The Council of Ambulance Authorities
2009-2010 ANNUAL REPORT PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Contents
Chairman’s Introduction pg. 2
Council of Ambulance Authorities pg. 4
Executive Director’s Report pg. 7
CAA Committees and Working Groups pg. 9
2009 Conference Week pg. 13
Jurisdictional Reports pg. 19
Comparative Data 2009-10 pg. 62
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 1 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Chairman’s Introduction
I am pleased to present the Annual Report of the Council of Ambulance Authorities (CAA) for the 2009‐10 year.
The CAA has broadened relationships over the past year both nationally and internationally. A focus has been strengthening the linkages with the work being undertaken on health reforms across Australia and New Zealand while maintaining understandings of developments in Canada and the United Kingdom (UK). The ambulance sector is recognised as an essential component of reforms to improve the health care of communities in all these jurisdictions.
Shared knowledge and the ability to support other services in the event of major incidents has also been a priority during this year as has the role of paramedics as part of international responses to disaster and emergency situations in nearby countries. The CAA role within the Australian Health Protection Committee has been instrumental in development of enhanced capability of services to support communities in need nationally and internationally.
The accreditation of higher education paramedic programs continues to progress with the development of competency standards available to all participating higher education providers. Ultimately, this will provide for easier movement of paramedics across jurisdictions and all the benefits that flow from those movements.
For the first time the CAA Convention and Rural and Remote Symposium combined with the International Round Table of Community Paramedicine was held in Auckland, New Zealand. This resulted in excellent presentations from around the world as well as attendance by representatives from seven participating countries. The strengthening of our relationship with other services has proved valuable in encouraging innovative thinking and sharing of concepts, both those that have worked and those that have not; both are valuable to know.
The National Ambulance Awards program was again very successful in 2009‐10. Finalists attended the Awards dinner held at the Hilton Hotel in Auckland where the overall STAR Award was presented to David Godfrey‐Smith representing Ambulance Tasmania for the project to support the recruitment, retention and recognition of volunteers. The program has been developed by volunteers for volunteers. The Awards continue to stimulate a high level of enthusiasm and the range of innovative projects from the member jurisdictions has
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 2 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
led to improvements in providing ambulance services to the communities of Australia and New Zealand and it was particularly pleasing to see a volunteer receive this award.
On behalf of the CAA, I would like to thank all of the jurisdictional representatives who work so hard as members of CAA Board and Committees to continually progress the important work of the CAA. I would also like to thank the CAA Executive team who very capably support the Board and its Committees to ensure that the strategic direction of the CAA is achieved.
On behalf of the CAA ambulance jurisdictions, I commend to you the 2009‐10 annual report.
Greg Sassella
Chairman
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 3 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Council of Ambulance Authorities
The Council of Ambulance Authorities Inc. (CAA) formally incorporated in December 2002, having operated as an informal grouping of the ambulance services of Australia, New Zealand, and Papua New Guinea since 1962. The CAA is the peak body representing the principal statutory providers of ambulance services in Australia, New Zealand and Papua New Guinea.
Intent
The intent of the Council of Ambulance Authorities is to influence, advise and develop superior pre‐hospital care and ambulance services in the Asia Pacific Region.
Purpose
Policy Actively contribute to the development of public policy;
Knowledge Develop a body of knowledge through research, exchange of information, monitoring and common KPI reporting;
Quality Develop and implement standards for improved quality of care and services;
Synergies Develop common systems and processes;
Leverage Jointly fund initiatives for common outcomes.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 4 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
History and Background
In the early 1960’s William Kelly, Secretary/Superintendent of the New South Wales Ambulance Service arranged the inaugural meeting of all state and territory ambulance authorities from 4‐6th December 1962 in Canberra. Meetings were then held every two years rotating between the state and territory capital cities until 1976 when meetings began to be held annually (Kaye‐Eddie, 1996).
In the 1980’s membership expanded to include New Zealand and Papua New Guinea and working parties and sub‐committees were created to address a number of issues as identified by newly titled ‘The Convention of Ambulance Authorities’. The Convention of Ambulance Authorities was formally incorporated in 2002. The title of the organisation was changed in 2005 to ‘Council of Ambulance Authorities’ (Kaye‐Eddie, 1996).
Over the past 47 years, the Council has provided an important platform for the exchange of information and ideas between member services across Australia, New Zealand and Papua New Guinea. The achievements of the Council are evident through the commonality of standards, and improved level and quality of service which has enhanced the delivery of ambulance services to the community across Australasia.
The CAA is strengthening its role to be recognised by organisations, politicians, stakeholders and the public as the leading credible organisation on issues relating to pre‐hospital emergency medicine and ambulance operations. The CAA is developing further capacity to influence and be seen as an equal partner and active interest group in ‘top table’ health and emergency management policy decision making.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 5 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Membership
Membership of the CAA includes the principal providers of ambulance services in each State and Territory of Australia, New Zealand and Papua New Guinea. The Board of the CAA consists of the Chief Executives of each member service. Standing Committee members are selected from senior executives most suitable for the role of the particular committee as selected by the member service. Convention delegates include the Chief Executive of each member service and senior executives.
Members of the CAA are:
• A.C.T Ambulance Service (Emergency Services Agency, ACT Department of Justice and
Community Safety)
• Ambulance Service of New South Wales
• Ambulance Tasmania (a Division of the Department of Health and Human Services)
• Queensland Ambulance Service (a Division of the Department of Community Safety)
• SA Ambulance Service
• St John Ambulance Australia (NT) Inc.
• St John Ambulance Australia (Western Australia) Inc.
• St John New Zealand
Associate Members are:
• Ambulance New Zealand
• St John Ambulance Papua New Guinea
Source: Kaye‐Eddie, I.L. (1996). A short history of the Convention of Ambulance Authorities 1962‐1995. St John Ambulance Australia – W.A. Ambulance Service Inc. Perth, Western Australia.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 6 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Executive Director’s Report
During the past financial year the Board has progressed their strategic direction and Committees have continued to focus on current and emerging issues for the ambulance sector. Health reforms have been a focus during this period.
The change to the profile of the Rural and Remote Symposium linking with the International Round Table on Community Paramedicine has led to the development of new international relationships and the building of previous linkages with overseas ambulance services. The event provided an opportunity for ambulance sectors in different countries to understand the current issues and to learn from the experiences of others.
The Convention included the Ambulance Awards dinner and for the first time an Open Conference with intent to broaden the information sharing between ambulance, health and emergency service providers. The support of sponsors assisted in providing an excellent forum so that delegates were able to share their experiences and have input into planning a more integrated approach to supporting the health care needs of communities.
The accreditation of entry‐level Paramedic Education Programs has been a focal point for the CAA over the past year. The accreditation process provides assurance that a graduate of an accredited course will possess the knowledge, skills and attributes necessary to achieve the necessary competencies to work as a professional paramedic. In the past twelve months the Guidelines for the Assessment and Accreditation of Entry‐level Paramedic Education Programs have been reviewed and updated and the Paramedic Professional Competency Standards developed and available on the CAA website www.caa.net.au.
The data collection process allows comparative information to be available in the Report on Government Services (ROGS). As part of the broadening of the performance indicator framework which was used for the first time in 2008/09, this year additional data has been reported under the cardiac arrest and patient satisfaction sections of the report.
I would like to thank the members of the CAA Board for their guidance and support. I would also like to thank the many members of CAA Committees and working groups whose valuable time and effort ensures that outcomes are achieved.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 7 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
The CAA Executive team has had a number of changes over the past twelve months. Karyn Williams commenced in October 2009 as the Paramedic Education Programs Accreditation Project (PEPAP) manager and following Natalie Blacker moving to a research role with an Adelaide University Mojca Bizjak‐Mikic joined the CAA team as the Data and Research Analyst. I would like to thank Karyn, Mojca and Louise (Caldwell, Office Administrator) for their tireless efforts to make sure that the many projects and work plans are successfully progressed.
Lyn Pearson
Executive Director
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 8 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES CAA Committees and Working Groups
Standing Committees
The CAA consists of three Standing Committees, each with terms of reference as approved by the Board of the CAA. The following standing committees report annually to the Board:
• Strategic and Business Advisory Committee
• Ambulance Education Committee
• Clinical Standards Committee
There are also various working groups/committees governed by the Standing Committees or directly by the Board which are created to deliver specific tasks.
Strategic and Business Advisory Committee (SBAC)
As a Standing Committee of the Council of Ambulance Authorities Inc., the SBAC provides a national focus and acts as the key advisory group to the CAA on matters relating to the strategic direction and development of business, resourcing, planning, reporting and operational matters within the sector.
In 2009/10 the Committee met on 2 September 2009 and 9 March 2010.
SBAC has provided data for the 2010 ROGS and is continuing to work on 2011 ROGS data.
The Committee has revised its work plan and restructured existing projects to fit within the five SBAC priorities: product costing, workforce planning, demand management, service delivery and staff welfare.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 9 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
SBAC has prepared and, with the Board approval, released a statement on off stretcher times ‘Council of Ambulance Authorities (CAA) Views on Access to Care in Hospital Emergency Departments’.
Ambulance Education Committee (AEC)
The AEC, as a Standing Committee of the Council of Ambulance Authorities Inc., provides a focal point on matters related to ambulance education programs and of professional practice by the sector and considers education matters relevant to the provision of quality ambulance services, providing recommendations on specific matters when requested by the Board of the CAA.
In 2009‐10 the Committee met on 10 November 2009 and 15 April 2010.
The Committee has progressed work on PEPAC (Paramedic Education Programs Accreditation Project) and as a result the accreditation process in now formally in place and contact has been made with all Universities who indicated their intention to participate.
The main focus of the AEC Working group was the development of the Paramedic Professional Competency Standards. The document has been finalised and was published in May 2010.
Clinical Committee
The Clinical Committee, as a Standing Committee of the Council of Ambulance Authorities (Inc.) provides a forum for the Medical Directors and the Clinical Managers of member authorities (and such other specialists in pre‐hospital emergency service as may be determined) to consider clinical matters relevant to the provision of quality ambulance services, and provides recommendations on specific matters when requested by the Board of the CAA.
In 2009‐10 the Committee met on 14 September 2009.
During the formal meetings the Clinical Committee addresses key tasks as agreed by the Board and also provides a useful exchange of clinical information and mutual support for medical personnel and clinical managers.
These meetings provide an opportunity to share clinical research occurring within each jurisdiction and enables future collaboration to the benefit of all jurisdictions.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 10 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Work continues in developing further range of treatment statements for clinical conditions identified important to the ambulance sector across Australia and New Zealand such as oxygen therapy and oxygen measurement and alternative referral pathways.
Members of the Clinical Committee represent CAA on various national and international health related organisations and committees.
Working Groups
Rural and Remote Group
The Rural and Remote Group (RRG), provides a national focus and acts as the key advisory group to the CAA on matters relating to the strategic direction and development of ambulance services in rural and remote areas, with particular reference to models of service delivery and strategic issues that affect the delivery of volunteer ambulance services.
Each year the RRG assists the host jurisdiction in planning a symposium. The 2009 Rural and Remote Symposium was hosted by St John New Zealand and held in Matakana, New Zealand on the 12th and 13th of October 2009. The symposium was joined by International Roundtable of Community Paramedicine group and provided delegates with an opportunity to better understand the current models of service delivery for rural ambulance services throughout Australasia and worldwide.
The group is progressing with the planning of the 2010 Rural and Remote Symposium, to be held in Swan Valley, Western Australia. The Symposium will focus on changes and challenges that the new health reforms in Australia and New Zealand will bring to the delivery of ambulance services in the rural and remote areas.
The RRG is a member of the National Rural Health Alliance. The NRHA is the peak body working to improve the health of Australians in rural and remote areas. It is comprised of 29 Member Bodies including representatives from both health consumers and service providers in non‐metropolitan areas.
Emergency Management Forum
The Emergency Management Forum’s activities include the ongoing provision of advice to the Board relating to issues impacting resource capacities and development, national standards and technical advice.
In 2009‐10 the Forum met on 2 February 2010.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 11 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
The Forum has been working on finalising the AusAID document, which will introduce and launch the AusAID program in participating ambulance jurisdictions. The Forum has been providing regular updates on H1N1 and assisting internationally where possible.
The Forum has finalised the capability survey and first data will be collected as part of the 2010 CAA consolidated returns.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 12 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES 2009 Conference Week
Rural and Remote Symposium
The 7th Council of Ambulance Authorities Rural and Remote Symposium in combination with the 5th Annual International Roundtable on Community Paramedicine and Rural Health Care Delivery was held on the 12 and 13 October 2009 in Matakana Coast Wine Country on the North Island of New Zealand sponsored by the North Central EMS Institute. The Symposium theme ‘The Community Paramedic and Integrated Health Care Options’ was chaired by Dr Tim Malloy, a Generalist Medical Practitioner in Lower Northland, Deputy Chairman of the NZ Rural General Practice Network and Inaugural Chairman of the Rural Faculty of the Royal NZ College of GP’s.
The program included five sessions; Service Delivery, Integrated Healthcare Options, Emergency Management Experiences, the Workforce, and Sharing Ambulance Service Experiences. Presenters and participants came from around the world including; Australia, New Zealand, Canada, United Kingdom, United States, Israel and the United Arab Emirates. Throughout the Symposium there were also 7‐15 participants watching from multiple countries using live internet streaming technology.
There were many highlights in the program, including a key note presentation ‘Australasian Ambulance Services – Rural and Remote Service Delivery Models’ by Tony Ahern, CEO St John Western Australia; a number of presentations from Dr Zvi Feigenberg on the Israel EMS system including education models for paramedics and an insight into management of multi casualty incidents caused by the explosion of suicide bombers; an international
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 13 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
teleconference sharing EMS Best Practices for H1N1 management; and presentations on a number of community paramedic initiatives from Australia, Canada, the United States and the United Kingdom. A study tour was held on the 14th October and included visits to the Rodney Surgical Centre, St John District Headquarters Whangarei (including helicopter operations) and St John Clinical Education Centre in Auckland.
Convention
The 41st CAA Annual Convention and Inaugural Open Conference ‘Expanding Ambulance Horizons’ was held in Auckland on the 14th and 15th of October.
The 2009 Convention was held in a different format to previous years. The first day of the Convention was attended by the CEO and a senior executive of each member jurisdiction to cover a general business agenda including evaluating the work undertaken by each Standing Committee from the previous 12 months and approving the work plan for the next 12 months. Chief Michael Nolan, President Elect, EMS Chiefs of Canada and Ms Kelly Nash, Executive Director of the EMS Chiefs of Canada attended the meeting with Michael presenting ‘Defining the Road Ahead – The Canadian EMS Journey’.
Delegates attending the 2009 Convention, Auckland, New Zealand
Left to Right: front row – Gary Wingrove (International Roundtable of Community Paramedicine), Douglas Kelson (PNG), Lyn Pearson (CAA), Aaron Chia (SA), Greg Sassella (AV), Kelly Nash (EMS Chiefs of Canada), Mike Willis (AV), Tony Ahern (WA), Jaimes Wood (NZ), Natalie Blacker (CAA); back row ‐ Anthony Smith (WA), Alex Currell (AV), Ray Creen (SA), David Dutton (ACT), Michael Nolan (EMS Chiefs of Canada), David Melville (QLD), Ross Coburn (NT), Tony Blaber (NZ), Keith Driscoll (SAAS), David Waters (Ambulance NZ)
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 14 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
The second day of the CAA Convention held the Inaugural Open Conference with the theme ‘Expanding Ambulance Horizons’. This event was developed to provide an opportunity to enhance and challenge current knowledge of the pre‐hospital setting by facilitating discussions on key issues for ambulance service providers and paramedics with an official address provided by the Hon Tony Ryall, New Zealand Minister of Health.
