 June 2009 for its portfolio of financial assets, AV obtained a valuation based on the best available advice using an estimated market value through a reputable financial institution. This value was compared against valuation methodologies provided by the issuer as at 30 June 2009. These methodologies were critiqued and considered to be consistent with standard market valuation techniques. Prices obtained from both sources were compared and were generally consistent with the full portfolio. The above valuation process was used to quantify the level of impairment on the portfolio of financial assets as at year end. (p) Payables These amounts consist predominantly of liabilities for goods and services. Payables are initially recognised at fair value, then subsequently carried at amortised cost and represent liabilities for goods and services provided to AV prior to the end of the financial year that are unpaid, and arise when AV becomes obliged to make future payments in respect of the purchase of these goods and services. The normal credit terms are usually Net 30 days. (q) Provisions Provisions are recognised when AV has a present obligation, the future sacrifice of economic benefits is probable, and the amount of the provision can be measured reliably. The amount recognised as a provision is the best estimate of the consideration required to settle the present obligation at reporting date, taking into account the risks and uncertainties surrounding the obligation. Where a provision is measured using the cashflows estimated to settle the present obligation, its carrying amount is the present value of those cash flows.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 87 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

(r) Resources Provided and Received Free of Charge or for Nominal Consideration Resources provided or received free of charge or for nominal consideration are recognised at their fair value when the transferee obtains control over them, irrespective of whether restrictions or conditions are imposed over the use of the contributions, unless received from another government department or agency as a consequence of a restructuring of administrative arrangements. In the latter case, such transfer will be recognised at carrying value. Contributions in the form of services are only recognised when a fair value can be reliably determined and the services would have been purchased if not donated. (s) functional and Presentation Currency The presentation currency of AV is the Australian dollar, which has also been identified as the functional currency of AV. (t) Goods and Services Tax Income, expenses and assets are recognised net of the amount of associated GST, unless the GST incurred is not recoverable from the taxation authority. In this case it is recognised as part of the cost of acquisition of the asset or as part of the expense. Receivables and payables are stated inclusive of the amount of GST receivable or payable. The net amount of GST recoverable from, or payable to, the taxation authority is included with other receivables or payables in the Balance Sheet. Cash flows are presented on a gross basis. The GST components of cash flows arising from investing or financing activities which are recoverable from, or payable to the taxation authority, are presented as operating cash flows. Commitments and contingent assets and liabilities are presented on a gross basis. (u) Employee Benefits Wages and Salaries, Annual Leave, Sick Leave and Accrued Days Off Liability for wages and salaries, including non-monetary benefits, annual leave, accumulating sick leave and accrued days off expected to be settled within 12 months of the reporting date are recognised in the provision for employee benefits in respect of employees’ services up to the reporting date, classified as current liabilities and measured at nominal values. Those liabilities that AV does not expect to settle within 12 months are recognised in the provision for employee benefits as current liabilities, measured at present value of the amounts expected to be paid when the liabilities are settled using the remuneration rate expected to apply at the time of settlement. Long Service Leave Current Liability -unconditional LSL (representing 10 or more years of continuous service) is disclosed as a current liability even where AV does not expect to settle the liability within 12 months because it will not have the unconditional right to defer the settlement of the entitlement should an employee take leave within 12 months. The components of this current LSL liability are measured at: Present value -component that AV does not expect to settle within 12 months; and Nominal value -component that AV expects to settle within 12 months. Non-Current Liability -conditional LSL (representing less than 10 years of continuous service) is disclosed as a non-current liability. There is an unconditional right to defer the settlement of the entitlement until the employee has completed the requisite years of service. Conditional LSL is required to be measured at present value. Consideration is given to expected future wage and salary levels, experience of employee departures and periods of service. Expected future payments are discounted using interest rates of Commonwealth Government guaranteed securities in Australia.

88 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

Superannuation Defined Contribution Plans Contributions to defined contribution superannuation plans are expensed when incurred. Defined Benefit Plans The amount charged to the Operating Statement in respect of defined benefit superannuation plans represents the contributions made by AV to the superannuation plans in respect to the services of current AV staff. Superannuation contributions are made to the plans based on the relevant rules of each plan. Employees of AV are entitled to receive superannuation benefits and AV contributes to both the defined benefit and defined contribution plans. The defined benefit plans provide benefits based on years of service and final average salary. The name and details of the major employee superannuation funds and contributions made by AV are as follows: Contributions for the year (Paid or Payable) Fund 2009 $’000 Defined Benefit Plans: Emergency Services Superannuation Fund 20,532 Defined Contribution Plans: Emergency Services Superannuation Fund 2,494 Total 23,026 AV does not recognise any defined benefit liability in respect of the superannuation plans because AV has no legal or constructive obligation to pay future benefits relating to its employees; its only obligation is to pay superannuation contributions as they fall due. The Department of Treasury and Finance administers and discloses the State’s defined benefit liabilities in its financial report. On-Costs Employee benefit on-costs (workers’ compensation, superannuation, annual leave and LSL accrued while on LSL taken in service) are recognised separately from provision for employee benefits. (v) Leases Leases of property, plant and equipment are classified as finance leases whenever the terms of the lease transfer substantially all the risks and rewards of ownership to the lessee. All other leases are classified as operating leases. Finance leases are recognised as assets and liabilities at amounts equal to the fair value of the lease property or, if lower, the present value of the minimum lease payment, each determined at the inception of the lease. The lease asset is depreciated over the shorter of the estimated useful life of the asset or the term of the lease. Minimum lease payments are allocated between the principal component of the lease liability, and the interest expense calculated using the interest rate implicit in the lease, and charged directly to the operating statement. Contingent rentals associated with finance leases are recognised as an expense in the period in which they are incurred. Operating lease payments, including any contingent rentals, are recognised as an expense in the operating statement on a straight line basis over the lease term, except where another systematic basis is more representative of the time pattern of the benefits derived from the use of the leased asset.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 89 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

Lease Incentives All incentives for the agreement of a new or renewed operating lease shall be recognised as an integral part of the net consideration agreed for the use of the leased asset, irrespective of the incentive’s nature or form or the timing of payments. In the event that lease incentives are received to enter into operating leases, such incentives are recognised as a liability. The aggregate benefits of incentives are recognised as a reduction of rental expense on a straight-line basis, except where another systematic basis is more representative of the time pattern in which economic benefits from the leased asset are consumed. Leasehold Improvements The cost of leasehold improvements is capitalised as an asset and depreciated over the remaining term of the lease or the estimated useful life of the improvements, whichever is the shorter. (w) Income Recognition Income is recognised in accordance with AASB 118 Revenue and is recognised as to the extent it is earned. Unearned income at reporting date is reported as income received in advance. Amounts disclosed as revenue are, where applicable, net of returns, allowances and duties and taxes. Government Grants Grants are recognised as income when AV gains control of the underlying assets in accordance with AASB 1004 Contributions. For reciprocal grants, AV is deemed to have assumed control when the performance has occurred under the grant. For non-reciprocal grants, AV is deemed to have assumed control when the grant is received or receivable. Conditional grants may be reciprocal or non-reciprocal depending on the terms of the grant. Indirect Contributions • Insurance premiums incurred by the Department of Health on behalf of AV are recognised as revenue following advice from the Department of Health. • Long Service Leave (LSL) revenue is recognised upon finalisation of movements in LSL liability in line with the arrangements set out in the Metropolitan Health and Aged Care Services Division Hospital Circular 34/2008. Donations and Other Bequests Donations and other bequests are recognised as revenue when received. If donations are for a special purpose, they may be appropriated to a reserve, such as the specific restricted purpose reserve. Transport Fees Revenue from ambulance services is recognised upon the provision of such a service. Membership Fee Revenue Membership revenue is recognised on a time proportionate basis over the membership period. Interest and Other Revenue Interest revenue is recognised on a proportional basis taking into account the effective yield of the financial assets. (x) Amalgamations and Mergers Assets and liabilities of the amalgamated entities are taken up at book value at date of amalgamation in accordance with Financial Reporting Direction 119. Crown assets acquired remain the property of the Crown, however they are reported as assets of AV, because effective control passes to AV along with a substantial benefit. (y) Property, Plant and Equipment Revaluation Reserve The property, plant and equipment revaluation reserve is used to record increments and decrements on the revaluation of non-current assets. (z) financial Asset Available-for-Sale Revaluation Reserve The financial asset available-for-sale revaluation reserve arises on the revaluation of available-for-sale financial assets. Where a revalued financial asset is sold, that portion of the reserve which relates to that financial asset is effectively realised, and is recognised in the operating statement. Where a revalued financial asset is impaired, that portion of the reserve which relates to that financial asset is recognised in the operating statement.