The conference included sessions on: Regulation and Registration, Demand Management, Workforce and Education, and Rural and Remote Service Delivery. Highlights included a panel on regulation and registration facilitated by former Tasmanian CEO, Grant Lennox. The panel included Peter Carver, Executive Director, National Health Workforce Taskforce; Greg Sassella, Chairman, CAA; A/Prof Richard Brightwell, ACAP; and Sue Ineson, Director, Karo Consultants. This session covered questions: whose decision is it to register or not register paramedics; are any of the criteria to protect the quality and safety of care provided by paramedics to the public already met through existing mechanisms; would volunteer ambulance officers be considered for registration; and if registration occurred in the future what would it mean for paramedics and ambulance employers.
Other highlights on the program included a presentation from Peter Carver ‘Progressing the Health Workforce Agenda’ which outlined the role of the new agency ‘Australia’s Health Workforce’ which will subsume the current ‘National Health Workforce Taskforce’. This presentation included an exciting announcement that Paramedicine is to be included in the Council of Australian Governments Clinical Training Subsidy arrangements. Mr David Waters, Chief Executive, Ambulance New Zealand presented on New Zealand ambulance sector initiatives.
In the Demand Session A/Prof Vivienne Tippett from the Australian Centre for Pre‐hospital Research presented the Queensland Ambulance Service Demand Project and Peter Bradley, Chief Executive, London Ambulance Service provided an update on improving the response to 999 callers.
The Workforce/Education session included an overview of the CAA Paramedic Education Programs Accreditation Process presented by Commissioner David Melville; an overview of the New Zealand national diploma in ambulance practice presented by Sue Gullery, St John New Zealand Education Projects Manager and a presentation from Chief Michael Nolan representing the EMS Chiefs of Canada.
The final session, Rural and Remote Service Delivery included an overview from Grant Lennox on the 2009 CAA Rural and Remote Symposium/International Roundtable on Community Paramedicine; Gary Wingrove presenting the history and future goals of the IRCP and Douglas Kelson, presenting on health services moving forward in Papua New Guinea.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 15 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
The new format of the Convention with the Open Conference was greatly accepted by the ambulance representatives, deeming it good value and a great platform to air and discuss issues that affect the ambulance sector in a highly professional manner with special guest speakers and presentations from various international health and emergency services.
The CAA Board is committed to progressing with the new Convention format in the future years.
Ambulance Awards
The Council of Ambulance Authorities (CAA) 2009 Ambulance Awards were presented at the CAA Convention Dinner held in Auckland, New Zealand on Wednesday night the 14th of October sponsored by Spectrum Data Systems International (SDSI).
The awards were first introduced in 2007 to acknowledge and encourage innovations from CAA member services throughout Australia, New Zealand and Papua New Guinea. The awards encourage Ambulance Services to showcase their achievements and be recognised for any exceptional project, quality or performance in any area of their organisation. These awards provide the platform for the sector to learn from each other and reduce duplication of effort.
There are four broad categories in which individuals or groups/units entered their project: operational performance, technical capability, management practice and clinical capability. Four awards were available in each category; Excellence (trophy); Innovation (trophy); Encouragement (trophy) and Commendation (certificate). The selection panel also chose one overall winner from the ‘Excellence’ awards to receive the ‘Star Award’. The winner of this award is identified as having, or proceeding to have, successfully developed, implemented and evaluated a project that is considered the most valuable for adoption by all CAA members.
The 2009 Star Award was received by Ambulance Tasmania for the ‘Tasmanian Volunteer Gateway Project’ which also won the Excellence Award in the Technical Capability Category.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 16 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
SA Ambulance Service received a total of seven awards, Ambulance Tasmania received four awards, Ambulance Service of NSW received two awards, and Queensland Ambulance Service, Ambulance Victoria and St John NZ each received one award.
Sponsors
The Rural and Remote Symposium was sponsored through the IRCP group and their sponsor North Central EMS Institute.
The Convention was sponsored by platinum sponsors Mercedes‐Benz and Laerdal, diamond sponsor Lightfoot Solutions, gold sponsors BOC and Optima and silver sponsors Britax, ETT, Mader and Ferno.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 17 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
The Ambulance Awards Dinner was sponsored by SDSI.
The CAA could not have prepared such successful events and provided guest speakers of the highest quality and relevance for the ambulance sector if not for the companies that were willing to support CAA and its work.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 18 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Jurisdiction Reports
This section presents the 2009‐10 annual reports of the Council of Ambulance Authorities jurisdiction members.
- A.C.T. Ambulance Service
- Ambulance Service of New South Wales
- Ambulance Tasmania
- Ambulance Victoria
- Queensland Ambulance Service
- SA Ambulance Service
- St John Ambulance Australia (NT) Inc
- St John Ambulance Australia (Western Australia) Inc
- St John Ambulance Papua New Guinea
- St John New Zealand
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 19 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
A.C.T. Ambulance Service
CONTACT DETAILS
Title: Chief Officer (Ambulance)
Incumbent: David Foot ASM
Location: ACT Emergency Services Agency HQ 9 Amberly Avenue Majura ACT 2609
Postal Address: PO Box 158 Canberra City 2600
Telephone: +61 2 6207 8701 Facsimile: +61 2 6207 9984 Email: [email protected]
CORPORATE VISION AND MISSION
OUR VISION
A prepared community supported by an expert and timely emergency service response.
OUR MISSION
Protection and preservation of life through professional ambulance services.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 20 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
The ACT Emergency Services Agency (ESA) provides emergency management arrangements for the ACT under the Emergencies Act 2004. The four operational services within the ESA include the ACT Ambulance Service, ACT Fire Brigade, ACT Rural Fire Service and the ACT State Emergency Service which, through collaborative working arrangements, play a significant role in preparing for, preventing and responding to emergency incidents within the Australian Capital Territory.
As a response agency of the ESA, the ACT Ambulance Service (ACTAS), holds legislated responsibility within the ACT for the provision of emergency, non‐emergency and specialist ambulance services and aero‐medical services to the surrounding region of south east NSW.
The Australian Capital Territory is the smallest territory of the Australian States and Territories. It occupies an area encompassed by South East New South Wales and covers approximately 2,360 square kilometres. The resident population of the Australian Capital Territory is approximately 336,000 primarily spread across various town centres of Civic, Woden, Belconnen, Tuggeranong and Gungahlin. The capital city of Canberra occupies an area of approximately 300 square kilometres.
THE YEAR IN REVIEW
Activity & Performance Dispatch system. Consistent with interstate trends, demand for ambulance In 2009‐10, ACTAS managed 35,908 services continues to be a major issue incidents involving 35,616 responses by requiring active resource management operational crews. This was achieved with and continued research and analysis. a patient satisfaction survey result of 97% of patients satisfied or very satisfied with Audit of Capability the level of service provided. In 2009 the ACT Auditor General ACTAS attended 50% of emergency conducted an Audit of the ACT Ambulance incidents in 9.58 minutes or less Service (Delivery of Ambulance Services to (performance target 8 minutes) and 90% the ACT Community). The Audit report in 15.46 minutes or less (performance included seventeen (17) target 12 minutes 30 seconds). recommendations for the consideration of Government towards improving the Emergency response time performance delivery of ambulance services to the ACT represents continuing increase in demand community. for ambulance services and a change in the reporting definition to the first Following the tabling of the Audit report, keystroke on the Computer Aided the Department of Justice and Community
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 21 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Safety commissioned Mr Grant Lennox, valuable strategy in increasing the former CEO of Ambulance Service participating of salaried and volunteer Tasmania to provide an independent staff in the vaccination program, reducing review of the ACTAS. This review, the impact of seasonal influenza on staff informed by the Audit report was absenteeism, and increasing preparedness completed in April 2010, and brought in the event of pandemic influenza. In forward nine (9) specific 2010, the program involved 557 recommendations targeted at enhancing departmental officers from ESA, ACT administrative, clinical and educational, Corrections, ACT Magistrates Court and operational and front line service delivery the Dept of Justice and Community Safety areas. receiving flu vaccinations.
Work, overseen by the departmental Capital Works Performance and Audit Committee, is Major capital works for the new ESA HQ progressing to implement the are nearing completion with the ESA recommendations agreed to from the ACT scheduled to move its administrative Auditor‐General’s Audit report with sections to new premises located at modifications to work plans as required Fairbairn in September 2010. Further noting the independent review transition in 2010 will see the ESA 000 undertaken by Lennox. Further scoping communications centre also moving to work to programmed changes will have to Fairbairn in late 2010 and ACTAS Clinical be considered following the review of the Services relocating to a new ESA joint ACT Auditor‐General’s Audit by the ACT training centre in Hume ACT. Standing Committee on Public Accounts. Work is also ongoing to complete major Emergency Planning and Preparedness upgrades at the existing helicopter base Front line specialist capability of the which includes new accommodation and ACTAS was strengthened with 74 training facilities to support dedicated members trained to Category 1 Urban aero‐medical crewing and additional Search and Rescue (USAR) operations via hangerage and office space to support joint training partnerships with the ACT rotary winged aircraft engaged under Fire Brigade. This initiative involves National Aerial Fire Fighting contracts. ACTAS members completing an e‐learning
package developed by the ACT Fire Key Achievements Brigade followed by theoretical and practical USAR exercise. The professionalism of ACTAS Intensive Care Paramedics was recognised on 29 ACTAS was also again responsible for March 2010 with Fair Work Australia developing and implementing the Commissioner Barbra Deegan handing departmental influenza vaccination down a decision which aligned the pay program. This program is viewed as a rates of ACTAS Intensive Care Paramedics
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 22 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES with that of other health care general management capacity targeted at professionals. enhancing the level of support provided to front line members. A Certificate IV (Frontline Management) was introduced for operational staff in The dedication to duty and August 2009 with ten (10) members professionalism of two ACTAS member completing the initial course offered via was appropriately recognised with the the ESA Training section. award of the 2010 ACT Community Protection Medal to Ambulance The response capability of the aero‐ Paramedic Wayne Battye and the medical helicopter was substantially Ambulance Service Medal (ASM) to enhanced with dedicated crewing Intensive Care Paramedic Rebecca Lundy. between 0800 ‐1800 commencing in February 2010. Achieved under joint funding arrangements with ACT Health, Key Targets for 2010 ‐ 11 this strategy has substantially improved In 2010‐11, a number of strategic planning response times of the aero‐medical activities will be progressed including: service. Further changes to current crewing arrangements are planned • implementation of the new ESA pending completion of capital works at Corporate Plan; the helicopter base in late 2010. • introduction of a number of new demand management strategies Funding of $5.1m announced by the ACT including Comcen Clinicians, additional Government in May 2010 for the 2010 – call taker capacity and enhanced audit, 11 budget for the ACTAS recognises a quality assurance and training number of the recommendations made by capacity; the ACT Auditor‐General (2009) – Delivery • review of the front line resourcing of Ambulance Service to the ACT model and facilities of the ACTAS Community), and specific being undertaken by UK based recommendations brought forward by Mr consultancy firm Occupational Grant Lennox in his review of the ACTAS in Research in Health; and April 2010. This funding will see • review of the current funding model of significant enhancements in critical the ACTAS. service delivery areas including call taking capacity, clinical triage, education and quality assurance in the ACTAS section of See www.ambulance.act.gov.au for the ESA Communications Centre and further information.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 23 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance Service of New South Wales
CONTACT DETAILS
Title: Chief Executive
Incumbent: Greg Rochford
Location: Ambulance Service of New South Wales State Headquarters Balmain Road Rozelle NSW 2039
Postal Address: Locked Bag 105 Rozelle NSW 2039
Telephone: +61 2 9320 7601 Facsimile: +61 2 93207802 Email: [email protected]
CORPORATE VISION AND MISSION
OUR VALUES
OUR VISION Professionalism Responsibility Excellence in care Accountability Teamwork Respect Care
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 24 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
THE YEAR IN REVIEW
ACTIVITY KEY STRATEGIES
Total Activity Management Practice and support for staff • Over 1,133,000 total emergency and non‐emergency responses. Key strategies included: • An average of 3,104 responses per Staff Support Services have increased day, or a response every 27.8 seconds. in recognition of needs across the • Average number of responses per day workforce with a focus of Peer increased by 1.2 per cent on the Support Officers, Grievance Contact previous year. Officers and Chaplaincy. • Emergency activity declined from 672,000 incidents in 2008‐09 to An updated Performance 663,000 in 2009‐10. Development Program, which focuses • Non‐emergency activity increased on improved communication and from 266,000 incidents in 2008‐09 to development of staff, has been rolled 277,000 in 09/10. out with extensive acceptance across all levels of management. This The movement from emergency to non‐ program will be extended to all staff in emergency demand indicated in the the coming year. figures is due mostly to a change in the classification of patients in Metropolitan 391 supervisors and managers Division. completed the Ambulance Management Qualification (AMQ). Response Times to potentially threatening Executive Development Program cases commenced for 67 senior managers as Fifty per cent of potentially life‐ an adjunct to the successful AMQ threatening cases were responded to program. within 10.30 minutes, compared to Improved communications with staff 10.27 minutes in the previous year. in the form of booklets, brochures and The small deterioration in response articles on relevant topics such as performance in 2009/10 is due management and leadership, healthy primarily to longer (+5.4 per cent) workplace strategies and staff support hospital turn‐around times, limiting services including Peer Support, the overall availability of ambulances Chaplaincy, Employee Assistance to respond; and an increase in the Program and Trauma Support. numbers of emergency ambulances 1160 staff attended 23 training being used to transport non‐ courses provided through the Learning emergency patients. and Development program.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 25 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Prevention of Bullying and Harassment The Clinical Assessment and Referral policy implemented. (CARE) project has been expanded, DVD on grievance with 340 additional paramedics management/respectful workplace trained to provide non‐emergency processes developed. alternatives to low risk, low acuity Staff Transfer policies revised and patients ‐ totalling 785 paramedics implemented (Compassionate, Lateral, across the state. CARE will become Rural Incentive, Priority Vacancy). core practice for Ambulance from Occupational Health and Safety Policy 2011 and all qualified paramedics will implemented. receive CARE training by June 2012. Casual Employment policy The Extended Care Paramedic (ECP) implementation commenced. program has been enhanced. This Internal Mediation Service program provides a high level of established. training for paramedics in clinical Death and Disability Award amended skills, decision making and operational to incorporate a Health and Wellness coverage in 11 locations across both Program. metropolitan and regional areas. Review of Psychometric Testing Twenty‐four additional paramedics processes for Paramedics undertaken completed the initial ECP training to improve selection processes. course during 2009/2010, with the Training, Education and Study Leave total number of ECPs now at 46. The (TESL) policy for Staff Specialists ECPs have attended over 17,000 implemented. patients and provided referral for Disability Action Plan implemented. alternate healthcare options and/or Performance Improvement Policy treatment and discharge for 38.6 per drafted. cent of these patients (average across the locations). 333 Paramedics and 84 Control Centre staff employed. The Ambulance Research Institute (ARI) is established with a substantial Completed the transition to Health research program underway and Shared Services for transactional‐ scholarships awarded to research based financial processes. fellows. New activity included: Clinical Capability A number of large epidemiological studies into chest pain, stroke and Key initiatives include improving initial spinal cord injury. patient assessment and authorisation for Two randomised controlled trials in referral and discharge of patients in progress: ‘Pre‐hospital CPAP for acute appropriate cases, to reduce the number cardiogenic pulmonary oedema’, and of patients taken to hospital emergency ‘Comparing two laryngeal mask departments. airways; and Key strategies included:
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 26 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Progressing to link major Ambulance operational conditions. Also facilitates and Health databases to facilitate capacity to support retrospective outcomes‐based research. review and analysis of live cases for An advanced cardiac care pilot clinical governance purposes. Control program has been established in the Centre Officers can develop expertise Hunter, to test methods for rapid in managing rare and difficult events. delivery of early reperfusion Review of vocational diploma treatments for heart attack patients. curriculum for paramedics. Consolidation and expansion of the Operational Performance clinical role of paramedics in small rural and remote communities, Key strategies included: particularly community health care activities. This follows a successful Supervisory capacity has been further pilot project in collaboration with strengthened by the completion of the Greater Southern Area Health Service. AMQ, Certificate IV in Frontline Mental Health training for paramedics Management ‐ across the majority of continued with an additional 644 front line managers. paramedics trained, bringing the total To assist in fatigue management, a number of paramedics authorised to trial of the Fatigue Management exercise powers under the Mental Standard Operating Procedure has Health Act (2007) to 1,921 ‐ (77 per rolled out throughout the Northern cent) of the paramedic workforce. Division. Partnerships with Charles Sturt The introduction of the Special University and University of Tasmania Operations Team paramedics has established to support tertiary resulted in the expansion of rapid paramedic education for Ambulance response capability. The specialist NSW. training and mobilisation of these Implemented system of paramedic single paramedic response units has release from operational rosters to enhanced the response and access facilitate compliance with paramedic capabilities of the Service across the certification standards, and achieve Sydney metropolitan area. clinical training priorities. The Control Centre Improvement Development of new curriculum for Project has delivered state‐wide training of Control Centre Officers as standardisation of Control Centre part of the Control Centre procedures and reviewed and Improvement Project. Completion of developed a training curriculum. It the course results in nationally also delivers improved Non‐ recognised Certificate IV qualification. Emergency Patient Transport Acquisition of Dispatch Simulation functions by separating the program to support Control Centre management and dispatch of Non‐ Officer education in authentic non‐live Emergency Patient Transport requests
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 27 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
within Control Centres. Around 40 per vehicles for use in bariatric and special cent of Non‐Emergency transport operations. work is undertaken by paramedics in A concept heavy duty off‐road Emergency ambulances in the Sydney ambulance vehicle underwent metropolitan area. It is expected that operational trial to improve patient the separation of Emergency and Non‐ support capability. Emergency work ‐ along with a Planning and development underway planned expansion in the number of for a Forward Command vehicle for Patient Transport Officers and vehicles Major Incident Control and ‐ will impact positively on ambulance Communications to address blackout emergency response performance. coverage scheduled for delivery in late The first stage of the separation of 2010. Non‐Emergency Transport functions The Sydney Infrastructure Review is a within the Control Centres high priority program of proposed commenced on 5 July, 2010. building work to address Recruitment commenced for 70 infrastructure needs across Sydney additional Patient Training Officers to due to growing population and support this separation process. transport congestion ‐ in order to Volunteer programs continue to maintain response times to life expand where resources permit, with threatening triple zero emergencies. 40 Community First Responder Enhanced rural facilities include the programs established in collaboration commissioning of new stations in with the SES and the two Fire Multi‐Purpose Service facilities at authorities. Merriwa, Warialda and Bingara. Implementation of the upgraded and Technical Capacity integrated State‐wide Computer Aided Key strategies included: Dispatch system was successfully completed in February 2010. This A new Asset Services Plan (2011‐ provides a platform for further 12/2020‐21) was developed to provide improvements in Triple Zero call taking an updated assessment of capital and ambulance dispatch. needs and priorities against available The Ambulance electronic medical funding and areas requiring additional record has been successfully trialled at funding. eight Ambulance stations and New equipment included mechanical preparations are underway for a state‐ restraining devices, 60 new ambulance wide rollout to be delivered over the stretchers and a further two Megalift next two years.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 28 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance Victoria
CONTACT DETAILS
Title: Chief Executive Officer
Incumbent: Greg Sassella
Location: 375 Manningham Road Doncaster VIC 3108
Postal Address: PO Box 2000 Doncaster VIC 3108
Telephone: +61 3 9840 3630 Facsimile:
+61 3 9840 3546 Email: [email protected]
CORPORATE VISION AND MISSION
Ambulance Victoria’s role is to: Improve the health of the Victorian community by providing high quality pre‐hospital care and medical transport.
Ambulance Victoria (AV) commenced operation on 1 July 2008. AV currently has four areas of focus that guide the development of its strategic direction: 1. Service quality, efficiency and innovation 2. Staff development, safety and welfare 3. Organisational support systems and resources 4. Health system and community integration
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 29 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
Ambulance Victoria (AV) reports through the Department of Human Services to the State Minister for Health, the Hon. Daniel Andrews, MP. The Board of Directors, appointed by the Governor in Council on the Minister’s recommendation, is responsible for the provision of comprehensive and efficient ambulance services. The organisation is managed by the Chief Executive Officer (who reports to the Board) and the executive team.
THE YEAR IN REVIEW
Emergency Road Services The use of 12‐lead ECG monitors for the transmission of ECG’s from the scene was Responding to nearly 460,000 emergency extended to eleven hospitals during 2009‐ road incidents, AV Operations Division 2010. This has led to significant experienced strong growth in 2009/2010 reductions in treatment times for STEMI (5.7%), building on a more moderate patients. increase in the previous year. The growth occurred despite the Referral Service Non‐Emergency Road Services handling over 8% of ‘000’ cases in the With just over 280,000 cases, non‐ metropolitan area without an emergency emergency caseload grew only dispatch. The percentage of Code 1 cases moderately at just 0.6%. Growth was responded to within 15 minutes was much higher in the metropolitan area 80.7% in 2009‐10. than in rural Victoria. Work continued throughout the year on Air Ambulance restructuring the MICA response capability. As part of this restructure, 3 Air Ambulance incidents increased by new MICA single responder units were 2.5% over 2009‐10 to nearly 6,700. Work introduced in regional locations. was also completed in July 2009 on a new helicopter service operating out of A plan to transition five rural call‐taking Warrnambool in south‐west Victoria. and dispatch centres from AV to a single centre managed by the Emergency Adult Retrievals Services Telecommunications Authority (ESTA) also commenced implementation AV is now mid‐way through implementing during the year. a three year Service Improvement Plan (SIP) for Adult Retrievals Victoria. All on‐ A draft Emergency Operations Plan to site staff have now been recruited and 2014‐2015 was also prepared during recruitment of registrars for 2011 2009‐2010. commenced. A system for adult retrieval in the metropolitan area was implemented in February 2010
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 30 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Information Management & included 11 publications in peer reviewed Communications journals including Circulation, Stroke and Epidemiology. During the year, a Strategic Information Management Plan was developed at AV. Staff Development The focus for information systems The focus in the area of Human Resources remains firmly on integration of has been on progressing with metropolitan and rural platforms for key organizational integration during systems. In 2009/2010, the payroll and 2009/2010. Nearly all Divisional HR systems were merged into a single structures within AV have now been system, as was the Service Desk. completed and implemented. Research & Development Health & Safety The transition of VACIS data into a Clinical A number of on‐going health and safety Data Warehouse was completed in initiatives continued to be implemented, 2009/2010 – this will enable improved including an early intervention strategy, accessibility to clinical data, the workplace stress, a focus on return to availability of integrated standard clinical work and manual handling initiatives. reporting and, ultimately, standard There was also an emphasis on integrating clinical reporting being made available the metropolitan and rural HSW initiatives nationally wherever possible. AV participated in 39 research studies and 2 registries in 2009‐10, Research outputs
FUTURE DIRECTIONS (2010‐11)
Although the process of organisational • Complete restructuring of consolidation is not complete, and will still metropolitan MICA road response, require a strong focus, AV continues to converting the existing 16 MICA units and develop and implement a range of new 4 single responders to 8 MICA units, 4 initiatives to improve services MICA Peak Period Units and 14 MICA single responders Emergency road services • Introduction of another 5 MICA On 30 June, the Government announced a single responder units in regional Victoria boost to paramedic resources in Victoria, and as a result AV will implement the • Introduction of 3 new Peak Period following resources to its emergency road Units at Yarraville, Grantville and Kinglake response:
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 31 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
A plan will also be developed to expand Research & Development the Referral Service to regional areas in The major body of research from the the coming years. Victorian Ambulance Cardiac Arrest Non‐Emergency road services Registry for 2010‐11 will be to investigate the state‐wide variation in cardiac arrest In the area of non‐emergency services, AV outcomes and develop strategies to will continue implementation of a three reduce differences. year state‐wide non‐emergency patient transport strategy and commence Significant randomised controlled trials for development of a longer term strategy. 2010/11 include a trial of induced hypothermia during pre‐hospital CPR Air Ambulance (RINSE) and a trial of hypothermia in A review of the effectiveness and patients with severe brain injury (POLAR). efficiency of Air Ambulance will be Staff capability & development undertaken, with a Service Improvement plan to be developed and implemented in On the people side, AV will continue to later years. VACIS is also expected to be develop a detailed paramedic workforce extended to air ambulance in 2010‐11. plan to address future graduate supply and demand and models to ensure work‐ Adult Retrievals readiness. The graduate training VACIS will be rolled out to Adult Retrieval framework will also be further developed Victoria (ARV) during 2010‐11. to ensure that graduates continue to meet required standards System integration Additionally an online Learning Improving coordination with other Management System is being developed healthcare providers to improve patients to increase flexibility in the delivery of outcomes remains a priority for AV; in staff training. 2010/2011, a pilot of real‐time sharing of ambulance pre‐arrival data and hospital Health & safety emergency department capacity data will Staff welfare remains a high priority, and continue. Additionally, a strategy on in‐ the existing strategies of the former field thrombolysis will be developed. organisations will continue to be pursued. Information management & At the same time, continued development communications of AV policies and procedures and delivery of an integrated AV health and safety By the end of 2010/11, it is expected that strategy will be a major focus. the remaining rural call‐taking and Additionally, a number of high priority dispatch centres operated by AV will have branches will be upgraded. transitioned successfully to a single centre operated by ESTA. Health system and community initiatives
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 32 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
A program to develop relationships with establishment of a strategy model for the Aboriginal community, including a developing relationships between AV and Reconciliation Plan, will continue to be targeted community organisations also implemented in 2010‐11. The remains a priority.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 33 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance Tasmania
CONTACT DETAILS
Title: Chief Executive Officer
Incumbent: Dominic Morgan
Location: 12 Brisbane Street Hobart TAS 7000
Postal Address: GPO Box 125 Hobart TAS 7001
Telephone: +61 3 6230 8580 Facsimile: +61 3 6230 8585 Email: [email protected]
CORPORATE VISION AND MISSION
Ambulance Tasmania’s vision is excellence in ambulance and health transport by providing optimal care integrated across all aspects of health and community transport.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 34 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
Ambulance Tasmania Emergency and Medical Service (AT‐EMS) (formerly Tasmanian Ambulance Service) was established under the Ambulance Service Act (1982). It is part of the Department of Health and Human Services (Health Services). AT has three operational regions each headed by a regional manager. Under the Ambulance Service Act (1982), the Director of Ambulance Services is responsible for co‐ordinating all ambulance services for AT‐EMS, and all independent services, which ostensibly operate under licence and this includes a commercial sector provider of non‐urgent patient transport and safety coverage at sporting events.
Tasmania is the only state that continues to enjoy free ambulance services for the general public although this has been under review by government in recent years.
THE YEAR IN REVIEW
The highlights for the year have included: Appointment of Clinical Deployment Officers to provide supervision and Completion of EMS Business Planning clinical advice in the State and linking of the organization’s Communications Centre Future Directions 2010‐2013 to the Recruitment of additional staff in broader Departmental Strategic state‐wide Communications Objectives. Completion of a new EBA that gives This also resulted in a name change to staff a career structure which provides Ambulance Tasmania which reflects incentives for career progression. the incorporation of new services of Multi‐million dollar upgrading of Patient Transport State‐wide, Medical ambulance equipment including Retrieval, Community Transport as training equipment, computer well as the existing Tasmanian hardware for electronic patient care Ambulance Service into the new reporting and new monitor organisation. defibrillators. Appointment of an additional 6 branch Progressing the procurement of station officers at Triabunna, Nubeena bariatric equipment and vehicles to and Queenstown branch stations to better manage obese patients. provide continuous paramedic Introduction of an electronic incident presence in those rural communities. monitoring system to monitor safety Completion of infrastructure and quality issues. development of new paramedic Purchasing the 100th new ambulance ambulance branch stations at under our four year vehicle fleet Queenstown, Nubeena and Triabunna. upgrade program.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 35 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
In collaboration with University of State Communications Centre and Tasmania, a new undergraduate State Headquarters. course commenced in February 2009 Completed an optimization study into that offers essential qualifications for the State’s aeromedical services. people wishing to undertake an Commissioning and commencement ambulance career. AT‐EMS will be of an Ambulance Staffing and extensively involved in providing Infrastructure study to provide options clinical placements for service planning until 2014/15 Near completion of a state‐of‐the‐art Introduction of an additional building for the State Operations paramedic crew into Hobart in January Centre that will accommodate the
FUTURE DIRECTIONS (2010‐11)
In the year ahead there will be a series of • Undertaking initial and ongoing initiatives to better coordinate all health emergency and medical demand transport in Tasmania from high acuity modelling to predict resource emergency response and medical retrieval requirements across the State. system cases through to non‐emergency • Undertaking workforce planning which patient transport and travel assistance addresses demand modelling schemes for patients. This major change predictions and known trends in aims to dovetail with the State Health Plan community emergency and medical and its components in the Clinical Services needs. and Primary health care fields. In the 2010‐11 budget, the government The government has announced a 11.25 has also announced funding for a million package of initiatives for 2010‐11 Helicopter Emergency Management which will fund those commenced in the System. This will be implemented previous years as well as enhancements progressively over the next few years. that include: From 1 July 2010, Ambulance Tasmania • Continuing upgrade of medical and will also assume responsibility for state‐ training equipment. wide coordination of non‐emergency • Commencement of a routine property patient transport and medical retrieval maintenance program which have been operated by the Area • Ongoing improvement of information Health Services in separate regions. systems
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 36 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Queensland Ambulance Service
CONTACT DETAILS
Title: Commissioner
Incumbent: David Melville APM
Location: Emergency Services Complex Cnr Kedron Park and Park Roads Kedron QLD 4031
Postal Address: GPO Box 1425 Brisbane QLD 4001
Telephone: +61 7 3635 3271 Facsimile: +61 7 3247 8267 Email: [email protected]
CORPORATE VISION AND MISSION
OUR VISION Safe and secure communities
OUR MISSION To provide ambulance services to meet the needs of the community with a timely response
Key Areas Focus on Front‐line service delivery Strengthen community safety, capability and resilience Support volunteer organisations Build organisational capability and resilience
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 37 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
Queensland Ambulance Service (QAS) operates under the authority of the Ambulance Service Act 1991. QAS is a Division of the Department of Community Safety which was created in March 2009 following Machinery of Government (MOG) changes which resulted in the amalgamation of the Department of Emergency Services and the Department of Corrective Services.