90 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

(aa) Restricted Specific Purpose Reserve The Restricted Specific Purpose Reserve represents funds raised by branch auxiliaries and is reserved for their use. It also represents specific purpose grant funding, unexpended at year end, for the following purposes: • Motor Vehicle Development • Motor Vehicle Replacement • Capital Projects • Long Service Leave (ab) Contributed Capital Consistent with Australian Accounting Interpretation 1038 ‘Contributions by Owners Made to Wholly-Owned Public Sector Entities’ and FRD 119 ‘Contributions by Owners’, appropriations for additions to the net asset base have been designated as contributed capital. Other transfers that are in the nature of contributions or distributions that have been designated as contributed capital are also treated as contributed capital. (ac) Net Result Before Capital & Specific Items The sub-total entitled “Net Result Before Capital & Specific Items” is included in the Operating Statement to enhance the understanding of the financial performance of AV. This sub-total reports the result excluding items of an unusual nature and amounts such as specific revenues and expenses. The exclusion of these items is made to enhance matching of income and expenses so as to facilitate the comparability and consistency of results between years. The Net Result Before Capital & Specific Items is used by the management of AV, the Department of Health and the Victorian Government to measure the ongoing result of AV. Capital and specific items which are excluded from the sub-total comprise: • Non-current asset revaluation increments/decrements • Impairment of financial and non-financial assets, which includes all impairment losses (and reversal of previous impairment losses), which have been recognised in accordance with note 1(n). (ac) New Accounting Standards and Interpretations Certain new accounting standards and interpretations have been published that are not mandatory for 30 June 2009 reporting period. AV has not and does not intend to adopt these standards early.

Standard / Interpretation Summary Applicable for Reporting Impact on AV’s Annual Periods Beginning on or Statements Ending on AASB 8 Operating Segments Supersedes AASB 114 Segment Beginning 1 January 2009 Not applicable. Reporting AASB 2007-3 Amendments to An accompanying amending Beginning 1 January 2009 Impact expected to be Australian Accounting standard, also introduced insignificant. Standards arising from AASB 8 consequential amendments into [AASB 5, AASB 6, AASB 102, other Standards AASB 107, AASB 119, AASB 127, AASB 134, AASB 136, AASB 1023 and AASB 1038] AASB 2007-6 Amendments to An accompanying amending Beginning 1 January 2009 All Australian government Australian Accounting standard, also introduced jurisdictions are currently still Standards arising from AASB consequential amendments into actively pursuing an exemption 123 [AASB 1, AASB 101, AASB other Standards for government from 107, AASB 111, AASB 116 & capitalising borrowing costs. AASB 138 and Interpretations 1 & 12] AASB 2008-3 Amendments to This Standard gives effect to Beginning 1 January 2009 Impact expected to be AASs arising from AASB 3 & consequential changes arising from insignificant. AASB 127 [AASB 1,2,4,5,7, revised AASB 3 and amended AASB 101,107, 112, 114, 116, 121, 127. The Prefaces to those Standards 128,131,132,133,134,136, 137, summarise the main requirements of 138 & 139 and Interpretation those Standards. 9 & 107]

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 91 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 1: Statement of Significant Accounting Policies (continued)

(ac) New Accounting Standards and Interpretations (continued)

Standard / Interpretation Summary Applicable for Reporting Impact on AV’s Annual Periods Beginning on or Statements Ending on AASB 2008-5 Amendments to A suite of amendments to existing Beginning 1 January 2009 Impact is being evaluated. AASs arising from the Annual standards following issuance of IASB Improvements Project [AASBs Standard Improvements to IFRSs in 5, 7,101,102,107, 108, 110, 116, May 2008, Some amendments result 118, 119, 120, 123, 127, 128, in accounting changes for 129, 131, 132, 134, 136, 138, presentation, recognition and 140, 141, 1023 & 1308] measurement purposes. AASB 2008-6 Further The amendments require all the Beginning 1 January 2009 Impact expected to be Amendments to Australian assets and liabilities of a for-sale insignificant. Accounting Standards arising subsidiary’s to be classified as held from the Annual Improvements for sale and clarify the disclosures project [AASB 1 & AASB 5] required when the subsidiary is part of a disposal group that meets the definition of a discontinued operation. AASB 2008-7 Amendments to Changes mainly relate to treatment Beginning 1 January 2009 Impact expected to be to AAS Cost of an Investment in a of dividends from subsidiaries or insignificant. Subsidiary, Jointly Controlled controlled entities. Entity or Associate [AASB 1, AASB 118, AASB 121, AASB 127 & AASB 136] AASB 2008-8 Amendments to The amendments to AASB 139 Beginning 1 January 2009 Impact is being evaluated. Australian Accounting clarify how the principles that Standards -Eligible Hedged determine whether a hedged risk or Items [AASB 139] portion of cash flows is eligible for designation as a hedged item, should be applied in particular situations. AASB 2008-9 Amendments to Amendments to AASB 1049 for Beginning 1 January 2009 Impact expected to be AASB 1049 for Consistency consistency with AASB 101 insignificant. with AASB 101. (September 2007) version. AASB 2009-1 Amendments to Amendments to Australian Beginning 1 January 2009 Impact expected to be Australian Accounting Accounting Standards to allow insignificant. Standards -Borrowing Costs of borrowing costs of Not-for- Profit Not-for-Profit Public Sector Public Sector Entities to be Entities [AASB 1, AASB 111 & expensed. AASB 123] AASB 2009-2 Amendments to Amendments to AASB 7 to enhance Beginning 1 January 2009 Impact expected to be to Australian Accounting disclosures about fair value insignificant. Standards -Improving measurements and liquidity risk. Disclosures about Financial Editorial amendments to AASB 4, Instruments [AASB 4, AASB 7, AASB 1023 & AASB 1038 resulting AASB 1023 & AASB 1038] from the amendments to AASB 7.

92 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 2: Income

2009 $’000

N oTE 2a: Revenue

Revenue from Operating Activities Government Grants 2c 271,067 Indirect Contributions by Department of Health* 2d 4,677 Transport Fees 2e 90,667 Memberships 2f 85,460 First Aid Education and Training 2,018 Merchandise 827 Total Revenue From Operating Activities 454,716

Revenue from Non-Operating Activities Interest 5,674 Property Rental 158 Total Revenue From Non-Operating Activities 5,832

Other Income 2b 2,815

Revenue from Capital Purpose Income Capital Grants 2c 40,185 Indirect Contributions by Department of Health* 2d 148 40,333

Revenue from Specific Income 2g 3,459

TOTAL REVENUE 507,155

* Indirect Contributions by Department of Health The Department of Health makes certain payments on behalf of AV. These amounts have been brought to account in determining the operating result for the year by recording them as revenues and expenses.

N oTE 2b: Other Income

2009 $’000

Recoveries 375 Donations and Bequests 765 Other 1,675 TOTAL OTHER INCOME 2,815

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 93 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 2c: GOVERNMENT GRANTS AV received grants from the Department of Health to cover the cost of transporting pensioners and Health Care Card Holders. AV also received grants from the Department of Justice in respect of AV’s participation in “whole of government” communications projects and Worksafe Victoria for other various initiatives. 2009 $’000 Department of Health Grants Operating Grants Ordinary 262,099 WorkCover 148 Total Operating Grants 262,247

Capital Grants Minor Works 9,544 Motor Vehicle Replacement/Development Grants 19,567 Other Capital 11,074 Total Capital Grants 40,185 Total Department of Health Grants 302,432

Non Department of Health Grants Department of Justice 8,780 Worksafe Victoria 40 Total Non Department of Health Grants 8,820 Total Government Grants 311,252

NOTE 2d: INDIRECT CONTRIBUTIONS BY DEPARTMENT OF HEALTH The Department of Health makes certain payments on behalf of AV. These amounts have been brought to account (at fair value of the transfer at the acquisition date) in determining the operating result for the year by recording them as non-cash revenue and as either expenses or capitalised costs. 2009 $’000 Long Service Leave 3,399 Insurance 1,278 Pre-Construction Costs 148 Total Indirect Contributions by Department of HEALTH 4,825

NOTE 2e: TRANSPORT FEES

2009 $’000 Patient Transport 40,583 Transport Accident Commission 20,572 WorkCover 5,329 Inter-Hospital and Outpatient Transfers 23,239 Public Duty 944 TOTAL TRANSPORT FEES 90,667

94 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 2f: MEMBERSHIPS

2009 $’000 Membership Revenue Family 62,066 Single 23,394 TOTAL MEMBERSHIP REVENUE 85,460

Membership Numbers No. Family 559,296 Single 421,637 Life Member & Other 9,639 TOTAL MEMBERSHIP NUMBERS 990,572

NOTE 2g: NET GAIN/(LOSS) ON DISPOSAL OF NON-CURRENT ASSETS 2009 $’000 Proceeds from Disposal of Non-Current Assets Land 46 Buildings 108 Plant and Equipment 21 Office Furniture and Equipment 5 Motor Vehicles 3,279 Total Proceeds from Disposal of Non-Current Assets 3,459

Less: Written Down Value of Non-Current Assets Disposed Land 57 Buildings 177 Plant and Equipment 102 Office Furniture and Equipment 11 Motor Vehicles 3,526 Total Written Down Value of Non-Current Assets Disposed 3,873

Net Gain/(Loss) on Disposal of Non-Current Assets Land (11) Buildings (69) Plant and Equipment (81) Office Furniture and Equipment (6) Motor Vehicles (247) Total Net Gain/(Loss) on Disposal of Non-Current Assets (414)

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 95 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 3: EXPENSES FROM ORDINARY ACTIVITIES

Vehicle and Operations Administration Property Other Total Maintenance Note 2009 2009 2009 2009 2009 $'000 $'000 $'000 $'000 $'000 Employee Benefits Expense Salaries and Wages 235,188 24,317 4,800 1,663 265,968 Superannuation 21,509 1,833 453 133 23,928 WorkCover 9,159 835 186 100 10,280 Long Service Leave 6,193 548 (48) 30 6,723 Fringe Benefits Tax 0 256 0 0 256 Total Employee Benefits Expense 272,049 27,789 5,391 1,926 307,155 Contract Payments and Services Non Emergency Services 32,339 0 0 0 32,339 Air Ambulance Services 26,954 0 0 0 26,954 Computer Aided Dispatch Services 21,801 0 0 0 21,801 Memberships Services 0 7,025 0 0 7,025 Total Contract Payments and Services 81,094 7,025 0 0 88,119 Supplies and Services Medical, Postage, Stationery, Computer Services, Telephone, Promotions 22,234 18,165 2,467 296 43,162 Total Supplies and Services 22,234 18,165 2,467 296 43,162

Maintenance Expenses Property and Other Maintenance Expenses 770 20 817 12 1,619 Vehicle and Equipment Maintenance Expense 4,495 224 11,280 58 16,057 Total Maintenance Expenses 5,265 244 12,097 70 17,676

Bad and Doubtful Debts 0 12,063 0 0 12,063

Other Expenses Fees - Auditor-General 0 119 0 0 119 - Consulting and Legal 0 1,807 0 0 1,807 - Internal Audit 30 428 0 0 458 Occupancy 5,440 99 1,556 83 7,178 First Aid Educational Services 0 0 0 594 594

Total Other Expenses 5,470 2,453 1,556 677 10,156

Total Expenses from Continuing Operations 386,112 67,739 21,511 2,969 478,331

Impairment of Financial Assets 0 0 0 2,364 2,364

Depreciation and Amortisation 4 0 0 0 21,285 21,285

Specific Expenses Revaluation Decrement on Non-Current Assets 0 0 0 1,980 1,980 Net Book Value of Assets Sold 0 0 0 3,873 3,873

Total Specific Expenses 2g 0 0 0 5,853 5,853

Total Expenses 386,112 67,739 21,511 32,471 507,833

96 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 4: Depreciation and Amortisation

2009 $’000 Depreciation Buildings 1,393 Plant and Equipment 7,694 Office Furniture and Equipment 177 Motor Vehicles 9,754 Total Depreciation 19,018

Amortisation Leasehold Improvements 532 Intangible Assets 1,735 Total Amortisation 2,267 Total Depreciation and Amortisation 21,285

NOTE 5: Cash and Cash Equivalents For the purpose of the Cash Flow Statement, cash assets includes cash on hand and in banks, and short-term deposits which are readily convertible to cash on hand, and are subject to an insignificant risk of change in value. 2009 $’000 Cash on Hand 65 Cash at Bank 14,202 Short Term Deposits 57,067 TOTAL CASH AND CASH EQUIVALENTS 71,334

NOTE 6: RECEIVABLES

2009 $’000 Current Contractual WorkCover 265 Sundry Debtors 1,560 Accrued Revenue 940 2,765 Statutory GST Receivable 2,476 Total Current Receivables 5,241

Non Current Statutory DHS -Long Service Leave 7,132 Total Non Current Receivables 7,132 TOTAL RECEIVABLES 12,373

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 97 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 7: Fees Receivable

2009 $’000 Current Patient Account* 11,841 Transport Accident Commission 5,448 WorkCover 1,459 Hospital Transfers 6,800 Public Duty 71 Total Current Fees Receivable 25,619

Less Provision for Doubtful Debts Patient Account* 6,537 Transport Accident Commission 1,424 WorkCover 271 Hospital Transfers 1,983 Public Duty 2 Total Provision for Doubtful Debts 10,217 Total Current Net Fees Receivable 15,402

* The ‘Patient Account’ category relates to fees receivable from patients who are not members of the Ambulance Service Victoria Membership Scheme and are not pensioners or health care card holders.

2009 $’000 (a) Movement in the Provision for Doubtful Debts Balance at Beginning of Year 0 Provision transferred as capital contributions 8,642 Amounts written off during the year (10,703) Amounts recovered during the Year 197 Increase recognised in allowance in operating statement 12,081 Balance at End of Year 10,217

(b) Aging Analysis of Receivables Please refer to note 18 for the aging analysis of receivables.

(c) Nature and Extent of Risk Arising from Receivables

Please refer to note 18 for the nature and extent of credit risk arising from receivables.

98 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 8: Other Financial Assets 2009 $’000 Current Available-for-Sale Fixed and Floating Rate Securities 1,898 Total Current Other Financial Assets 1,898

Non Current Available-for-Sale Fixed and Floating Rate Securities 7,589 Total Non Current Other Financial Assets 7,589 TOTAL OTHER FINANCIAL ASSETS 9,487 (a) Ageing Analysis of Other Financial Assets Please refer to Note 18 for the ageing analysis of other financial assets. (b) Nature and Extent of Risk Arising From Other Financial Assets Please refer to Note 18 for the nature and extent of credit risk arising from other financial assets. NOTE 9: Inventories 2009 $’000 Current First Aid Kits - at cost 29 Medical Supplies Held for Distribution -at cost 2,028 Motor Vehicle Parts - at cost 247 Radio Spares - at cost 115 Stationery - at cost 67 Cleaning - at cost 16 Other - at cost 62 TOTAL INVENTORIES 2,564

NOTE 10: NON-CURRENT ASSETS CLASSIFIED AS HELD FOR SALE 2009 $’000 Motor Vehicles 508 TOTAL NON-CURRENT ASSETS CLASSIFIED AS HELD FOR SALE 508

NOTE 11: PROPERTY, PLANT AND EQUIPMENT

2009 $’000 Land Freehold Land at Cost 549 Freehold Land at Valuation 17,830 Crown Land at Valuation 32,628 Total Land 51,007

Buildings Buildings under Construction 3,881

Buildings at Cost 906 Buildings at Valuation 63,357 Less Accumulated Depreciation (228) Total Buildings 67,916

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 99 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 11: PROPERTY, PLANT AND EQUIPMENT (Continued)

2009 $’000 Leasehold Improvements Leasehold Improvements under Construction 87

Leasehold Improvements at Valuation 24,804 Less Accumulated Depreciation (1,915) Total Leasehold Improvements 22,976

Plant and Equipment Plant and Equipment under Construction 1,283

Plant and Equipment at Fair Value 65,161 Less Accumulated Depreciation (36,366) Total Plant and Equipment 30,078

Office Furniture and Equipment Office Furniture and Equipment under Construction 49

Office Furniture and Equipment at Fair Value 2,051 Less Accumulated Depreciation (750) Total Office Furniture and Equipment 1,350

Motor Vehicles Motor Vehicles under Construction 5,764

Motor Vehicles at Fair Value 79,261 Less Accumulated Depreciation (31,607) Total Motor Vehicles 53,418

TOTAL PROPERTY, PLANT AND EQUIPMENT 226,745

Reconciliations of the carrying amounts of each class of asset at the beginning and end of the previous and current financial year are set out below: Leasehold Plant Office Motor Land Buildings Improve- and Furniture & Total Vehicles ments Equipment Equipment $’000 $’000 $’000 $’000 $’000 $’000 $’000 Total Assets transferred at beginning of financial year 52,127 62,756 2,843 29,457 930 47,676 195,789 Additions 918 6,835 13,406 8,417 608 19,530 49,714 Disposals (57) (177) 0 (102) (11) (3,526) (3,873) Classified as held for sale 0 0 0 0 0 (508) (508) Revaluation Increments/(Decrements) (1,981) 6,210 944 0 0 0 5,173 Net transfers between classes 0 (6,315) 6,315 0 0 0 0 Depreciation and Amortisation (Refer Note 4) 0 (1,393) (532) (7,694) (177) (9,754) (19,550) Balance at 30 June 2009 51,007 67,916 22,976 30,078 1,350 53,418 226,745

100 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 11: PROPERTY, PLANT AND EQUIPMENT (Continued)

Land and buildings carried at valuation An independent valuation of AV’s land and buildings was performed by the Valuer-General Victoria to determine the fair value of this class of assets. The valuation, which conforms to Australian Valuation Standards, was determined by reference to the amounts for which assets could be exchanged between knowledgeable willing parties in an arm’s length transaction. The valuation was based on independent assessments. The effective date of the valuation is 30 June 2009. Plant and Equipment, Office Furniture and Equipment and Motor Vehicles carried at valuation In accordance with FRD 103D, AV’s non-current physical assets (excluding land and buildings) were subjected to a detailed managerial valuation in the current financial year. NOTE 12: INTANGIBLE ASSETS

2009 $’000 Software Development Costs Capitalised 8,885 Less Accumulated Amortisation (4,097) Total Written Down Value 4,788

Reconciliation of the carrying amounts of intangible assets at the beginning and end of the current financial year is set out below: Development Costs Total $’000 $’000 Balance at 1 July 2008 0 0 Assets transferred as capital contributions 5,546 5,546 Additions 977 977 Amortisation (Refer Note 4) (1,735) (1,735) Balance at 30 June 2009 4,788 4,788

NOTE 13: PAYABLES

2009 $’000 Current Contractual Trade Creditors 4,197 Accrued Expenses 19,789 Other Creditors 28 TOTAL PAYABLES 24,014