The Department of Community Safety is responsible for the provision of ambulance services, fire, search, rescue, counter disaster, hazardous materials services and corrective services.
QAS serves over four million Queenslanders and 146,000 tourists per day across a vast state of 1.77 million square kilometres, including about 1,000 offshore islands. Queensland is Australia’s most decentralised state and accounts for 22.5% of Australia’s land mass.
QAS provides essential emergency medical services including pre‐hospital care and related services across Queensland. QAS aims to improve the health, safety and well‐being of individuals and the community by continuing to strive for excellence through innovation.
Services include:
providing pre‐hospital paramedical response services; emergency and routine pre‐hospital patient care; coordination of aeromedical services; inter‐facility ambulance transport; planning and coordination of multi‐casualty incidents and disasters and casualty room services; community services including public education and baby capsule hire and fitting service; and pre‐hospital care research.
QAS provides its services through 3,759 full‐time equivalent employees and approximately 328 volunteers including Ambulance Attendants, Community First Responders and volunteer drivers and health service responders.
THE YEAR IN REVIEW
Response Performance Queensland. This compares with the 2008‐09 figure of 744,004 incidents. In 2009‐10 QAS provided services in response to 744,623 incidents across Demand for ambulance services has been positively affected by demand
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 38 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
management strategies implemented performance management, budget and following the QAS Audit 2007. The overall resourcing, and the interface with increase in demand has reduced during Queensland Health. Two of the initiatives the previous two financial years from were not accepted by Government. 7.65% in 2007‐08 to 2.76% in 2008‐09. In February 2010, the Final Report on the For the 2009‐10 year overall demand implementation of the Audit increased by only 0.08% despite a 6.96% acknowledged that all appropriate increase in code 1 responses. The lower demand management strategies have than expected increase in demand is now been implemented. largely due to a 10% decline in non‐urgent As a result of the substantial work in patient transport services as a result of addressing the Audit’s recommendations, the Queensland Health Authorised QAS is more efficient and effective and is Transport (QHAT) agreement. well‐placed to continue to build on longer‐ In the 2009‐10 financial year, there was a term policy initiatives including an 6.96% increase in Code 1 incidents improved interface with Queensland compared to the same period in the 2008‐ Health. The initiatives implemented, and 09 financial year. the work progressed to date, places QAS in a strong position to better manage In spite of growth in demand, 50 % of service demand. Code 1 life threatening incidents were attended within 8.1 minutes, and 90 % of Clinical Advances Code 1 life threatening incidents attended In July 2009 QAS employed a Senior Pre‐ within 16.4 minutes. This is a marked Hospital Care Registrar. This is a doctor improvement on figures of 8.4 minutes undertaking specialised emergency and 17.2 minutes for the same medicine training. The QAS is the only performance targets in the previous ambulance service in Australia to gain financial year. advanced training accreditation from the In the 2009‐10 financial year, the QAS Australasian College for Emergency employed an additional 50 Ambulance Medicine. A different Registrar rotates Officers above attrition. through the position every 6 months, with two Registrars now having completed QAS Audit their terms. In September 2007, the Premier QAS is continuing a trial program using a announced that an audit of the QAS rapid trauma response vehicle (RTRV), would be undertaken. The QAS Audit staffed by the Medical Director or the QAS report made a total of 21 Senior Pre‐Hospital Care Registrar and an recommendations incorporating 46 Intensive Care Paramedic. The RTRV initiatives in the areas of demand attends cases of major trauma in a radius management, workforce issues, of 50km from the Brisbane CBD. These
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 39 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
responses provide enhanced medical care • Increased dose of Paracetamol in line outside the current scope of practice of with current best practice; and paramedics. • Salbutamol and sodium bicarbonate for The use of ultrasound technology in the adults with suspected hyperkalaemia, and Emergency Departments within • The introduction of five new drugs for Australasia is now common place and is use by Extended Scope of Role ‐ Flight particularly used in the rapid assessment Paramedics. of major trauma. In July 2009, QAS took delivery of an ultrasound machine for trial Vehicles in the pre‐hospital environment. The aim is to rapidly improve patient assessment, For the 2009‐10 financial year $20.9 whilst minimising pre‐hospital scene time. million was allocated for the commissioning of 150 new and Codes of Practice for the new QAS Drug replacement ambulance vehicles. The QAS Management Policy were endorsed and operates a two year rolling vehicle implemented in mid 2009. acquisition and fit‐out program to ensure a continuous flow of new and A complete review of the QAS Drug replacement vehicles which enables the Therapy Protocols (DTPs) was completed target number of commissioned vehicle to in November 2009. This has involved an be achieved. updating of current protocols with an expanded list of indications and updated Research doses for certain drugs. These include: The Australian Centre for Pre‐Hospital • Clopidogrel for patients who have Research (ACPHR) collaborated on five received fibrinolytic therapy; major research projects examining various aspects of emergency health services • Glyceryl Tri‐nitrate for autonomic demand and system management dysreflexia, an emergency condition; priorities, including ramping and associated with spinal‐injured patients; aeromedical service provision. This • Hydrocortisone for patients suffering includes three grants ($1.4million) adrenal gland insufficiency; secured in 2007‐08 in collaboration with academic and public sector research • Magnesium Sulphate for paediatric partners, to be completed by 2012 and patients suffering Torsades de Pointes and approximately $410,000 in external life‐threatening asthma; research grants secured in the 2008‐09 • Methoxyflurane is now approved for financial year. administration by First Response Officers;
• Intravenous Naloxone to facilitate
airway management;
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 40 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Capital Works As the 30 June 2009 there were 1,178 student paramedics studying in QAS had 21 major projects listed in the Queensland of which 528 were QAS 2009‐10 Budget Paper 3 of which eleven Diploma of Applied Science students and are complete and eight are in progress. 650 were undertaking undergraduate Education degree paramedic program with Queensland Universities.
FUTURE DIRECTIONS (2010‐11)
Managing Demand for Services Fentanyl for pain relief, Noradrenaline for treatment of shock (flight paramedics), Demand for emergency ambulance and Rocuronium (flight paramedics) to services continues to grow, particularly in maintain muscle paralysis in the intubated the south‐eastern corner of the state, patient. which includes some of the nation’s fastest growing areas. Queensland’s Research population growth rate remains higher QAS through the Australian Centre for than the national average and the highest Pre‐Hospital Research has contributed of all Australian states. Population growth funding and extensive in‐kind support for and ageing continue to be the main the projects listed below. These significant drivers of demand for health services. projects have staged completion dates Over recent years the growth in Code 1 which will see them deliver results in and 2 incidents has averaged in excess of 2011‐12: 9% annually, however, in 2008‐09 the QAS recorded a decline in Code 1 and 2 •Queensland Emergency Health Services incidents of 0.32%. Study (ARC Linkage Grant – with Queensland University of Technology); In order to meet future challenges, QAS will employ an additional 75 ambulance • Reducing the Impact of Traffic Incidents officers across the state in 2010‐11, (ARC Linkage Grant with University of bringing the total staff increase to 630 in a Melbourne and University of four year period. Queensland);
Clinical Advances • Framework for Eco‐Health Vulnerability Due to Climate Change (ARC Linkage In 2011 QAS plans to apply to Queensland Grant with Queensland University of Health for approval to introduce a number Technology); of new drugs. These include Ipratropium Bromide for severe asthma, Magnesium • Environmental Health Risks associated Sulphate for Irukandji Envenomation with Heat Waves (ARC Linkage Grant with Syndrome for Advanced Care Paramedics,
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 41 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Queensland University of Technology); The service will commence, continue or and complete six new ambulance stations and 14 replacement, redeveloped or • Trauma Data Linkage Extension Project refurbished ambulance facilities. (QLD Trauma Clinical Network Grant with Queensland Health). Vehicles
Capital Works QAS will commission 165 new or replacement ambulance vehicles to QAS will commence design for the $7 ensure the ambulance fleet is effectively million Spring Hill emergency services maintained to meet increasing community complex including redevelopment of the needs. ambulance station.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 42 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
SA Ambulance Service
CONTACT DETAILS
Title: Chief Executive Officer
Incumbent: Ray Creen
Location: 216 Greenhill Road Eastwood SA 5063
Postal Address: GPO Box 3 Adelaide SA 5001
Telephone: +61 8 8274 0401
Facsimile: +61 8 8272 9232 Email: [email protected]
CORPORATE VISION AND MISSION
VISION VALUES
The community of South Australia is secure We value our reputation and professional in the quality of care provided by its profile and these values influence the way ambulance service. our business is conducted and how our organisation is managed. We do this with MISSION accountability, integrity and innovation. We value the passion, effectiveness and To save lives, reduce suffering and enhance potential of our people, and their need to quality of life through the provision of feel valued and respected. accessible and responsive quality care and transport.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 43 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
Our purpose and objectives SAAS is constituted by the Health Care Act SA Ambulance Service (SAAS) is the 2008 under which it is an identifiable principal provider of emergency incorporated entity. In accordance with ambulance services in South Australia. the Act, SAAS is managed by a chief executive officer who reports to the chief This provision of ambulance service executive of SA Health. comprises: • emergency patient care and transport Operational workforce • non‐emergency patient care transport • emergency and major event SAAS operates out of 108 ambulance management stations across the state, including 17 • MedSTAR – State‐wide Retrieval career metropolitan stations, 23 country Service. career stations and 68 volunteer stations including three joint career‐volunteer To complement the provision of stations. SAAS’s workforce comprises of ambulance services, SAAS also: 1260 paid staff (1040 patient services and • coordinates the Motor Accident 220 support employees) and 1423 Commission state rescue helicopter volunteers (1257 patient services and 166 operations support). (SAAS also supports over 100 • collaborates with Flinders University industrial volunteer ambulance officers at to deliver the Bachelor of Health nine mining sites across the state). Sciences (paramedic) and the Master of Health Sciences (Pre‐Hospital and SAAS supports five community emergency Emergency Care) responder teams. • operates as a registered training organisation providing in‐house, Reporting relationships nationally accredited training to its staff The chief executive of SA health is • promotes and administers the responsible for the administration of SAAS Ambulance Cover subscription scheme and has appointed and delegated • promotes and manages Call Direct—a appropriate managerial powers to the 24‐hour personal monitoring chief executive officer of SAAS. emergency service • hosts the Advanced Incident At a corporate level, SAAS ultimately Management System (AIMS) for SA reports to the SA Health to the Minister Health. for Health. However, it continues to maintain its status as a separate entity for Legislation
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 44 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
the purpose of reporting to the are therefore reported through to the Department of Treasury and Finance. chief executive of SA Health via the executive director, Operations Division of For operational matters, SAAS has a close SA Health. relationship with the Operations Division of SA Health. Issues that have an impact on the operations of the health system
THE YEAR IN REVIEW
Service delivery • The development of a new four‐year volunteer recruitment campaign, • Overall patient satisfaction with SAAS, which will be rolled out in early 2010‐ as reported through the CAA National 11. Patient Satisfaction Research, remained very high at 99 per cent Our people • SAAS achieved its response time targets responding to 56.8 per cent of • Continued improvement to SAAS’s emergency (category A) cases within support programs for staff. The Peer eight minutes, and having a stretcher Support Program added a new carrying ambulance to these cases in component in pastoral care and 16 minutes 97.5 per cent of the time. increased the number of contacts with At the same time, total incidents staff by 200 from the previous year. across the state rose by eight per cent. • Rollout of mandatory training for • SAAS expanded its Extended Care cultural awareness, disability Paramedic (ECP) program across the awareness and Aboriginal cultural metropolitan area and increased the awareness across the organisation. number of qualified ECPs to 18. • Held the largest ever graduation and • Emergency medical dispatch support presentation ceremony to publicly officers again achieved their acknowledge staff for their performance target, answering 91 per achievements throughout the year. cent of triple zero (000) calls in 10 • Continued improvements to OHS seconds. systems, policies and procedures. This • New stations in Port Adelaide and included improved regular statistical Quorn were officially opened, with and trend reporting. construction of a new station in • Commencement of a review and Prospect well underway, as well s update of all educational learning planning for a new city station in materials. Parkside. Strategy and planning
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 45 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
• The development of SAAS’s new • The continued rollout of initiatives as strategic plan: Vision 2015 which identified in Defining the road ahead: consolidates on the previous strategic Service Delivery Model (2008‐2015). plan and underpins the values held This included expansion of the within Defining the road ahead. Extended Care Paramedic program • Conducted and reviewed the results of across metropolitan Adelaide, an organisation‐wide staff survey. implementation of Automatic Vehicle Action plans to address the results of Location (AVL) systems in SAAS the survey were developed, which will vehicles and further expansion of the assist in planning for the future. volunteer supported crewing model in country regions.
FUTURE DIRECTIONS (2010‐11)
• The continuation of initiatives as • The implementation of the new identified in Defining the road ahead. strategic plan: Vision 2015 which This includes: consolidates on the previous strategic o the implementation of mobile data plan and underpins the values held terminals for the ambulance fleet within Defining the road ahead. to enable direct information Scheduled to launch in early 2010‐11, transmission to vehicles without the new plan identifies strategic voice contact directions in the four key areas of our o implementation of an automatic people, leadership, service delivery vehicle location system and community. All elements of the o continued improvements and plan contain links to both South development of the ECP program. Australia’s Strategic Plan and the SA Health Strategic Plan.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 46 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
St John Ambulance Australia (NT) Inc
CONTACT DETAILS
Title: Chief Executive Officer
Incumbent: Ross Coburn
Location: 50 Dripstone Road Casuarina NT 0810
Postal Address: PO Box 40221 Casuarina NT 0811
Telephone: +61 8 8922 6201 Facsimile: +61 8 8922 6266 Email: [email protected]
CORPORATE VISION AND MISSION
VISION
Territorians form approximately 1% of the Nation’s population but currently have the highest growth percentages in population with 30% of the population being indigenous. The vision for the Service is to promote health and wellbeing to all Territorians and to form an integral part of the total Health deliver continuum.
MISSION
To be the leading provider of first aid, ambulance, and related health services in the Northern Territory.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 47 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
St John Ambulance Australia (NT) Inc is a non‐profit organisation that operates under contract to the NT Government to provide the Ambulance Services throughout the NT. The organisation comprises of essentially two separate entities – one delivering contracted Ambulance and associated services – and the other operating the traditional St John volunteer services, first aid training, first aid kit sales and contract paramedical and vehicle fit‐out activities.