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 101 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 14: Employee Benefits

2009 $’000 Current Provisions Employee Benefits Unconditional and expected to be settled within 12 months (nominal value) 42,756 Unconditional and expected to be settled after 12 months (present value) 33,322 76,078 Provisions related to employee benefit on-costs Unconditional and expected to be settled within 12 months (nominal value) 7,111 Unconditional and expected to be settled after 12 months (present value) 6,596 13,707 Total Current Provisions 89,785

Non-Current Provisions Employee Benefits (present value) 7,283 Provisions related to employee benefit on-costs (present value) 3,332 Total Non-Current Provisions 10,615

Current Employee Benefits Unconditional LSL entitlements 41,999 Annual leave entitlements 20,626 Accrued Salaries & Wages 8,041 Accrued Days Off 7,368 Accrued Time-bank 357 Non-Current Employee Benefits Conditional LSL entitlements (present value) 7,284 Total Employee Benefits 85,675 On-Costs Current On-Costs 11,393 Non-Current On-Costs 3,332 Total On-Costs 14,725 Total Employee Benefits and Related On-Costs 100,400

Movement in Long Service Leave: Employee Benefits transferred as capital contributions 55,011 Provision made during the year 6,723 Settlement made during the year (2,303) Balance at end of year 59,431

NOTE 15: PREPAID INCOME

2009 $’000 Current Prepaid Membership Revenue 46,944 Total Current Prepaid Income 46,944

Non Current Prepaid Membership Revenue 11,890 Total Non-Current Prepaid Income 11,890 TOTAL PREPAID INCOME 58,834

102 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 16: EQUITY

2009 $’000 (a) Reserves Property, Plant and Equipment Revaluation Reserve (1) Revaluation Increments -Buildings 6,210 -Leasehold Improvements 944 Balance at the end of the Reporting Period* 7,154

Financial Assets Available-for-Sale Revaluation Reserve (2) Valuation gain recognised in Equity 518 Balance at the end of the Reporting Date 518

TOTAL RESERVES 7,672

Restricted specific purpose funds held represent funds held for Motor Vehicle Development, Motor Vehicle Replacement, Long Service Leave, Properties and Branch Auxiliaries. (1) The property, plant and equipment revaluation reserve arises on the revaluation of property, plant and equipment. (2) The financial assets available-for-sale revaluation reserve arises on the revaluation of available for sale financial assets. Where a revalued financial asset is sold, that portion of the reserve which relates to the financial asset, and is effectively realised, is recognised in the operating statement. Where a revalued financial asset is impaired, that portion of the reserve which relates to the financial asset is recognised in the operating statement.

(b) Contributed Capital Capital Contributions Received from Victorian Government 157,700 Balance at the end of the Reporting Period 157,700

(c) Accumulated Surplus/(Deficit) Net Result for the Year (678) Balance at the end of the Reporting Date (678)

(d) Total Equity at End of Financial Year 164,694

Ambulance Victoria was created under section 23(1)(a) of the Ambulance Services Act 1986 (“the Act”). In accordance with section 23(1)(g) of the Act, Metropolitan Ambulance Service, Rural Ambulance Victoria and Alexandra District Ambulance Service were abolished and all assets, powers, works, rights, liabilities and obligations immediately before their abolition were vested in Ambulance Victoria on 1 July 2008. In accordance with section 23(1)(k) of the Act, the contributed capital of Ambulance Victoria on 1 July 2008 ($153.5m) was equal to the sum of the assets and liabilities vested in Ambulance Victoria under section 23(1 )(g) of the Act.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 103 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 16: EQUITY (CONTINUED) The Balance Sheet on creation of Ambulance Victoria as at 1 July 2008 is as follows: 1 July 2008 $’000 Current Assets Cash and Cash Equivalents 41,225 Receivables 8,529 Fees Receivable 15,749 Other Financial Assets 36,292 Inventories 1,759 Prepayments 1,003 Non-Current Assets Classified as Held for Sale 66 Total Current Assets 104,623

Non-Current Assets Other Financial Assets 16,823 Receivables 6,044 Property, Plant and Equipment 191,569 Intangible Assets 5,546 Investment Property 35 Total Non-Current Assets 220,017 TOTAL ASSETS 324,640

Current Liabilities Payables 22,770 Provisions 82,313 Prepaid Income 44,892 Total Current Liabilities 149,975

Non-Current Liabilities Provisions 9,256 Prepaid Income 13,097 Total Non-Current Liabilities 22,353 TOTAL LIABILITIES 172,328 NET ASSETS 152,312

Plus: Assets Not Previously Recognised -Land and Buildings 4,185 -Cash and Cash Equivalents Held by AV Auxiliaries 1,203 TOTAL ASSETS NOT PREVIOUSLY RECOGNISED 5,388 ADJUSTED CONTRIBUTED CAPITAL 157,700

104 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 17: RECONCILIATION OF NET RESULT FOR THE YEAR TO NET CASH INFLOW/(OUTFLOW) FROM OPERATING ACTIVITIES

2009 $’000 Net Result For The Year (678)

Depreciation and Amortisation 21,285 Indirect Capital Contributions (148) Revaluation Decrement on Non-Current Assets 1,980 Net Loss from Sale of Property, Plant and Equipment 414 Change in Operating Assets and Liabilities Increase in Provision for Doubtful Debts 1,575 Decrease in Receivables 2,200 Increase in Fees Receivable (1,228) Increase in Inventories (805) Increase in Prepayments (3,738) Decrease in Payables (898) Increase in Accrued Expenses 2,142 Increase in Employee Benefits 8,832 Increase in Prepaid Income 845 Net Cash Flows From Operating Activities 31,778

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 105 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 18: fINANCIAL INSTRUMENTS

(a) Financial Risk Management Objectives and Policies AV’s principal financial instruments comprise of: • Cash Assets • Term Deposits • Receivables (excluding statutory receivables) • Investment in Equities and Managed Investment Schemes • Payables (excluding statutory payables)

Details of the significant accounting policies and methods adopted, including the criteria for recognition, the basis of measurement and the basis on which income and expenses are recognised, in respect of each class of financial asset, financial liability and equity instrument are disclosed in Note 1 to the financial statements. The main purpose in holding financial instruments is to prudentially manage AV’s financial risks within the government policy parameters. Categorisation of Financial Instruments Details of each category in accordance with AASB 139, shall be disclosed either on the face of the balance sheet or in the notes. Carrying Amount 2009 $’000 Financial Assets Cash and cash equivalents 71,334 Receivables 18,167 Available for sale 9,487 Total Financial Assets (i) 98,988

Financial Liabilities Payables 24,014 Total Financial Liabilities (ii) 24,014

(i) The total amount of financial assets disclosed excludes statutory receivables (i.e. GST input tax credit recoverable) (ii) The total amount of financial liabilities disclosed excludes statutory payables (i.e. taxes payable) Carrying Amount 2009 $’000 Financial Assets Cash and cash equivalents (i) 0 Receivables (i) 0 Available for sale (i) 1,846 Total Financial Assets (i) 1,846

Financial Liabilities Payables 0 Total Financial Liabilities (ii) 0

(i) For cash and cash equivalents, receivables and available-for-sale financial assets, the net gain or loss is calculated by taking the interest revenue, plus or minus foreign exchange gains or losses arising from revaluation of the financial assets, and minus any impairment recognised in the net result. (ii) For financial assets and liabilities that are held-for-trading or designated at fair value through profit or loss, the net gain or loss is calculated by taking the movement in the fair value of the financial asset or liability.

106 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 18: Financial Instruments (continued)

(b) Credit Risk Credit risk represents the loss that would be recognised if counterparties fail to meet their obligations under the retrospective contracts at maturity. The credit risk on financial assets of AV has been recognised on the Balance Sheet as the carrying amount, net of any provision for doubtful debts. Credit risk is minimised as transactions are undertaken with a large number of consumers. AV is not materially exposed to any individual debtor. AV’s exposure to credit risk and effective weighted average interest rate by ageing periods is set out in the following table. For interest rates applicable to each class of asset, refer to individual notes to the financial statements. Ageing analysis of financial asset as at 30 June 2009 Past Due But Not Impaired Carrying Not Past Less than 1-3 months 3 months 1-5 Years Impaired Amount Due and 1 month - 1 Year Financial Not Assets Impaired

2009 $’000 $’000 $’000 $’000 $’000 $’000 $’000 Financial Assets Cash and Cash Equivalents: 71,334 71,334

Loans and Receivables WorkCover 265 265 Sundry Debtors 1,560 921 214 354 71 Accrued Revenue 940 940 Patient Account 5,304 959 1,092 1,615 1,638 Transport Accident Commission 4,024 1,819 1,038 546 621 WorkCover Transports 1,188 416 288 230 254 Hospital Transports 4,817 1,691 1,402 1,043 681 Public Duty 69 19 25 22 3

Other Financial Assets Available for Sale Fixed and Floating Rate Securities 9,487 9,487

Total Financial Assets 98,988 78,364 4,059 3,810 3,268 0 9,487

Ageing analysis of financial assets excludes all types of statutory financial assets (i.e. GST input tax credit)

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 107 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 18: Financial Instruments (continued)