The Northern Territory sits in the central north of Australia, between Western Australia and Queensland, directly above South Australia. It covers an area in excess of 2.16 million square kilometres and the total population – around 225,000 – tends to be concentrated around two major centres – Darwin (including Palmerston) and Alice Springs.
There are many challenges in the NT with the expanse we face, the large indigenous population and the average age being 31 years, the approach to Ambulance Services is certainly unique and reflects an understanding of the cultural extremities, and activities of the young, which exist.
THE YEAR IN REVIEW
Operations Centre in the Darwin Region and is likely to do so for some time. The Alice Springs • Education Region model is under review to ensure a St John Ambulance is currently Territory wide one model fits all is investigating options for the implemented in the very near future. implementation of the Degree program to Workload levels continue to remain high be run in conjunction with the current and additional resources in this area are Diploma and Advance Diploma model that of the utmost priority. St John provides as an RTO, in full • Industrial relations compliance with AQTF standards. St John is currently in negotiations for a • Communication new three year Enterprise Agreement and St John continues to co‐locate with Police, with the new Legislation, this has been a Fire and Emergency Services at a Joint huge job. Parity of wages compared to Emergency Services Communications other jurisdictions for Paramedics will form a major part of these discussions.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 48 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
FUTURE DIRECTIONS (2010‐11)
• New Agreement considered as the need remains for a much improved statistical data collection The establishment of a new system. agreement/contract for the delivery of the Ambulance Service in the NT is currently • Workload Statistics underway with an implementation date of Significant work has been done in the last 1 November 2010 planned. Matching twelve months to ensure our Paramedics current and future workloads to are delivering the best possible service for Government estimates has been the needs of the patient. The previous particularly challenging during difficult “Clinic Option” offered by St John has financial times an extensive financial been streamlined significantly due to the modelling has been undertaken to match number of other providers in this area costs to growth estimates. that exist with the Health system. Patients • VACIS/Alternative transported have remained steady this year at 38,000 but the case cycle time and The proposal for the NT Ambulance patient kilometres travelled have Electronic PCR system remains a priority increased. A 4% growth in Patients is and form a part of the current estimated for the year 2010‐11. negotiations. All options are being
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 49 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
St John Ambulance Australia (Western Australia) Inc
CONTACT DETAILS
Title: Chief Executive Officer
Incumbent: Tony Ahern ASM
Location: 209 Great Eastern Highway Belmont WA 6104
Postal Address: PO Box 183 Belmont WA 6104
Telephone: +61 8 9334 1222 Facsimile: +61 8 9334 1275 Email: [email protected]
CORPORATE VISION AND MISSION
OUR VISION
For the Service of Humanity.
OUR MISSION
To serve the Western Australian Community through the provision of high quality and cost effective First Aid and Ambulance Services.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 50 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
St John Ambulance Australia (Western Australia) Inc provides ambulance services in Western Australia. St John is a charitable, non‐profit organisation incorporated under the Associations Incorporation Act 1987. St John Ambulance is the principal provider of ambulance services for the State of Western Australia.
Western Australia covers an area of approximately 2,500,000 square kilometres. The Perth metropolitan area has a population of over 1.659 million with another 830,000 people dispersed throughout the rest of the state. The largest populated centres outside of the Perth metropolitan area are Bunbury 33979, Geraldton 37895 and Kalgoorlie 32365.
Ambulance services in the metropolitan area are provided by paid ambulance officers and paramedics. In the larger country centres, a fusion of paid and volunteer staff provide ambulance services to their given region. In the remaining country centres, services are provided entirely by volunteers who contribute around three million hours of service annually.
THE YEAR IN REVIEW
The 2009/10 year has been both a country areas serviced by career centres rewarding and very challenging year for St and 18,266 by volunteer centres. The John Ambulance in Western Australia. The increase in activity this year is just slightly year commenced with the combination of higher than the long term trend of four the financial challenges resulting from the per cent in the last decade. The majority Global Financial Crisis, coupled with of the increase in activity was in the significant public criticism following the emergency (Priority 1) and urgent (Priority airing of the ABC’s Four Corners program, 2) categories which were 10.3 per cent which saw the Minister for Health higher than last year. The non‐urgent announce a Review into the State’s categories only increased by 0.1 per cent. ambulance operations. The Review The combination of significant increases in handed down 13 recommendations, ramp time and activity growth has meant which also saw the State Government that our ‘response capacity’ continued to commit a record $146 million in funding deteriorate to levels that have made the for St John Ambulance to provide achievement of the response time targets ambulance services to the State over the impossible during the year. next four years. 2009‐10 saw the greatest number of first Across the state there were 206,316 aid students ever taught in one financial ambulance cases an increase of over five year by St John Ambulance in Western per cent on last year. There were 164,250 Australia. A total of 145,633 students cases in the metropolitan area, 23,800 in attended and completed St John
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 51 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance’s first aid courses. This is a year’s success includes the First Aid Focus significant achievement and increase over initiative which provides free first aid the previous very successful year of training in schools. The First Aid Focus 137,908 first aid students. A part of this project trained 46,521 school students.
FUTURE DIRECTIONS (2010‐11)
2010‐11 is a year of consolidation for the needed to ensure we are able to achieve organisation and will include the roll out the ambitious recruitment targets that of resources within the new contract with have been set. the State Government for the provision of A more comprehensive review of the Ambulance Services. One of the greatest activities of St John Ambulance in Western challenges for the organisation in the year Australia, is available in our annual report ahead, is the area of recruitment and which can be downloaded at our website building the organisation’s capacity www.ambulance.net.au.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 52 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
St John Ambulance Papua New Guinea
CONTACT DETAILS
Title: Chief Commissioner
Incumbent: Douglas J Kelson MES, MBE, OStJ
Location: National Headquarters Rainbow Estate Gerehu National Capital District (NCD) Papua New Guinea
Postal Address: PO Box 6075 Boroko, NCD, PNG
Telephone: +(675) 3262222 Email: [email protected]
CORPORATE VISION AND MISSION
OUR VISION
St John Ambulance Service Papua New Guinea will provide a quality and sustainable Ambulance Services within the framework of the National Health Plan of Papua New Guinea.
OUR MISSION
St John Ambulance Service Papua New Guinea will achieve our Vision by providing pre‐ hospital emergency care within a reasonable timeframe, to the community of Papua New Guinea under our agreements with the Department of Health.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 53 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
The Independent State of Papua New Guinea is a diverse Country with a population of approx 5 million people, speaking more than 800 languages and spread throughout 20 provinces. Port Moresby is the Capital of Papua New Guinea and is located within the Central Province. The National Capital District is a suburb within Port Moresby and is the business and Government hub of the Country. Approx six hundred thousand people live in Port Moresby.
St John Ambulance conducts a variety of activities within PNG and is one of the biggest Non‐ Government Organisations in the Country.
The services we provide to the community are:
• Ambulance Services – Pre‐hospital Emergency Care and Transport to the sick and injured. St John has undertaken Ambulance Services within PNG since 1983 under an agreement from the National Department of Health. Over the last 5 years we have expanded our services from Port Moresby, to include the townships of, Wewak, Popendetta, Hula, Madang and Kupiano.
• Blood Service – with the collapse of the Red Cross Blood Bank and other Blood Services in 2004, St John now operates the National Blood collection programme, including mobile collections and offers, screening and testing services as required by legislation. Our main operation is located within the grounds of the Port Moresby General Hospital.
• Health Service – Since 2008, St John has refurbished and re‐opened closed and/or near collapsed health facilities within Central Province. St John now operates on behalf of the Government, a level five Hospital at Gerehu (within Port Moresby) which has an outpatients’ clinic attached to it. St John also operates an outpatient clinic at Gordons (within Port Moresby) and between both facilities, approx 27,000 patients are seen each month, taking an enormous burden off of an already strained Port Moresby General Hospital. Additionally, St John operates smaller clinics in villages outside of Port Moresby at Gire and Tubisary.
• Volunteer Service – the traditional St John operation where members of the community come together and learn First‐Aid and other patient care principles and provide their time voluntarily to serve their communities by attending football matches and fetes, etc… and providing First‐Aid interventions until the arrival of an Ambulance. St John has approx 100 dedicated Volunteers.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 54 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
• Education Service – providing First‐Aid training to St John members, the community and industry. This is a fee for service like any other First‐Aid training conducted by various organisations throughout the World. The Education Service is also responsible for Ambulance Officer Education, induction, leadership and promotion courses for members and the personal and professional development of staff.
• Blind Service – providing primary eye care and screening to school children, assisting in the rehabilitation of persons who are newly diagnosed as vision impaired, including providing and giving instruction on how to use a white cane to assist with mobility.
Response in a Time of Need The temporary Cholera Treatment Facility was constructed by ST John staff from The Ambulance Service operated by St military tents and a hard wooden floor John in PNG is a 24/7 operation. The was installed by the Volunteers. St John communications centre answers the calls Medical and Nursing staff worked at the for assistance for a large part of the facility and were assisted by additional Country and within NCD alone; there are staff from the Provincial Health Services approx 1,100 requests for service each and St John Volunteers. month. Our operations of the Hospital and From late April 2010 until mid‐July 2010, Ambulance Service were split – so as to increased demand for service was made offer dedicated services to Cholera by a large scale Cholera Outbreak within patients without cross infecting other Central Provence. Approx 500 additional patients as we continued to operate our transports were provided to sufferers of existing services. Cholera or patients with Cholera symptoms to the St John Cholera Ambulance Service Challenges Treatment Facility, which was a Our challenges are an ageing fleet of temporary, independent, quarantined second‐hand vehicles acquired through facility located at the rear of the St John various means, which are now beyond Hospital at Gerehu. This temporary 20 bed their economic life and parts are facility admitted 342 patients and more increasingly expensive and more difficult than 500 sufferers of mild Cholera to obtain. A lack of mechanical training symptoms were treated at oral and the absence of certain types of rehydration stations established in other vehicles from PNG impose additional parts of the city. Additionally approx 500 difficulty in having some of our fleet patients were reviewed and treated but serviced and maintained. not admitted at the Cholera Treatment Facility. Limited training in patient care and a perceived lack of enthusiasm by the
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 55 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Government to provide additional funds St John has expanded its range of services to Ambulance Service, means that the in a bid to increase profits and cash flow. approx 50 Ambulance employees, who With the opening of a retail shop, St John treat more than 6,000 patients a year is now able to provide sales of First‐Aid continue to remain underdeveloped in Kits to members of the public, industry, more advanced and potentially lifesaving sporting associations and a host of other interventions. businesses which experienced difficulty in being able to purchase First‐Aid Kits and An ageing and less than ideal National supplies previously. Filling the unmet telephone system sees the Ambulance need has generated significant profits communications officers answer approx which assist us to continue work in other 600 “ghost calls” per day, which ties up areas which receive little or no funding. the 111 Emergency Service telephone lines and requires St John to roster The provision of dedicated Ambulance additional communication staff to cope crews staffed by Health Extension Officers with the inordinate amount of ghost / (Rural Doctors) has also assisted St John to false telephone activations. raise its profile, raise additional funds, and provide much needed medical support to Corporate Activities a growing industrial market.
FUTURE DIRECTIONS (2010‐11)
• Replacing and ageing and • Undertaking accreditation and uneconomical fleet improving compliance and governance • Up skilling all clinical staff beginning • Re‐structuring a workforce in order to with Ambulance Service sustain the organisation and have the • Up skilling of Education staff right skill sets developed for our • Re‐writing PNG specific First‐Aid management team publications and Ambulance texts
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 56 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
St John New Zealand
CONTACT DETAILS
Title: Chief Executive
Incumbent: Jaimes Wood
Location: St John House 114 The Terrace Wellington New Zealand
Postal Address: PO Box 10043 Wellington 6143, New Zealand
Telephone: +64 4 472 3600 Facsimile: + 64 4 499 2320 Email: [email protected]
CORPORATE VISION AND MISSION
VISION
Enhanced health and well‐being for all New Zealanders.
MISSION
The mission of St John is to prevent and relieve sickness and injury, and act to enhance the health and well‐being of all people throughout New Zealand.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 57 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
JURISDICTION
St John has provided ambulance services in New Zealand since 1885. St John is a community‐based charitable organisation with a national office in Wellington and five regional trust boards; the organisation comprises more than 16,000 volunteer and paid members.
The total population of New Zealand is 4.3 million and expected to reach 5 million in 2028. The population continues to age. The number of people aged 65 and over has doubled since 1972, to 510,000 in 2006. By the late 2020s, the number is expected to exceed one million.
St John provides ambulance services to over 85% of the country’s population and 95% of the geography. Ambulance services in Wellington are provided by Wellington Free Ambulance – an independent not‐for‐profit organisation. Services in the Taranaki and Wairarapa regions are operated by the respective District Health Boards.
St John works closely with the National Ambulance Sector Office (NASO) established by government to:
Help foster a consistent, national direction for New Zealand’s ambulance services and Co‐ordinate funding from the main agencies that fund the ambulance sector
In June 2009 NASO launched a long‐term strategy for the delivery of ambulance services in New Zealand.
Ambulance services are contracted under separate and different arrangements with the Ministry of Health (MoH) for medical emergencies and the Accident Compensation Corporation (ACC) for accident emergencies.
Funding arrangements with District Health Boards (DHB) are negotiated separately with each DHB and cover inter‐hospital patient transfer services.
Air Ambulance, contracted by the lead road ambulance service for health and directly contracted by ACC, provide a unique challenge with a complex contractual framework. Air ambulances are mobilised by road ambulance controlled communications centres to protocols developed by ACC and MoH in collaboration with the ambulance sector.
The sector body, Ambulance New Zealand, was established in the early 1990s to represent the collective interests of the various operators. This body operates as an incorporated society, independent of Government. The Board comprises representatives of land and air ambulance operators plus non‐industry representation.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 58 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
THE YEAR IN REVIEW
2010 is the year St John celebrated 125 crewed) ambulances in rural areas outside years of service in New Zealand. of the main urban centres (excluding “remote” areas. In July 2009 87% of our Strategy and Funding ambulances were fully crewed. By June St John has more than 3,700 members 2010 more than 90% of ambulances were involved in emergency ambulance and operating with a full team. patient transfer services – nearly 2,800 of With the financial support of communities whom are volunteers. We operate a fleet we continued to fund an operating deficit of 500 ambulances plus 100 support in ambulance of more than $12 million. vehicles from 193 ambulance stations The current delivery model for emergency around the country. Demand for ambulance services is not sustainable on ambulance services is growing at an this basis and we are committed to average of 4% a year. making changes and introducing In the 2009–10 year our growth in alternative care pathways that will deliver resources was insufficient to meet rising good outcomes for patients more demand, particularly in urban areas. In economically. urban areas – specifically in Auckland, We took steps to drive unity and Hamilton, Palmerston North and consistency in our decision‐making by Christchurch ‐ we are also dealing with developing our Statement of strategic increasing urban sprawl which affects our intent 2010 – 2014, re‐aligning our senior ability to reach these targets. leadership team to ensure the correct In December 2009 the Ministry of Health focus, and deciding to amalgamate our allocated $6 million recurring additional Central and Midland regions into a new funding to recruit 85 more ambulance Central Region. These are developments officers. This enabled us to increase our that will better position St John for future service coverage and helped us meet challenges in the health sector. We increasing on‐call patient demand. This continue to focus on improvements to also enabled us to improve service consolidate and deliver consistency, cost‐ capability in rural areas and to meet New savings, innovation, and balance. Zealand Transport Agency requirements Operations for managing work hours. The Operations function is managed by With that additional funding we have the Operations Director who reports to recruited 85 new full time (equivalent) the Chief Executive and delivers services ambulance officers to serve the through the five St John regions. Other community in 37 predominantly rural national functions such as Human locations. This means we are substantially Resources, Information and closer to having fully crewed (i.e. double Communication Technology, Finance etc
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 59 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
provide support at national, regional and incidents that might need a combined local levels. The Operations function is response. This has the potential to reduce serviced by a Planning and Development response times. Since July 2009 more than team to provide national consistency to 79,000 events have been transferred policy, fleet, clinical, emergency planning, electronically between services. quality, and management reporting In addition to the InterCAD project we including the use of advanced modelling renewed information and communication tools for service delivery. technology systems in our The Operations function also has communications centres, investing $5 responsibility for ongoing clinical million. This investment was in new education and clinical excellence. computer servers, improved telephony systems, upgraded paging systems and Communication Centres new workstations and screens. This year, Telecom directed 1.1 million Clinical Excellence calls to New Zealand’s three emergency communications agencies. Nearly one We continued our focus on clinical third of those ‐ 353,000 ‐ were 111 excellence – on improving clinical skills emergency calls for an ambulance. A 7% and judgement, building capability and increase on the previous year. They were implementing interventions that are managed by 142 call takers and effective and make the best use of dispatchers at the emergency ambulance resources. communications centres in Auckland, To mitigate the risk of errors, incidents Wellington and Christchurch. The and near misses we introduced a new Wellington centre is a 50/50 joint venture adverse incident management reporting with Wellington Free Ambulance, system ‐ “AIM”. It will help embed a safety operating as part of one virtual centre culture across St John, align our reporting across the three localities. with the Ministry of Health New Zealand In July 2009 a new electronic data transfer Incident Management System (NZIMS), system (called InterCAD) was introduced. introduce a systems review approach, and This connects the individual systems used improve the sharing of learning from by ambulance, Police and Fire. Our incidents and near misses. emergency ambulance communications centres now automatically share information – in real time ‐ about
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 60 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
FUTURE DIRECTIONS (2010‐11)
Strategy Development ‐ Changing How We There are also alternative response Deliver Services services that we are piloting in specific communities to prove their efficacy. These It is clear that St John must change and include: adapt our health service delivery model for the challenges facing the health sector. A Nurse Response Pilot in Those challenges include a growing and Christchurch. This provides a nurse ageing population, fewer people working, response in a vehicle to appropriate more chronic illness (heart disease, some 111 calls by patients to our cancers, diabetes and tobacco‐related Communications Centre. disorders), limits on health spending and An integrated paramedic and rural changing public expectations – New care service in Taumarunui. We are Zealanders expect the health and working with Waikato District Health disability system to provide a broader Board to co‐locate an Advanced range of services and treatments, some of Paramedic in Taumarunui Hospital to which involve expensive new work alongside clinical staff and technologies. provide an extended pool of healthcare services. We are aligning our intentions with the An extended care paramedic service Government’s strategy for primary programme we are setting up with healthcare and the introduction of new MidCentral Primary Health ways of delivering healthcare in a Organisations (in the mid‐ North community setting. We are working with Island). This is part of the local and supporting other healthcare providers strategy to reduce demand on acute in the development of business cases in care where a team of three advanced response to the Government’s ‘Better, paramedics will have additional Sooner, More Convenient’ primary training in assessment and treatment healthcare initiative. of a wider range of conditions than they traditionally have.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 61 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Comparative Data 2009-10
The following section includes data collected for the financial year 2009‐10. Data is presented in descending order based on population of the jurisdictions.
Please note the financial results have been adjusted by the Australian Bureau of Statistics (ABS) gross domestic product (GDP) price deflator where appropriate. Therefore financial results relating to previous years may not appear as first published.
The CAA gives thanks to the Productivity Commission for assistance in producing the tables and associated footnotes in this section. Benchmarking information is published annually in the Report on Government Services and further information regarding annual reports can be found at www.pc.gov.au.
For further information regarding definitions, please refer to the CAA data dictionary which can be found at www.caa.net.au.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 62 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Reported ambulance incidents, responses, patients and transport (a)
Unit NSW(b) Vic (c) Qld (d ) WA (e) SA (f) Tas ACT NT (g) Aust NZ Incidents Emergency 000 508 261 232 58 123 35 14 na 1,230 190 Urgent 000 156 159 284 50 58 23 16 na 746 98 Non-emergency 000 277 322 224 90 86 12 6 na 1,023 82 Casualty Room Attendance 000 0 0 6 0 0 0 0 0 6 Total 000 941 742 758 199 268 70 36 na 3,005 370 Population (g) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Per 1000 people no. 131 135 168 87 164 138 101 na 136 99 Responses Emergency 000 638 356 305 61 153 38 13 10 1,576 238 Urgent 000 189 188 309 52 67 24 15 18 861 113 Non-emergency 000 306 356 224 94 87 11 7 9 1,093 88 Total 000 1,133 900 838 206 307 73 36 38 3,530 439 Population (g) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Per 1000 people no. 158 164 187 91 188 144 100 166 159 118 Patients Transported 000 769 617 628 189 190 52 24 31 2,499 310 Treated not transported 000 124 65 54 17 38 9 7 3 318 45 Total 000 892 683 683 207 229 61 31 34 2,817 355 Population (g) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Per 1000 people no. 124 124 153 91 140 120 86 149 127 95 Total fleet road m km 33.4 39.6 30.3 6.3 10.4 2.7 0.9 0.8 114.4 17.1 Flying hours fixed w ing 000hrs 8.1 4.7 0.0 0.0 0.0 1.4 0.0 0.0 14.2 0.0 Flying hours rotary w ing 000hrs 6.5 2.8 0.0 0.4 0.0 0.5 0.7 0.0 10.8 0.0 Growth over last year Incidents % 0.2% 3.9% 0.1% 5.5% 8.7% 9.8% 10.3% 2.4% -0.8% Responses % 1.2% 4.2% 1.1% 5.5% 12.7% 11.7% 3.5% 1.0% 3.3% 1.0% Patients % 1.0% 4.1% 3.7% 5.4% 4.1% 20.9% 7.6% 0.5% 3.4% 0.2% (a) An incident is an event that results in a demand for ambulance resources to respond. An ambulance response is a vehicle or vehicles sent to an incident. There may be multiple responses/vehicles sent to a single incident. A patient is someone assessed, treated or transported by the ambulance service. (b) NSW: Prior to 2005-06, did not triage emergency calls. Urgent incident and response caseload are included in emergency caseload figures. In 2005-06, the introduction of medical prioritisation has allow ed for the separation of emergency and urgent activity. Comparisons of NSW cases types in 2008/09 w ith previous years is affected by changes in the Medical Priority Dispatch System classification w hich w ere implemented in 2008/09. (c) Vic: Victorian incidents and responses are for road ambulances only (excludes air ambulance). (d) Qld: Patients transported data are extrapolated to the end of each financial year utilising the end of March data. Incident and response data has been adjusted to better align w ith the Report on Government Services definition of 'Ambulance Events' and excludes standby incidents for the purpose of coverage. (e) WA: Does not have a policy of automatically dispatching more than one unit to an incident unless advised of more than one patient. Separate statistics are not kept for incidents and responses. Numbers show n under incidents are cases. (f) SA: Prior to 2006-07 incidents, response and patient data w ere based on patient case cards. Incidents, response and patient data for 2006-07 are extracted from SA Ambulance Computer Aided Dispatch data and are more aligned to the definitions provided by the CAA. As a result in some areas the data are not directly comparable w ith prior years. For 2007-08 RFDS cases w ere reclassified from urgent to non- emergency. In the 2010 report figures w ere revised retrospectively to more directly align w ith definitions except for in 2004-05. (g) NT: Incident data are unavailable as data are not recorded on the JESC systemand all cases are considered an incident. A response is counted as an incident, therefore, data for incidents are not included in the rates for Australia. (h) Historical rates in this table may differ from those in previous Reports, as historical population data have been revised using Final Rebased Estimated Resident Population (ERP) data follow ing the 2006 Census of Population and Housing (for 31 December 2001 to 2005). Population data relate to 31 December, so that ERP at 31 December 2007 is used as the denominator for 2007-08. na = Not available. .. = Not applicable. – = Nil or rounded to zero.
Incidents, responses and patients are interrelated as multiple vehicles can be sent to a single incident, and there may be more than one patient per incident. Ambulance services may also respond to incidents that do not have patients requiring treatment or transport.
In 2009‐10 ambulance services in Australia and New Zealand attended 3.4 million incidents. Two thirds of ambulance work involved attending emergency and urgent incidents with 41% of incidents categorised as emergency, 25% urgent and 34% non‐emergency.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 63 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 1: Emergency and urgent incidents per 100,000 people
14000
12000
10000
8000
6000
4000
2000
0 NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 8692 7036 10664 4147 9571 9662 6541 0 8269 5419 2006/07 9257 7563 11506 4110 10003 10022 6686 0 8797 5896 2007/08 9756 7494 12345 4174 10250 10340 7254 0 9154 7084 2008/09 9550 7321 11548 4439 10574 10667 7406 0 8939 7400 2009/10 9188 7596 11476 4727 11047 11369 8269 0 8966 7731
Figure 2: Emergency and urgent incidents per 100,000 people – 1 and 5 year growth
50.0% 40.0% 30.0% 20.0% 10.0% 0.0% ‐10.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % ‐3.8% 3.7% ‐0.6% 6.5% 4.5% 6.6% 11.7% 0.3% 4.5% 5 year % 5.7% 8.0% 7.6% 14.0% 15.4% 17.7% 26.4% 0.0% 8.4% 42.7%
In Australia over the past year the rate of emergency and urgent incidents per 100,000 people has increased by 0.3%; with decreases in New South Wales and Queensland and increases in the rest of the states and territories ranging from 3.7% in Victoria to 11.7% in ACT.
In New Zealand the emergency and urgent incidents rate per 100,000 people has increased by 4.5% over the past year.
Over the past five years, emergency and urgent incidents per 100,000 people have increased both in Australia and New Zealand, ranging from 5.7% in New South Wales to 42.7% in New Zealand.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 64 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 3: Non‐emergency incidents per 100,000 people
7000
6000
5000
4000
3000
2000
1000
0 NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 3603 5269 5124 3492 3278 2463 1580 0 4225 1726 2006/07 3585 5407 5146 3863 3716 2337 1961 0 4335 2188 2007/08 3697 5836 5206 3996 4343 1935 2276 0 4551 3039 2008/09 3782 5994 5557 4100 4705 2002 1952 0 4727 2852 2009/10 3838 5826 5075 3957 5271 2358 1769 0 4640 2194
Figure 4: Non‐emergency incidents per 100,000 people – 1 and 5 year growth
70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% ‐10.0% ‐20.0% ‐30.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % 1.5% ‐2.8% ‐8.7% ‐3.5% 12.0% 17.8% ‐9.3% ‐1.8% ‐23.1% 5 year % 6.5% 10.6% ‐1.0% 13.3% 60.8% ‐4.3% 12.0% 0.0% 9.8% 27.1%
In Australia over the 2009‐10 year the non‐emergency incidents per 100,000 people have decreased by 1.8%. Decreases have been seen in Victoria, Queensland, Western Australia and the ACT and increases were recorded in New South Wales, South Australia and Tasmania.
New Zealand has this past year seen a decrease in non‐emergency incidents per 100,000 people of 23.1%.
Over the past five years, both Australia and New Zealand have recorded an increase in non‐emergency incidents per 100,000 people; Australia by 9.8% and New Zealand by 27.1%. Queensland and Tasmania have experienced a decrease of 1% and 4.3% respectively.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 65 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 5: Non‐emergency incidents as a % of all incidents
60%
50%
40%
30%
20%
10%
0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 29% 43% 32% 46% 26% 20% 19% 34% 24%
2006/07 28% 42% 31% 48% 27% 19% 23% 33% 27% 2007/08 27% 44% 30% 49% 30% 16% 24% 33% 30% 2008/09 28% 45% 32% 48% 31% 16% 21% 35% 28% 2009/10 29% 43% 31% 46% 32% 17% 18% 34% 22%
Figure 6: Non‐emergency incidents as a % of all incidents – 1 and 5 year growth
30.0%
20.0% 10.0% 0.0%
‐10.0% ‐20.0% ‐30.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % 3.9% ‐3.6% ‐5.6% ‐5.1% 4.9% 8.7% ‐15.5% ‐1.4% ‐20.5% 5 year % 0.5% 1.4% ‐5.5% ‐0.3% 26.6% ‐15.4% ‐9.4% 0.8% ‐8.5%
In 2009‐10, non‐emergency incidents accounted for 34% of all incidents across Australia. This ranged from 17% in Tasmania to 46% in Western Australia. Overall Australia has seen a decrease of 1.4% in non‐ emergency incidents as percentage of all incidents.
In New Zealand non‐emergency incidents represent 22% of all incidents which decreased from 28% in the 2008 ‐09 year.
Over the last five years, non‐emergency incidents as a percentage of all incidents in Australia have seen an increase of 0.8% and New Zealand has seen a decrease of 8.5%
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 66 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Figure 7: All incidents per 100,000 people
20000
18000 16000 14000
12000 10000 8000
6000 4000 2000
0 NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 12296 12305 15789 7639 12849 12125 8121 0 12495 7145 2006/07 12842 12971 16652 7972 13720 12360 8648 0 13132 8083 2007/08 13454 13330 17552 8169 14592 12275 9530 0 13706 10123 2008/09 13332 13316 17105 8539 15278 12668 9357 0 13666 10252 2009/10 13025 13422 16551 8683 16317 13727 10039 0 13607 9925
Figure 8: All incidents per 100,000 people – 1 and 5 year growth
45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% ‐5.0% ‐10.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % ‐2.3% 0.8% ‐3.2% 1.7% 6.8% 8.4% 7.3% ‐0.4% ‐3.2% 5 year % 5.9% 9.1% 4.8% 13.7% 27.0% 13.2% 23.6% 0.0% 8.9% 38.9%
Overall the rate of incidents per 100,000 people in Australia has declined by 0.4% in the 2009‐10 year.
Decreases were recorded in New South Wales and Queensland, and increases ranged in other states and territories from 0.8% in Victoria to 8.4% in Tasmania.
In 2009‐10 the New Zealand incidents rate per 100,000 people decreased by 3.2%.