(c) Liquidity Risk The following table discloses the contractual maturity analysis for AV’s financial liabilities. For interest rates applicable to each class of liability, refer to individual notes to the financial statements. Maturity analysis of financial liabilities as at 30 June 2009 Maturity Dates Carrying Contractual Less than 3 months - 1 -3 months Over 5 Years Amount Cash Flows 1 month 1 year $’000 $’000 2009 $’000 $’000 $’000 $’000 Financial Liabilities Payables Trade Creditors 4,197 4,197 4,197 Accrued Expenses 19,789 19,789 19,789 Other creditors 28 28 28 Total Financial Liabilities 24,014 24,014 24,014 0 0 0

Ageing analysis of financial liabilities excludes all types of statutory financial liabilities (i.e. GST input tax payable) (d) Market Risk AV’s exposures to market risk are primarily through interest rate risk with only insignificant exposure to foreign currency and other price risks. Objectives, policies and processes used to manage each of these risks are disclosed in the paragraph below. Currency Risk AV is exposed to insignificant foreign currency risk through its payables relating to purchases or supplies and consumables from overseas. This is because of a limited amount of purchases denominated in foreign currencies and a short timeframe between commitment and settlement. Interest Rate Risk AV’s exposure to interest rate risk arises predominantly from assets and liabilities bearing variable interest rates. Minimisation of risk is achieved by mainly undertaking fixed rate or non-interest bearing financial instruments. Interest rate exposure of financial assets and liabilities as at 30 June 2009

Interest Rate Exposure Weighted Carrying Fixed Floating Non Average Amount Interest Interest Interest Effective Rate Rate Bearing Interest 2009 Rates (%) $’000 $’000 $’000 $’000 Financial Assets Cash and Cash Equivalents (i) Cash on Hand 65 65 Cash at Bank 0.41 14,202 14,202 Short Term Deposits 3.31 57,067 57,067 Receivables 18,167 18,167 Available for Sale 3.82 9,487 800 8,687 98,988 57,867 22,889 18,232 Financial Liabilities Payables (i) 24,014 24,014 24,014 0 0 24,014

(i) The carrying amount excludes all types of statutory financial assets and liabilities (i.e. GST input tax credit and GST payable).

108 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 18: Financial Instruments (continued)

Sensitivity Disclosure Analysis Taking into account past performance, future expectations, economic forecasts and management’s knowledge and experience of the financial markets, AV believes the following movements are ‘reasonably possible’ over the next 12 months (base rates are sourced from the Reserve Bank of Australia). - A parallel shift of + I% and - 1% in market interest rates (AUD) from year end rates of 3% - A parallel shift of + 1% and -1% in inflation rates from year end rates of 1.5% The following table discloses the impact on net operating result and equity for each category of financial instrument held by AV at year end as presented to key management personnel, if changes in the relevant risk occur.

Interest Rate Risk -1% +1% Carrying Profit Equity Profit Equity Amount 2009 $’000 $’000 $’000 $’000 $’000 Financial Assets Cash and Cash Equivalents (i) Cash on Hand 65 Cash at Bank 14,202 (142) (142) 142 142 Short Term Deposits 57,067 Receivables 18,167 Available for Sale 9,487 (87) (87) 87 87 Financial Liabilities Payables 24,014 (229) (229) 229 229

The carrying amount excludes all types of statutory financial assets and liabilities (i.e. GST input tax credit and GST payable). Impairment As at 30 June 2009, CDO’s with a cost of $10.641 m were valued at $8.277m. The valuation was based on the best available advice of market value. While a level of protection is available for the CDO’s, a conservative approach was taken and the impairment in the CDO’s value of S2.364m was recognised in the Operating Statement.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 109 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 19: COMMITMENTS FOR EXPENDITURE 2009 $’000 Capital Expenditure Commitments Payable: Land and Buildings 14,027 Motor Vehicle Replacement 2,712 Equipment & Technology Purchases 139 Total Capital Commitments 16,878

Not Later than One Year 16,878 Total 16,878

Other Expenditure Commitments Payable: Fleet Management and Maintenance Services 167 RAVNet Services 440 Transport Services 117,478 Membership Services 5,572 Metro Mobile Radio/Mobile Data Network 20,364 Other Services 1,774 Total Expenditure Commitments 145,795

Not Later than One Year 48,006 Later than One Year and Not Later than 5 Years 97,789 Total 145,795

Lease Commitments Commitments in relation to leases contracted for at the reporting date: Operating Leases 63,800 Total Lease Commitments 63,800

Operating Leases Non-Cancellable Not Later than One Year 5,257 Later than One Year and Not Later than 5 Years 21,213 Later than 5 Years 37,330 Total 63,800

Total Commitments for expenditure (inclusive of GST) 226,473 Less GST recoverable from the Australian Taxation Office (20,588) Total Commitments for expenditure (exclusive of GST) 205,885

NOTE 20: CONTINGENT ASSETS AND CONTINGENT LIABILITIES AV is currently negotiating an Enterprise Bargaining Agreement with the AEA-V. An in principle agreement has been reached which will be voted on by members of the AEA-V by the end of October 2009. This is likely to result in a liability to AV which is not yet quantifiable. A portion of this liability will be offset by Government funding.

110 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 21a: RESPONSIBLE PERSONS DISCLOSURES In accordance with the Ministerial Directions issued by the Minister for Finance under the Financial Management Act 1994, the following disclosures are made regarding responsible persons for the reporting period. Period Responsible Ministers The Honourable Daniel Andrews, MLA, Minister for Health 1 July 2008 to 30 June 2009

Governing Board Members Ms Marika McMahon ( Chair) 1 July 2008 to 30 June 2009 Mr John Frame 1 July 2008 to 30 June 2009 Ms Rhonda Whitfield 1 July 2008 to 30 June 2009 Ms Jan Moffatt 1 July 2008 to 30 June 2009 Mr Kevin Boote 1 July 2008 to 30 June 2009 Ms Rosalyn Buchanan 1 July 2008 to 14 April 2009 Ms Alison Teese 1 July 2008 to 30 June 2009 Mr George Braitberg 1 July 2008 to 30 June 2009 Ms Jean Sutherland 1 July 2008 to 30 June 2009 Mr Leigh Hocking (Delegate) 1 July 2008 to 30 June 2009

Accountable Officer Greg Sassella 1 July 2008 to 30 June 2009

2009 Remuneration of Responsible Persons No. The number of Responsible Persons are shown below in their relevant income bands: Income Band $0-$9,999 1 $20,000-$29,999 7 $30,000-$39,999 1 $50,000-$59,999 1 $350,000-$359,999 1 Total Numbers 11

$’000’s Total Remuneration Received or Due and Receivable by Responsible Persons from Ambulance Victoria amounted to: 1,924

Amounts relating to Responsible Ministers are reported in the financial statements of the Department of Premier and Cabinet.

2009 Other Transactions of Responsible Persons and their Related Parties $’000 Bendigo Health Care Group Ms Marika McMahon, Chair, is also the Chair of Bendigo Health Care Group, which provides services to AV on normal terms and conditions. Bendigo Health Care Group provides linen services to AV. Total payable and payments for the financial year were: 190 Total receivable and receipts from Bendigo Health Care Group for ambulance services for the financial year were: 454

Barwon Health Mr John Frame, Director, is also a Director of Barwon Health, which provides services to AV on normal terms and conditions. Barwon Health provides linen services to AV. Total payable and payments for the financial year were: 676 Total receivable and receipts from Barwon Health for ambulance services for the financial year were: 523

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 111 Ambulance Victoria Notes to the Financial Statements for the year ended 30 June 2009

NOTE 21b: EXECUTIVE OFFICER DISCLOSURES Executive Officers’ Remuneration The number of Executive Officers, other than Ministers and Accountable Officers, and their total remuneration during the reporting period is shown in the first column in the table below in their relevant income bands. The base remuneration of Executive Officers, which now reflects AV’s classification as a Level 1 organisation within the Health sector, is shown in the second column. Base remuneration is exclusive of bonus payments, long service leave payments, redundancy payments and retirement benefits.

Total remuneration Base remuneration 2009 2009 No. No. $130,000 - $139,999 1 1 $140,000 - $149,999 2 2 $160,000 - $169,999 0 2 $170,000 - $179,999 2 4 $180,000 - $189,999 3 2 $190,000 - $199,999 3 0 Total Numbers 11 11 $ 1,924,000 $ 1,841,000

NOTE 22: EVENTS OCCURRING AFTER THE BALANCE SHEET DATE No transactions have occurred subsequent to the reporting date which would render any of the details in these accounts misleading or inaccurate. NOTE 23: ECONOMIC DEPENDENCY AV is dependent on the Department of Health for a significant portion of its revenue. The Department of Health has provided confirmation that it will continue to provide AV adequate cash flow support to meet its current and future obligations as and when they fall due for a period up to September 2010.