Over the last five years both Australia and New Zealand have been experiencing an increase in all incidents per 100,000 people. Australia has had an overall increase of 8.9% with ranges from 5.9% in New South Wales to 27% in South Australia, and New Zealand has had a 38.9% increase.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 67 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 9: Patients per 100,000 people
18000
16000 14000 12000
10000 8000 6000
4000 2000 0 NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 11798 11391 14854 7925 12322 9425 7463 12978 11839 8057 2006/07 12977 11954 15034 8340 12974 10051 7973 13704 12524 8478 2007/08 13748 12251 15403 8543 13660 10008 8003 13773 12996 7731 2008/09 12550 12219 15126 8896 13631 10014 8153 15181 12590 9740 2009/10 12360 12345 15171 9040 13936 11949 8532 14808 12785 9525
Figure 10: Patients per 100,000 people – 1 and 5 year growth
30.0% 25.0% 20.0%
15.0% 10.0% 5.0%
0.0% ‐5.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % ‐1.5% 1.0% 0.3% 1.6% 2.2% 19.3% 4.7% ‐2.5% 1.5% ‐2.2% 5 year % 4.8% 8.4% 2.1% 14.1% 13.1% 26.8% 14.3% 14.1% 8.0% 18.2%
Australian ambulance services have in 2009‐10 attended to 2.8 million patients and New Zealand has attended to 350,000 patients.
In the past year patients per 100,000 people increased by 1.5% in Australia. Increases ranged from 0.3% in Queensland to 19.3% in Tasmania and decreases were recorded in New South Wales 1.5% and Northern Territory 2.5%.
New Zealand saw a decrease of 2.2% in number of patients per 100,000 people in the past year.
Over the last five years, patients per 100,000 people have increased in Australia by 8% and 18.2% in New Zealand.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 68 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 11: Patients treated but not transported as % of all patients
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 2005/06 18.2% 8.6% 7.5% 8.9% 16.4% 20.7% 23.8% 8.1% 12.5% 11.6% 2006/07 20.3% 9.4% 8.4% 10.6% 14.0% 24.7% 28.0% 7.7% 13.8% 12.9%
2007/08 20.8% 9.5% 7.2% 10.2% 15.3% 25.4% 26.3% 6.1% 13.8% 16.3% 2008/09 13.5% 9.5% 7.7% 9.6% 16.0% 24.7% 24.0% 10.2% 11.3% 13.1% 2009/10 13.8% 9.6% 8.0% 8.4% 16.8% 14.4% 22.8% 9.5% 11.3% 12.6%
Figure 12: Patients treated but not transported as % of all patients – 1 and 5 year growth
2.0% 0.0%
‐2.0%
‐4.0% ‐6.0% ‐8.0%
‐10.0%
‐12.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % 0.3% 0.1% 0.2% ‐1.1% 0.8% ‐10.2% ‐1.2% ‐0.7% ‐0.1% ‐0.5% 5 year % ‐4.4% 0.9% 0.5% ‐0.5% 0.4% ‐6.2% ‐1.0% 1.3% ‐1.2% 1.0%
In Australia in 2009‐10 patients treated and not transported made up 11.3% of all patients. Overall Australia saw a decrease of treated but not transported patients, by 0.1%. The decrease was biggest in Tasmania, 10.2%, with the biggest increase reported in Victoria, 0.3%.
New Zealand also saw a decrease of patients treated and not transported, by 0.5%. These patients made up 12.6% of all patients in New Zealand.
The last five years have seen a decrease in treated patients not transported in Australia of 1.2%, and an increase in New Zealand of 1%.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 69 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES Ambulance services' human resources Unit NSW (b) Vic (c) Qld (g) WA (d) SA Tas (e) ACT (f) NT Aust NZ Salaried Personnel Ambulance Operatives % 86.4 81.3 82.9 70.0 77.1 80.3 80.4 79.7 82.2 63.6% Ambulance Operatives FTE 3,563.4 2,587.5 3,118.0 598.6 900.3 255.3 134.4 126.0 11,283.5 1,015.0 Patient transport officers FTE 190.1 60.0 179.0 34.9 110.2 6.4 8.3 2.0 590.9 56.3 Student & base level ambulance officers FTE 600.7 322.1 567.0 115.0 84.2 62.0 15.0 48.0 1,814.0 0.0 Qualified ambulance officers FTE 2,421.5 2,102.0 1,979.0 398.8 616.5 162.4 98.4 58.0 7,836.6 837.0 Clinical other FTE 53.6 10.9 1.0 2.0 9.3 0.5 0.0 0.0 77.3 0.0 Communications operatives FTE 297.5 92.5 392.0 47.9 80.1 24.0 12.7 18.0 964.7 121.7 Operational support personnel FTE 285.2 261.9 301.0 119.1 102.3 39.0 17.6 15.0 1,141.0 221.4 Corporate support personnel FTE 276.5 332.5 340.0 137.8 164.8 23.6 15.1 17.0 1,307.3 360.7 Total salaried personnel FTE 4,125.0 3,181.9 3,759.0 855.5 1,167.4 317.9 167.1 158.0 13,731.8 1,597.1 Volunteers Ambulance operatives no. 226 489 136 2,577 1,219 508 0 20 5,175 2,672 Operational and corporate support staff no. 0 0 0 241 166 0 0 6 413 132 Total volunteers no. 226 489 136 2,818 1,385 508 0 26 5,588 2,804 Ambulance community first responders Ambulance community first responders no. 140 474 192 559 38 62 0 0 1,465 156.0 Availability of ambulance officers/paramedics Population (e) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Students and base level officers per 100,000 people FTE 8.4 5.9 12.7 5.1 5.2 12.3 4.2 21.1 8.2 0.0 Qualified ambulance officers per 100,000 people FTE 33.7 38.2 44.2 17.6 37.7 32.1 27.7 25.5 35.4 22.6 Total per 100,000 people FTE 57.3 57.9 83.5 37.2 73.0 63.6 41.8 79.0 61.9 43.2 (a) Previous years data may not be comparable. Prior to 2007-08 volunteer data were categorised into volunteers with transport capability and first responders with no transport capability. Community first responders are reported separately from 2007-08. (b) NSW: A volunteer ambulance service audit was undertaken in 2008-09 which lead to improved reporting of community first responder numbers. (c) Vic: Data on volunteers includes some renumerated volunteers. These volunteers were remunerated for some time (usually response), but not for other time (usually on-call time). Data on community first responders includes 50 CERT and 30 Hatzolah responders. (d) WA: Operational and corporate support volunteers are the total of volunteers who perform a support role and do not undertake ambulance rosters. The reduction in this number in 2008-09 compared with earlier years has resulted from an improvement in the volunteer records system. Prior to 2008-09, the comparatively high number of volunteers in the operational and corporate support category arises from including staff involved in the provision of the public First Aid services division which accounts for 45.7 FTE of corporate personnel. (e) Tas: The number of non remunerated volunteer ambulance operatives was 448 in 2004-05, down from 567 in the preceding year due to (a) the exclusion of district health hospital staff trained to volunteer level, and (b) inactive volunteers. In Tasmania, clinical other relates to part time doctors. (f) ACT: Includes attribution of Emergency Service Agency Staff; on 1 July 2006 the ESA was re-absorbed into the Department of Justice & Community Safety and the ACT Government centralised Finance and HR staff in a Shared Service Centre. In 2007-08 ACT operational support staff are calculated by partial attribution using total ESA FTE as a driver and does not include FTE's from Shared Services. (g) Qld: Volunteer numbers may fluctuate as members leave the service, new members are recruited and data cleansing occurs. In addition, the decrease of ASOs from 2007-08 to 2008-09 can be attributed to the removal from this category of university students undergoing paramedical studies enrolled as Honorary Officers. (h) Historical rates in this table may differ from those in previous Reports, as historical population data have been revised using Final Rebased Estimated Resident Population (ERP) data following the 2006 Census of Population and Housing (for 31 December 2001 to 2005). Population data relate to 31 December, so that ERP at 31 December 2008 is used as the denominator for 2008-09. (i) From 2007-08 operational support staff include community service operatives previously reported under corporate support staff. FTE = full time equivalent. – = Nil or rounded to zero.
In 2009‐10 Australia had 13,732 full time equivalent (FTE) salaried personnel employed by ambulance services. 82% of all staff were employed primarily for operational purposes. New Zealand had 1,597 full
time equivalent salaried personnel, of which 63.6% were operational.
Volunteers are counted in number and not FTE. Australian ambulance services in total had 5,588 volunteers, of these 93% were involved in operations in 2009‐10. New Zealand had 2,804 volunteers, with a total of 95% involved in operations.
2009‐10 saw 1,465 first responders in Australia and 156 in New Zealand. These are the type of volunteers that provide an emergency response (with no transport capacity) and first aid care before ambulance arrival.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 70 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 13: Ambulance service volunteers/first responders
2005/06 2006/07 2007/08 2008/09 2009/10 8000
7000 6000 5000 4000
3000
2000 1000
0 NSW VIC QLD WA SA TAS ACT NT Australia NZ
Figure 14: Ambulance service volunteers/first responders – 1 year growth
120.0% 100.0%
80.0%
60.0%
40.0%
20.0% 0.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ ‐20.0%
‐40.0%
Ambulance volunteers in Australia and New Zealand represent a substantial proportion of the workforce, particularly in Western Australia, South Australia, Tasmania and New Zealand. Ambulance services deeply value the significant contribution volunteers make to Australian and New Zealand communities and the many sacrifices and challenges volunteers face in their duties, particularly in rural and remote areas.
Nationally in Australia in 2009‐10 ambulance services consisted of 7,053 volunteers, including community first responders. Volunteer and first responder numbers have changed insignificantly over the last year, with an exceptional increase occurring in Northern Territory.
New Zealand had a total of 2,960 volunteers and first responders in the last year, which was a 35% increase from the previous year.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 71 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance stations and locations by staff type (number) Unit NSW Vic Qld WA SA Tas ACT NT Aust NZ Ambulance stations and locations Paid staff no. 2221622372744117 4 71416 mixed paid and volunteer staff no. 6430123170 3 84104 volunteer staff no. 39 27 27 150 68 21 0 2 334 62 Total no. 267 232 264 189 115 49 7 9 1,132 182 Per 100,000 people Population (a) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Paid staff no. 3.1 2.9 5.3 1.2 2.7 2.2 2.0 1.8 3.2 0.4 mixed paid and volunteer staff no. 0.10.8–0.50.23.4– 1.30.42.8 volunteer staff no. 0.5 0.5 0.6 6.6 4.2 4.2 – 0.9 1.5 1.7 Total no. 3.7 4.2 5.9 8.3 7.0 9.7 2.0 4.0 5.1 4.9 (a) Population data relate to 31 December, so that ERP at 31 December 2009 is used as the denominator for 2009/10. – = Nil or rounded to zero.
Figure 15: Ambulance stations and locations by staff type per 100,000 people
Paid Mixed Volunteer
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NSW VIC QLD WA SA TAS ACT NT Australia NZ
In 2009 ‐10 there were 1,132 ambulance response locations Australia wide, 63% with paid staff only, 7% combination of paid and volunteer staff and 30% fully volunteer supported. The distribution varies between states and territories, with Western Australia, South Australia and Tasmania heavily relying on volunteer based response locations in rural and remote areas.
New Zealand had 182 response locations in 2009‐10. 9% were paid staff supported, 57% were supported by paid and volunteer staff and 34% were fully volunteer supported.
Ambulance services provide volunteers with quality education and ongoing training and support to ensure volunteer ambulance personnel are well prepared to meet the needs of their communities. Ambulance services continue to develop new initiatives to support the development of current Figure 16: Ambulance service salaried personnel volunteers and the recruitment of new volunteers.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 72 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 16: Ambulance service salaried personnel
2005/06 2006/07 2007/08 2008/09 2009/10
16000 14000 12000 10000 8000 6000 4000 2000 0 NSW VIC QLD WA SA TAS ACT NT Australia NZ
Figure 16 represents the numbers by jurisdiction for salaried personnel in 2009‐10.
Figure 17 represents salaried personnel per 100,000 people. Across Australia and New Zealand the number of salaried staff per 100,000 people has increased slightly from the previous year.
Figure 17: Ambulance service salaried personnel per 100,000 population
2005/06 2006/07 2007/08 2008/09 2009/10
90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 NSW VIC QLD WA SA TAS ACT NT Australia NZ
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 73 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 18: Availability of paramedics/ambulance officers per 100,000 people
2005/06 2006/07 2007/08 2008/09 2009/10
60.0
50.0
40.0
30.0
20.0
10.0
0.0 NSW VIC QLD WA SA TAS ACT NT Australia NZ
Figure 19: Availability of paramedics/ambulance officers per 100,000 people – 1 year growth
20.0%
15.0%
10.0%
5.0%
0.0%
‐5.0%
‐10.0%
‐15.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ 1 year % ‐0.6% 1.0% 1.2% ‐2.8% ‐0.5% 8.7% 4.2% ‐10.6% 0.3% 14.4%
The figures for ambulance officers/paramedics include student and base level ambulance officers and qualified ambulance officers, but exclude patient transport officers.
Overall, Australia experienced a small increase of 0.3%. Increases were highest in Tasmania, 8.7% and the ACT 4.2% and decrease was biggest in Northern Territory, 10.6% followed by Western Australia, 2.8%.