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AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 113 114 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Appendices

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 115 Appendix A: Statement of Priorities 2008–2009

Status at 30th June 2009

Strategic Priorities

S trategic Priority Deliverables Due Date Status Increase road response State-wide recruitment of 358 graduate Jun ‘09 Recruitment resources to meet and student paramedics and additional Actual recruitment as of Jun ’09 is 334. expected growth in resources established as follows: Metropolitan resources demand Metropolitan resources 1. 20 new AP teams now operational (12 PPU & 1. New Ambulance Paramedic units 8 x 24-hour). 2 existing PPUs converted to including 8 24-hour teams, 12 Peak 24-hour operation. Period Units and 2 existing PPUs converted to 24-hour operation 2. Implementation of MICA restructure rescheduled for 2009/2010 2. Restructure of MICA road response, Rural resources converting the existing 16 MICA units and 4 single responders to 8 MICA 1a) Colac: 24-hour roster implemented. units, 4 MICA Peak Period Units and All 5 vacancies filled 14 MICA single responders 1b) Gisborne: New roster implemented. Rural resources All 4 vacancies filled 1. Additional Ambulance Paramedic 1c) Kilmore: 4 of the 6 vacancies filled crews at 5 locations 1d) Woodend: 3 of 4 vacancies filled 2. Additional Ambulance Paramedics to 1e) Kyneton: All 4 vacancies filled work with ACOs at 4 locations 2. All vacancies filled at Anglesea, Apollo Bay, 3. 2 day crews operating in Alexandra Timboon and Mirboo South 4. 4 new MICA single responders 3. 5 positions filled in Alexandra 4. MICA implementation dependent on EBA progress Expand air ambulance 1. Retrieval helicopter (HEMS 5) Mar ‘09 1. HEMS 5 commenced 16 Mar ‘09. services operational at Essendon Airport 2. Building works and recruitment Jul ‘09 2 HEMS 4 commenced 1 Jul ‘09 completed and helicopter service agreement in place for Warrnambool helicopter (HEMS 4) Ensure appropriate Integrated AAV facility at Essendon Feb ‘09 Facility completed and operations commenced facilities available for completed from the new site on 10 Feb ‘09. efficient air service delivery Improve the quality VACIS implemented in all regional May ‘09 Completed. VACIS now fully operational in all and extent of clinical career paramedic branches regional career paramedic branches. data Provide reliable and Completion of full transition to Telstra Jun ‘09 Complete sustainable radio supported, state-wide rural radio communications across network (RAVNet) the state Develop an integrated 1. Integration of key business systems Jun ‘09 1. Organisational integration is progressing state-wide service and processes commenced well. Key integration milestones achieved in 2 New organisational structure 2008/09 include: implemented • all organisational governance processes • integration of the General Ledger and establishment of a common Chart of Accounts • planning systems and KPIs • high priority operational policies & procedures 2. New organisation-wide management structure approved by Board and implementation progressing

116 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Performance priorities

2008/2009 2008/2009 Target Actual YTD Timely Response Proportion of emergency (Code 1) incidents responded to within 15 minutes 85% 82.51 Proportion of emergency (Code 1) incidents responded to within 15 minutes in centres 90% 88.21 with more than 7,500 population CERT Arrivals prior to ambulance where CERT is dispatched 85% 82.1% Quality and safety Accreditation Status Full Full Audited emergency cases meeting clinical practice standards 95% 98.3% Audited non-emergency cases meeting clinical practice standards 94% 98.1% Audited CERT attended cases meeting clinical practice standards 85% 98.7% Proportion of patients experiencing severe cardiac and traumatic pain whose level of pain is 90% 87.7% reduced significantly2 Percentage of adult VF/VT cardiac arrest patients with vital signs at hospital3 44% 51.2% Percentage of adult VF/VT cardiac arrest patients surviving to hospital discharge3 18% 23.0% Activity Total number of metro emergency road cases 319,000 312,924 Total number of rural emergency road cases4 127,000 120,625 Total number of metro non-emergency road cases 222,800 220,210 Total number of rural non-emergency road cases4 55,000 60,603 Total number of Statewide emergency air cases 2,500 2,488 Total number of Statewide non-emergency air cases 4,100 4,041 Total number of pensioner & concession card holder emergency cases 204,600 208,747 Total number of pensioner & concession card holder non-emergency cases 181,100 173,999 Percentage of 000 callers receiving health advice or service from another health provider 6.0% 7.2% as an alternative to emergency ambulance response

1. Based on Computer Aided Dispatch system data for Metropolitan and Patient Care Record data for Rural 2. Adult patients (16 or older) with an initial pain score greater than 7 and a reduction in score of 2 or more 3. Cardiac arrests excluding those witnessed by a paramedic occurring in patients 16 years or older where resuscitation is attempted and the arrest rhythm on first ECG assessment was either Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) 4. Counting method updated for AV-wide consistency, and differs from the 2008–2009 reporting to DHS and previous RAV reporting

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 117 Appendix B: Statistical and Financial Summary

Statistical Summary 2008–20091

2008-2009 2007-2008 2006-2007 2005-2006 2004-2005

Road Incidents (Metropolitan region) Emergency Operations Code 1 169,259 167,447 179,686 166,040 154,183 Code 2 102,890 103,279 95,338 84,916 79,808 Code 3 40,775 38,778 23,525 22,428 19,630 Total Emergency Road Incidents 312,924 309,504 298,549 273,384 253,621 Non-Emergency Operations (Code 3) 3rd Party Stretcher Services 145,699 143,041 136,592 134,144 123,076 Clinic Transport Services 74,511 69,955 73,206 67,355 55,429 Total Non-Emergency Road Incidents 220,210 212,996 209,798 201,499 178,505 Total Metropolitan Road Incidents 533,134 522,500 508,347 474,883 432,126

Road Incidents (Rural regions) Code 1 70,612 60,185 52,760 52,644 49,259 Code 2 50,013 58,493 60,851 54,391 49,355 Code 3 42,124 39,837 35,508 35,816 32,303 3rd Party (Code 3) 18,479 21,220 16,925 13,110 14,453 Total Rural Road Incidents 181,228 179,735 166,044 155,961 145,370

Road Incidents (all regions) Code 1 239,871 227,632 232,446 218,684 203,442 Code 2 152,903 161,772 156,189 139,307 129,163 Code 3 321,588 312,831 285,756 272,853 244,891 Total Road Incidents 714,362 702,235 674,391 630,844 577,496

Air Incidents (all regions) Fixed Wing - Emergency 729 684 660 673 675 Fixed Wing - Non-Emergency 4,041 3,734 3,884 4,092 3,533 Total Fixed Wing Incidents 4,770 4,418 4,544 4,765 4,208 Helicopters2 HEMS 1 (Essendon) 674 707 769 868 904 HEMS 2 (Latrobe Valley) 491 452 450 471 477 HEMS 3 (Bendigo) 432 437 423 460 432 HEMS 5 (Retrieval)3 136 Docklands4 26 54 39 Total Helicopter Incidents (all Emergency) 1,759 1,650 1,681 1,799 1,813 Emergency Air Incidents 2,488 2,334 2,341 2,472 2,488 Non Emergency Air Incidents 4,041 3,734 3,884 4,092 3,533 Total Air Incidents 6,529 6,068 6,225 6,564 6,021

118 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Statistical Summary 2008–2009 continued

2008-2009 2007-2008 2006-2007 2005-2006 2004-2005

Adult Retrievals5 Road retrievals - paramedic only 457 Road retrievals - doctor & paramedic 160 Total road retrievals 617 Air retrievals - paramedic only 794 Air retrievals - doctor & paramedic 173 Total air retrievals 967 Total adult retrievals 1,584

Code 1 Road Response Time6 Percentage of responses within 15 minutes Victoria all regions 82.5% 81.9% 84.8% 87.1% 87.7% Centres7 with population > 7,500 88.2% 87.5% n/a n/a n/a

Patients Transported Road Transports (Metropolitan region) Emergency Operations 228,066 225,522 217,066 202,143 184,633 Non-Emergency Operations Stretcher 138,131 138,969 132,883 130,341 120,098 Total Stretcher 366,197 364,491 349,949 332,484 304,731 Non-Emergency Clinic Transport Services 70,470 66,184 69,368 63,826 53,085 Total Metropolitan region 436,667 430,675 419,317 396,310 357,816 Road Transports (Rural regions) Total Rural regions 150,738 150,494 139,894 131,298 122,716 Total Patients Transported by Road 587,405 581,169 559,211 527,608 480,532

Air Transports (all regions) Fixed Wing transports 4,606 4,194 4,432 4,628 4,188 Helicopters2 HEMS 1 (Essendon) 488 510 557 573 595 HEMS 2 (Latrobe Valley) 394 354 352 366 361 HEMS 3 (Bendigo) 369 326 330 332 323 HEMS 5 (Retrieval)3 117 Docklands4 19 50 35 Total Helicopter transports 1,387 1,240 1,274 1,271 1,279 Total Air Transports 5,993 5,434 5,706 5,899 5,467

Total Patient Transports 593,398 586,603 564,917 533,507 485,999

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 119 Appendix B: Statistical and Financial Summary continued

Statistical Summary 2008–2009 continued

2008-2009 2007-2008 2006-2007 2005-2006 2004-2005

Road Patients Transported – Charging Categories8 Compensable Transports Veterans' Affairs 54,418 56,019 55,867 50,366 47,735 Transport Accident Commission 12,198 11,940 11,792 13,638 13,576 Workcover 4,290 4,658 4,601 4,454 4,385 Hospital Transfers 25,194 24,368 20,815 19,648 17,628 Ordinary 49,230 45,674 41,360 36,644 35,517 Subscriber 88,045 85,533 79,618 73,685 66,196 Total Compensable Road Transports 233,374 228,191 214,053 198,435 185,037 Community Service Obligation Road Transports 354,031 352,978 345,158 329,173 295,494 Total Patients Transported by Road 587,405 581,169 559,211 527,608 480,532

Road Patients Transported – Kilometres Travelled (Rural)9 Code 1 2,408,085 1,861,794 1,618,892 1,531,514 1,383,276 Code 2 1,795,814 1,946,034 2,038,128 1,944,301 1,748,696 Code 3 6,238,226 6,038,303 5,250,177 4,954,518 4,865,731 Total Kilometres (Rural regions) 10,442,125 9,846,131 8,907,197 8,430,333 7,997,703

Referral Service (Metropolitan region)10 Calls Managed 33,034 30,249 26,528 20,942 11,300 Referrals (no emergency dispatch required) 24,145 20,808 18,516 13,498 7,193

NOTES 1. AV commenced operations on 1 July 2008. Data prior to 2008/2009 are aggregated Metropolitan Ambulance Service and Rural Ambulance Service data. Some data published in previous MAS and RAV Annual Reports have been updated and it has been necessary to estimate some data due to differences in MAS and RAV data definitions and collection. Data reported to DHS in 2008–2009 was based on previous definitions. 2. The HEMS 4 helicopter based in Warrnambool commenced operation in 1 July 2009. 3. The HEMS 5 retrieval helicopter based at Essendon Airport commenced operations on 16 March 2009. 4. AV assumed responsibility for the Docklands paediatric retrieval helicopter in July 2006; this helicopter ceased operations on 16 March 2009. 5. AV assumed responsibility for Adult Retrieval Services in November 2007. Note that all retrievals also appear as either a road or an air incident. 6. Metropolitan response time reporting from 2007/2008 is based on data sourced from the computer aided dispatch system. Earlier metropolitan and all rural response times are sourced from patient care records completed by paramedics. 7. Based on the Australian Bureau of Statistics Urban Centre Location boundaries and population. 8. The charge class assigned to patients transported is subject to change during the period when an account is being finalised, and significant movements between charge classes occur over a period of approximately four months from the time of the transport. 9. Metropolitan region data are not available. 10. The Referral Service commenced operations in September 2003. Referrals are not included in road or air incidents or transports.

120 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Statistical Summary 2008–2009 continued

DEINITIF ONS Incident: An event to which one or more ambulances are dispatched. Emergency: An incident to which one or more ambulances are dispatched in response to a ‘000’ call from a member of the public, or a medical request for transport requiring an emergency ambulance (due to patient acuity or transport timeframe). Dispatch Codes: Code 1 incidents are time critical (proceed with lights and sirens); Code 2 incidents are acute, but not time critical (without warning devices); Code 3 incidents are not urgent. Non-Emergency: Request for patient transport where patient has been medically assessed and the transport is medically authorised; covered by the NEPT regulations and usually pre-booked. Compensable: Not funded by DHS - patient or third party (e.g. hospital, DVA, WC, TAC, MSS) responsible for fee. Community Service Obligation: Funded by DHS - Pensioner or Health Care Card Holder exempt from fee. Retrieval: Coordinated interhospital transfer of a patient, who has a critical care or time critical healthcare need, which is unable to be met at the original health service. Retrieval services are provided by specialised clinical crews with advanced training in transport, retrieval and critical care medicine, operating within a structured system which ensures governance & standards. Referral Service: The Referral Service provides additional triaging of lower priority calls to 000 by a health professional; suitable calls are referred to other service providers as an alternative to an emergency ambulance dispatch. Referral options include locum general practitioners, nursing service, hospital response teams and non-emergency ambulance transport.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 121 Appendix B: Statistical and Financial Summary continued

Summary of Financial Results

In its first year as an integrated new entity, AV recorded a reportable net deficit for 2008-2009 of $0.678 million. Government contributions for the year amounted to $316.077 million, which was 62 per cent of AV’s total revenue source. These government contributions included capital and one-off funds received from the Department of Human Services ($40.333m) and specific-purpose funds from the Department of Justice ($8.780m). Transport revenue was $90.667 million, representing 18 per cent of AV’s total revenue. This revenue included chargeable transports only and excludes community service obligations, such as pensioners and health care card holders. Membership Scheme revenue was $85.460 million, which was 17 per cent of AV’s total revenue. Statewide membership numbers increased by 50,209, totalling 990,572 as at 30 June 2009. Revenue from other sources such as donations, bequests, interest, etc. amounted to $14.951 million, which made up the remaining 3 per cent of AV’s total revenue source. Total expenditure was $507.833 million, of which $395.274 million (78 per cent) related to Employee Benefits and Contractual obligations for outsourced service provision (for example, non-emergency services, Air Ambulance, and computer aided dispatch services). A further $68.016 million (13 per cent) related to medical supplies, vehicle and property maintenance, rental and occupancy costs, membership promotion and office and technical expenses. The balance of $44.543 million (9 per cent) included depreciation and amortisation, revaluation decrement, doubtful debts, first aid educational services, audit and other charges. AV has invested statewide on recruitment, technology enhancement and infrastructure expenditure to address growth in demand and maintain operational response times. In addition, the organisation has invested on integration costs, including the implementation of a new payroll/HR system, Oracle Financial system, quality system and accreditation, as well as integration of policies and procedures for both operational and administrative functions. AV’s first financial year results reflect an acceptable liquidity position, however, the organisation’s year-end cash balance includes funds committed for capital expenditures, specifically for rural property refurbishments; three-year and five-year Membership Scheme revenue received in advance; as well as funds reserved to meet future long service leave commitments. Bankers: Westpac Institutional Bank, Level 10, 360 Collins Street, Melbourne Vic 3000 Westpac Institutional Bank, 302 Sturt Street, Ballarat Vic 3350 Internal Auditors: Deloitte Touche Tohmatsu, QV 180 Lonsdale Street, Melbourne 3000; Pitcher Partners, Level 19, 15 William Street Melbourne 3000; Price WaterhouseCoopers, Freshwater Place, 2 Southbank Blvd, Southbank 3006 External Auditors: Auditor-General of Victoria, Victorian Auditor-General’s Office, Level 24, 35 Collins Street, Melbourne Vic 3000

122 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Summary of Financial Results

2008-09 $’000 Total Revenue 507,155 Total Expenses 507,833 Operating Surplus (678) Retained Surplus (678) Total Assets 347,942 Total Liabilities 183,248 Net Assets 164,694 Total Equity 164,694

Financial Indicators 2008-09 Current Assets Ratio 0.63 Debtors Turnover (Days) 63 Creditors Payable Turnover (Days) 35 Bad & Doubtful Debt Prov/YTD Billings Ratio 0.13 Cost Per Road Incident 638 Liability Ratio 0.53 Asset Turnover Ratio 1.50

Operating Revenue Sources 2008-09 Operating Expenses 2008-09

Government Grants 316,077 Operations 386,112 Service Fees 90,667 Administration 55,676 Memberships 85,460 Vehicle & Property Maintenance 21,511 Other 14,951 Other 11,186 Total 507,155 Depreciation 21,285 Bad & Doubtful Debts 12,063 Total 507,833

Employees 2008-09 Patients by account category 2008-09

Operational staff 2,059 Patients Operational MICA non-chargeable 405,068 paramedics 403 Patients chargeable 89,994 Operational Management Ambulance members 87,731 and support 276 Total 582,793 Management and Administration 321 Total 3,059

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 123 Appendix C: Statutory compliance

F reedom of Information

AV received 1311 requests under the Freedom of Information Internal reviews 2008-2009 Act 1982 in 2008-2009. This was made up of 852 personal Requests received 3 requests and 459 non-personal requests. Outcome of Internal Reviews Twenty requests were carried over from the previous financial year while 84 requests were pending as at 30 June 2009. Original decision confirmed 2 Full or partial access was granted in 1150 requests. Seven Original decision varied 1 requests were denied in full and 69 requests were for information not located on AV record-keeping systems. Freedom of Information Requests 2008-2009 The most common reason for AV seeking to fully or partially Requests received during the year 1311 exempt requested documents was the protection of personal Requests carried over from the previous year 20 privacy in relation to requests for information about persons Requests completed within the 1303 other than the applicant. statutory period Twenty-one requests were withdrawn or not proceeded with Requests transferred to another agency 0 by the applicant. Requests transferred from another agency 0 Most applications were received from lawyers, members of the Requests withdrawn or not proceeded with by 21 public and the Transport Accident Commission. the applicant Most applications were for access to patient care records by Access granted in full 1088 patients attended by AV, their legal or other representatives, or surviving next of kin. Access granted in part (exemptions claimed) 62 AV collected $23,417.20 in application fees and waived $6,342.50. Access refused in full (exemptions claimed) 7 AV fulfilled its obligations to protect patient and staff privacy Requests where no relevant documents could 69 be located and/or confidentiality Requests awaiting completion at the end 84 of the financial year

124 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT VIPP Contracts Consultancy fees

Under the Victorian Industry Participation Policy (VIPP) Act Fees 2003, AV is required to disclose whether it had any VIPP Incurred contracts during the year. 2008–2009 $’000 AV had three VIPP contracts that began in 2008-2009 with a total estimated contract value of $147.756 million, excluding Consultancies in excess of $100,000 GST (total estimated value over the contract life). Two of these Capital Foresight Pty Ltd - Property Portfolio 256 contracts were statewide and one was in the rural regions. Implementation Strategy There were two VIPP contracts that ceased during the year at a Valuer General - 219 total value of $64.108 million. Both contracts were statewide Valuation of Land and Buildings contracts. Grant Thornton Pty Ltd - Organisation 639 In accordance with Victorian Government Purchasing Board Structure and Financial Integration (VGPB) policies, the VIPP statements were not required to be Frontier Software Pty Ltd - 141 used as part of the evaluation process for these contracts as Payroll Implementation and Upgrade there were not two or more tender submissions of equal rating. Consultancies costing less than $100,000 44 consultancies were employed during 391 National Competition Policy 2008-2009 each valued at less than $100,000 TOTAL 1,646 AV complies, to the extent applicable, with the National Competition Policy. Building standards Purchasing In November 1994, the Minister for Finance issued guidelines All tender processes conformed to VGPB guidelines. Wherever pursuant to Section 220 of the Building Act 1993 to promote possible, whole of government and government endorsed conformity in building standards for buildings owned by supplier arrangements were utilised. public authorities. Major tender processes undertaken during the year included AV maintains a high level of compliance with building fleet management services, fuel provision services, medical standards and regulations. All works carried out during the oxygen and fixed-wing services. year were conducted in accordance with the Building Act and relevant building regulations.

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 125 Appendix C: Statutory compliance continued

Whistleblower disclosure Equal Employment Opportunity

The Whistleblowers’ Protection Act 2001 provides the legal Throughout the 2008-09 year there were a total of 12 framework within which disclosure can be made revealing complaints escalated to HR that warranted investigation. corrupt conduct, conduct involving a substantial Of these, one complaint was substantiated mismanagement of public resources or a substantial risk to public health and safety or the environment. Code of Conduct AV recognises the importance and value of accountability and transparency in its management and administrative practices AV employees are currently subject to the Code of Conduct and supports the making of these disclosures. The alleged for Victorian Public Sector Employees. conduct however must be proven to be serious enough to Previously, MAS and RAV had their own Codes of Conduct. constitute a criminal offence or reasonable grounds for The HR department is developing a new Code of Conduct dismissal to satisfy the Whistleblowers’ Protection Act 2001. policy and procedure for AV. A disclosure about improper conduct or detrimental action by AV or its employees may be made to AV contacts below or alternatively to the Ombudsman. Disability Action Plan AV Contact Person(s) Paul Bean AV is in the process of finalising its first Disability Action Plan Manager Professional Standards (DAP) using internal consultation and review processes, which 375 Manningham Road Doncaster Victoria 3108 will assist AV to improve its service delivery, communication Telephone: 03 9840 3635 and community engagement for people with disabilities, and Fax: 03 9840 3785 will help raise staff awareness and develop competencies in working with and serving people with disabilities. Tony Walker General Manager Regional Services AV recognises the number and diversity of people with 375 Manningham Road Doncaster Victoria 3108 disabilities in the community and within its own workforce. Telephone: 03 9840 3970 AV’s DAP will ensure that all policy, planning, information Fax: 03 9840 3709 and communication methods are inclusive of the rights of people with disabilities, and all employees understand and Mark Rogers respect the rights and needs of people with disabilities. General Manager Specialist Services 375 Manningham Road AV undertakes to support and resource the DAP, to Doncaster Victoria 3108 continuously review it and ensure it is as effective as possible. Telephone: 03 9840 3716 Progress on its implementation will be reported in future Fax: 03 9840 3709 annual reports. Alternative Contact: The Ombudsman Victoria Level 9, 459 Collins Street Melbourne Victoria 3000 Internet: www.ombudsman.vic.gov.au Telephone: 03 9613 6222 Toll Free: 1800 806 314 AV did not receive any disclosures under the Act during 2008–2009.

126 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT Appendix D: Disclosure index

The AV annual report is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identification of the Department’s compliance with statutory disclosure requirements..

Legislation Requirement Page Reference Ministerial Directions Report of Operations Charter and purpose FRD 22B Manner of establishment and the relevant Ministers 64 FRD 22B Objectives, functions, powers and duties 64 FRD 22B Nature and range of services provided 64 Management and structure FRD 22B Organisational structure 69 Financial and other information FRD 10 Disclosure index 127 FRD 11 Disclosure of ex-gratia payments 88 FRD 21A Responsible person and executive officer disclosures 64 FRD 22B Application and operation of Freedom of Information Act 1982 124 FRD 22B Application and operation of the Whistleblowers Protection Act 2001 126 FRD 22B Compliance with building and maintenance provisions of Building Act 1993 125 FRD 22B Details of consultancies over $100,000 125 FRD 22B Details of consultancies under $100,000 125 FRD 22B Major changes or factors affecting performance 118, 119, 120 FRD 22B Occupational health and safety 53 FRD 22B Operational and budgetary objectives and performance against objectives 122, 123 FRD 22B Significant changes in financial position during the year 122, 123 FRD 22B Statement of availability of other information 76 FRD 22B Statement of merit and equity 126 FRD 22B Statement on National Competition Policy 125 FRD 22B Subsequent events 112 FRD 22B Summary of the financial results for the year 122 FRD 22B Workforce Data Disclosures 19 FRD 25 Victorian Industry Participation Policy disclosures 125 SD 4.2(j) Report of Operations, Responsible Body Declaration 73 SD 4.5.5 Attestation on Compliance with Australian/New Zealand Risk Management Standard 72 Financial Statements Financial statements required under Part 7 of the FMA SD 4.2(a) Compliance with Australian accounting standards and other authoritative pronouncements 76 SD 4.2(b) Operating Statement 79 SD 4.2(b) Balance Sheet 80 SD 4.2(b) Statement of Changes in Equity 81 SD 4.2(b) Cash flow Statement 82 SD 4.2(c) Accountable officer’s declaration 76 SD 4.2(c) Compliance with Ministerial Directions 76 SD 4.2(d) Rounding of Amounts 84 Legislation Freedom of Information Act 1982 124 Whistleblowers Protection Act 2001 126 Victorian Industry Participation Policy Act 2003 125 Building Act 1993 125 Financial Management Act 1994 76

AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 127 Appendix E: Donations and bequests

AMBULANCE VICTORIA DONATIONS & BEQUESTS JULY 2008 - JUNE 2009 DONATIONS & BEQUESTS $1000 & OVER AV Amount $ ALMA SYLVIA & CARMEN FIGUEROLA TRUST 23,785.72 AMELIA ELIZA HOLLAND TRUST 4,626.47 ASU NATIONAL OFFICE 3,799.00 BERWICK OPPORTUNITY SHOP INC 5,000.00 BEVERLEY CARMAN - CAN DO AND MORE 7,000.00 BLANCHE CLARA COLLINGS 10,000.00 CARMELITE MONASTERY 1,000.00 COUNTRY WOMENS' ASSOCIATION - YEA BRANCH 2,800.00 DR RON CHRISTIE 1,000.00 EH & VM CAMERON 1,100.00 ESTATE OF CAROL HELEN BAUM 1,000.00 KAYNE PTY LTD 2,900.00 LEONGATHA RSL 6,500.00 LIONS CLUB OF PHILLIP ISLAND 1,000.00 LORD MAYORS CHARITABLE FUND 28,014.59 MALDON CERT 3,559.00 MOTORCYCLING VICTORIA 1,000.00 MOUNT HOTHAM SKIING COMPANY PTY LTD 1,000.00 MRS W D STEVENS 1,000.00 NANGILOC/COLIGNAN CERT 4,001.18 NEXUS SERVICE CLUB OF TERANG 1,980.00 PEOPLE SUPPORTING PEOPLE 15,992.00 PHILLIP ISLAND PATCHWORK & QUILTERS SOCIETY INC 1,000.00 PHILLIP ISLAND RSL SUB BRANCH 12,000.00 PLANET COMPUTER SERVICES 3,412.00 PLB LEASK 3,000.00 RITCHIES 3,310.93 ROTARY CLUB OF OCEAN GROVE 3,000.00 ST MARY'S SWAN HILL 1,116.00 STEPHEN CREESE 2,000.00 STILL & CO 40,000.00 THE ISLANDER CARAVAN PARK 1,500.00 TONGALA CERT 1,824.90 WARRAGUL AMBULANCE BRANCH SOCIAL CLUB 1,100.00 WATERFRONT COMPUTERS 1,805.00 TOTAL DONATIONS & BEQUESTS $1000 & OVER 203,126.79 DONATIONS & BEQUESTS UNDER $1000 561,854.79 TOTAL DONATIONS & BEQUESTS AS AT 30 JUNE 2009 764,981.58

128 AMBULANCE VICTORIA • 2008–2009 ANNUAL REPORT 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.

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 additional minute for ambulance helicopter services.

Publications and brochures The AV website at www.ambulance.vic.gov.au contains information about AV and is regularly updated with the latest in statistics, developments and media releases. AV also produces a range of publications and brochures which are available on request.

Printed in Australia on an environmentally sustainable paper. ce Vict l B A

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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