New Zealand saw an increase of 14.4% in ambulance officers/paramedics availability per 100,000 people.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 74 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance services' human resources Unit NSW (b) Vic (c) Qld (g) WA (d) SA Tas (e) ACT (f) NT Aust NZ Salaried Personnel Ambulance Operatives % 86.4 81.3 82.9 70.0 77.1 80.3 80.4 79.7 82.2 Ambulance Operatives FTE 3,563.4 2,587.5 3,118.0 598.6 900.3 255.3 134.4 126.0 11,283.5 1,015.0 Patient transport officers FTE 190.1 60.0 179.0 34.9 110.2 6.4 8.3 2.0 590.9 56.3 Student & base level ambulance officers FTE 600.7 322.1 567.0 115.0 84.2 62.0 15.0 48.0 1,814.0 0.0 Qualified ambulance officers FTE 2,421.5 2,102.0 1,979.0 398.8 616.5 162.4 98.4 58.0 7,836.6 837.0 Clinical other FTE 53.6 10.9 1.0 2.0 9.3 0.5 0.0 0.0 77.3 0.0 Communications operatives FTE 297.5 92.5 392.0 47.9 80.1 24.0 12.7 18.0 964.7 121.7 Operational support personnel FTE 285.2 261.9 301.0 119.1 102.3 39.0 17.6 15.0 1,141.0 221.4 Corporate support personnel FTE 276.5 332.5 340.0 137.8 164.8 23.6 15.1 17.0 1,307.3 360.7 Total salaried personnel FTE 4,125.0 3,181.9 3,759.0 855.5 1,167.4 317.9 167.1 158.0 13,731.8 1,597.1 Volunteers Ambulance operatives no. 226 489 136 2,577 1,219 508 0 20 5,175 2,672 Operational and corporate support staff no. 0 0 0 241 166 0 0 6 413 132 Total volunteers no. 226 489 136 2,818 1,385 508 0 26 5,588 2,804 Ambulance community first responders Ambulance community first responders no. 140 474 192 559 38 62 0 0 1,465 156.0 Availability of ambulance officers/paramedics
Population (e) m 7.2 5.5 4.5 2.3 1.6 0.5 0.4 0.2 22.2 3.7 Students and base level officers per 100,000 people FTE 8.4 5.9 12.7 5.1 5.2 12.3 4.2 21.1 8.2 0.0
Qualified ambulance officers per 100,000 people FTE 33.7 38.2 44.2 17.6 37.7 32.1 27.7 25.5 35.4 22.6 Total per 100,000 people FTE 57.3 57.9 83.5 37.2 73.0 63.6 41.8 79.0 61.9 43.2 (a) Previous years data may not be comparable. Prior to 2007-08 volunteer data were categorised into volunteers with transport capability and first responders with no transport capability. Community first responders are reported separately from 2007-08. (b) NSW: A volunteer ambulance service audit was undertaken in 2008-09 which lead to improved reporting of community first responder numbers. (c) Vic: Data on volunteers includes some renumerated volunteers. These volunteers were remunerated for some time (usually response), but not for other time (usuall y on-call time). Data on community first responders includes 50 CERT and 30 Hatzolah responders. (d) WA: Operational and corporate support volunteers are the total of volunteers who perform a support role and do not undertake ambulance rosters. The reduction in this number in 2008-09 compared with earlier years has resulted from an improvement in the volunteer records system. Prior to 2008-09, the comparatively high number of volunteers in the operational and corporate support category arises from including staff involved in the provision of the public First Aid services division which accounts for 45.7 FTE of corporate personnel. (e) Tas: The number of non remunerated volunteer ambulance operatives was 448 in 2004-05, down from 567 in the preceding year due to (a) the exclusion of district health hospital staff trained to volunteer level, and (b) inactive volunteers. In Tasmania, clinical other relates to part time doctors. (f) ACT: Includes attribution of Emergency Service Agency Staff; on 1 July 2006 the ESA was re-absorbed into the Department of Justice & Community Safety and the ACT Government centralised Finance and HR staff in a Shared Service Centre. In 2007-08 ACT operational support staff are calculated by partial attribution using total ESA FTE as a driver and does not include FTE's from Shared Services. (g) Qld: Volunteer numbers may fluctuate as members leave the service, new members are recruited and data cleansing occurs. In addition, the decrease of ASOs from 2007-08 to 2008-09 can be attributed to the removal from this category of university students undergoing paramedical studies enrolled as Honorary Officers. (h) Historical rates in this table may differ from those in previous Reports, as historical population data have been revised using Final Rebased Estimated Resident Population (ERP) data following the 2006 Census of Population and Housing (for 31 December 2001 to 2005). Population data relate to 31 December, so that ERP at 31 December 2008 is used as the denominator for 2008-09. (i) From 2007-08 operational support staff include community service operatives previously reported under corporate support staff. FTE = full time equivalent. – = Nil or rounded to zero.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 75 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 20: Operational ambulance workforce by age group
Under 30 30‐39 40‐49 50‐59 60 or over
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NSW VIC QLD WA SA TAS ACT NT Australia NZ
Figure 20 presents operational workforce by age group and is identified as staff with paramedic qualifications desirable or essential to the role. The larger the proportion of operational workforce closer to retirement, the more likely sustainability problems will arise in the future.
In Australia 81% of the workforce was aged under 50, and 70% in New Zealand. These numbers have changed slightly from the previous year.
Figure 21 presents 2009‐10 staff attrition, which is calculated as the proportion of FTE employees who exit the organisation during the year.
In Australia staff attrition was 4.1% and varied between states and territories from 18.5% in Northern
Territory to 1.2% in South Australia. New Zealand had a 4.4% staff attrition rate.
Figure 21: Operational ambulance staff attrition (FTE)
20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% NSW VIC QLD WA SA TAS ACT NT Australia NZ
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 76 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance assets (number)(a) Unit NSW (b) Vic (c) Qld WA SA Tas ACT (d) NT Aust NZ Ambulance stations and locations Response locations no. 267 232 264 189 115 49 7 9 1,132 182 Communications centres no. 5 10711 11 1 273 Other locations no. 47 33 25 113 16 6 3 1 244 34 Total no. 319 275 296 303 132 56 11 11 1,403 219 First responder locations Ambulance first responder locations no. 13 30 27 87 54 - - 166 37 Third party first responder locations no. 568- - 8 3 - - 84 91 Total no. 18 98 27 87 13 7 0 0 250 128 Ambulance and other vehicles Ambulance general purpose no. 887 528 788 448 207 108 20 31 3,017 390 Patient transport vehicles no. 95 50 110 16 19 4 3 2 299 76 Operational support vehicles no. 371 298 216 12 95 23 4 9 1,028 104 Special operations vehicles no. 57 15 13 8 15 0 0 0 108 31 Administrative vehicles no. 48 146 54 44 36 2 2 9 341 113 Other vehicles no. 74 30 56 19 13 5 4 5 206 52 Total no. 1,532 1,067 1,237 547 385 142 33 56 4,999 766 (a) Differences in geography, topography and operational structures require different resourcing models across jurisdictions. (b) NSW: A volunteer ambulance service audit w as undertaken in 2008-09 w hich has led to improved reporting of data for ambulance stations and locations. (c) Vic: General purpose ambulances exclude contractors’ nonemergency vehicles and special operations vehicles include four fixed w ing and three rotary w ing aircraft under contract. In 2006-07 for the then Victorian Metropolitan Ambulance Service (MAS), tw o ambulances w ere excluded as they w ere loaned for student training purposes only and not used for responding. (d) ACT: For 2006-07 the ESA provided shared HQ/Comcen, Fleet Workshop and Store/Logistics Centre to all four operational agencies (ambulance, urban fire, rural fire, and SES). (e) Response locations data for 2007-08 and subsequent years reflect changes in the new data definition, w hich do not include first responder locations, now reported separately. – = Nil or rounded to zero.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 77 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance Service Costs ($000) (2009/10 dollars) (a)
NSW Vic (b) Qld WA(c) SA (d) Tas (e) ACT (f) NT (g) Aust NZ 2005/06 Labour (f) 339,536 295,153 252,283 43,596 77,927 22,370 14,251 10,006 1,055,122 Capital Depreciation 16,481 20,310 24,047 6,080 8,675 2,227 383 642 78,846 User cost of capital Land 5,518 3,916 4,607 2,510 607 206 239 24 17,627 Other assets 13,800 14,820 21,393 4,246 3,688 883 1,328 760 60,917 Other costs 130,980 135,649 80,080 34,580 29,535 10,247 7,408 3,355 431,834 Interest on 123 0 379 0 0 0 0 20 521 Total costs (h) 500,798 453,374 366,602 88,502 119,824 34,515 23,371 14,762 1,601,749 2006/07 Labour (f) 341,927 287,919 261,812 45,057 87,804 23,441 12,646 10,768 1,071,371 Capital Depreciation 16,711 20,935 27,958 8,215 8,468 1,249 584 604 84,725 User cost of capital Land 5,275 3,958 6,821 3,907 808 190 308 23 21,291 Other assets 13,030 16,811 22,912 1,882 3,850 904 713 864 60,965 Other costs 150,922 144,987 92,211 42,807 33,102 11,050 8,476 3,514 487,069 Interest on 2 0 230 0 0 0 0 0 232 Total costs (h) 522,589 470,652 394,852 97,961 133,224 35,293 22,419 15,750 1,692,739 2007|08 Labour (f) 374,589 305,349 284,355 53,651 100,931 25,783 13,542 13,330 1,171,531 Capital Depreciation 23,238 20,320 28,257 9,370 8,997 1,860 495 785 93,322 User cost of capital Land 4,908 4,155 6,526 774 1,039 174 349 22 17,947 Other assets 12,105 15,638 23,809 5,100 3,807 1,075 709 884 63,126 Other costs 170,332 149,835 93,071 42,030 40,798 10,711 8,605 4,204 519,587 Interest on 0 0 139 0 0 0 0 0 139 Total costs (h) 580,265 491,142 418,021 110,151 154,533 37,903 23,351 19,203 1,834,567 2008/09 Labour (f) 413,424 307,293 301,477 58,343 159,666 27,968 14,885 11,718 1,294,774 89,985 Capital Depreciation 19,852 21,206 34,002 10,235 9,975 1,789 792 871 98,722 11,256 User cost of capital Land 4,755 4,081 8,878 737 1,048 567 412 21 20,499 2,413 Other assets 11,875 17,383 26,165 5,002 3,450 1,486 671 248 66,280 4,706 Other costs 183,384 166,491 111,579 39,825 40,779 11,557 9,015 4,227 566,857 79,710 Interest on 0 0 48 0 0 0 0 0 48 1,035 Total costs (h) 628,535 512,373 461,318 113,405 213,870 41,272 25,363 17,064 2,013,200 189,105 2009/10 Labour (f) 438,194,000 333,951,742 340,360,000 63,604,000 121,114,000 29,784,000 22,798,000 13,142,000 1,362,947,742 107,193 Capital Depreciation 20,303,000 26,389,895 37,098,000 10,492,374 9,672,000 2,240,000 721,000 918,000 107,834,269 13,822 User cost of capital Land 5,281,680 4,020,516 8,892,720 770,022 1,048,480 597,000 412,000 21,000 21,043,418 2,387 Other assets 10,724,800 15,376,531 26,723,600 5,190,000 3,653,280 1,772,000 701,360 249,000 64,390,571 5,054 Other costs 194,238,000 170,852,632 102,661,000 45,733,000 42,471,000 11,361,000 10,274,000 3,903,000 581,493,632 50,616 Interest on 0 0 9,000 0 0 0 0 0 9,000 400 Total costs (h) 663,459,800 546,570,800 493,353,600 125,019,374 176,910,280 43,468,000 34,494,360 18,212,000 2,101,488,214 179,471 (a) Data are adjusted to 2008-09 dollars using the gross domestic product (GDP) price deflator (2008-09 = 100). (b) Vic: From 1st July 2006 Metropolitan Ambulance Service (MAS), now Ambulance Victoria (AV), was exempt from Payroll Tax. (c) WA: uses a contracted service model for ambulance services. (d) SA: The increase in salaries and payments in the nature of salaries from 2007-08 to 2008-09 reflect three significant events: 1) increase in wages, 2) subsequent back pay paid to frontline paramedics as a result of the "work value" case (from the 2007 enterprise bargaining agreement) reaching finalisation and 3) an increase in the number of frontline paramedics recruited. (e) Tas: The service is part of the Department of Health and Human Services and sources Corporate Support Services from the Department. The value of other assets reported in 2004-05 was overstated; it included the value of land that was already reported separately.
(f) ACT: For 2005-06, the Ambulance Service data has been collated using the new Emergency Services Agency Capability Model, which utilises a different cost attribution model for shared costs across the Emergency Services Agency. Therefore, the financial figures for 2005-06 cannot be directly compared with those of previous years. (g) NT: use a contracted service model for ambulance services. All property holding assets are held under a separate entity to St John Ambulance NT.
(h) The user cost of capital is partly dependent on depreciation and asset revaluation methods employed. na. = not available/ – = Nil or rounded to zero. COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 78 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Satisfaction with ambulance service organisations (a) Unit NSW Vic Qld W A SA Tas ACT NT Aust NZ 2006 Patients surveyed 1300 2600 1300 1300 1300 1300 1300 1300 11700 na Very satisfied or satisfied % 98.0 97.0 98.0 95.0 99.0 97.0 98.0 96.0 97.0 na Neither satisfied nor dissatisfied % 1.0 2.0 1.0 3.0 - 2.0 1.0 1.0 1.0 na Dissatisfied or very dissatisfied % 1.0 1.0 1.0 2.0 1.0 1.0 1.0 3.0 2.0 na Total usable responses % 30 40 44 25 46 52 36 20 37 na Total usable responses no. 395 1,028 568 329 597 679 471 260 4,326 na Patients not s urveyed (b) 000 800 577 599 160 191 45 24 26 2,421 na Total patients (c) 000 801 579 601 161 192 46 25 27 2,432 na 2007 Patients surveyed 1300 2600 1300 1300 1300 1570 1300 1300 11970 na Very satisfied or satisfied % 97.0 97.5 97.0 97.0 98.0 99.0 95.0 93.0 97.0 na Neither satisfied nor dissatisfied % 1.0 2.0 1.0 1.0 1.0 1.0 3.0 4.0 2.0 na Dissatisfied or very dissatisfied % 2.0 0.5 2.0 2.0 1.0 - 2.0 3.0 1.0 na Total usable responses % 36 47 39 23 49 43 37 19 38 na Total usable responses no. 464 1,227 507 305 641 679 479 241 4,543 na Patients not s urveyed (b) 000 888 615 620 172 203 48 26 28 2,599 na Total patients (c) 000 8896176211742044927292611 na 2008 Patients surveyed 1300 2600 1300 1300 1300 1560 1300 1300 11960 1300 Very satisfied or satisfied % 96.0 98.0 99.0 96.0 98.0 98.0 96.0 96.0 98.0 97 .0 Neither satisfied nor dissatisfied % 2.0 1.0 - 2.0 1.0 - 1.0 2.0 1.0 2.0 Dissatisfied or very dissatisfied % 2.0 1.0 1.0 2.0 1.0 2.0 3.0 2.0 1.0 1.0 Total usable responses % 27 44 37 30 45 45 35 18 36 33 Total usable responses no. 350 1,136 479 389 590 701 458 236 4,339 430 Patients not s urveyed (b) 000 951 640 650 181 216 48 26 29 2,741 280 Total patients (c) 000 9526436511822175027302753281 2009 Patients surveyed no. 1300 2600 1300 1300 1300 1590 2081 1300 12771 1300 Very satisfied or satisfied % 98.0 97.0 98.0 96.0 98.0 98.0 96.0 97.0 97.0 98 .0 - 95% confidence interval (d) % ±1.4 ±0.9 ±1.2 ±1.8 ±1.0 ±1.1 ±1.3 ±2.4 ±0.5 ±1.3 Neither satisfied nor dissatisfied % 1.0 2.0 1.0 2.0 1.0 1.0 1.0 3.0 2.0 2.0 Dissatisfied or very dissatisfied % 1.0 1.0 1.0 2.0 1.0 1.0 3.0 - 1.0 - Total usable responses % 36 43 44 34 47 43 36 16 38 34 Total usable responses no. 467 1,121 571 444 613 689 744 202 4,851 437 Patients not s urveyed (b) 000 882 653 657 195 218 49 26 32 2,712 353 Total patients (c) 000 8846566581962205028332725354 2010 Patients surveyed no. 1300 2600 1300 1300 1300 1730 1300 1300 12130 1395 Very satisfied or satisfied % 98.0 98.0 98.0 98.0 99.0 97.0 97.0 97.0 98.0 98.0% - 95% confidence interval (d) % ±1.1 ±0.9 ±1.3 ±1.3 ±0.9 ±1.1 ±1.6 ±2.4 ±0.4 ±1.5 Neither satisfied nor dissatisfied % 1.0 1.0 1.0 1.0 – 1.0 1.0 1.0 1.0 1.0% Dissatisfied or very dissatisfied % 1.0 1.0 1.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0% Total usable responses % 37% 42.5% 36.0% 31.0% 43.0% 46% 40.0% 15% 37% 32.0% Total usable responses no. 486 1 071 466 400 565 795 526 194 4 503 450 Patients not s urveyed (b) 000 891 680 681 205 227 59 29 33 2 805 354 Total patients (c) 000 892 683 683 207 229 61 31 34 2 817 355 (a) These results are from a survey randomly distributed to Code 1 and 2 (Emergency and Urgent) patients, per jurisdiction, per year. (b) Number of patients not surveyed is equal to the total number of patients (those transported plus those not transported) minus the patients who were surveyed. (c) Total patients is equal to the sum of the number of patients transported plus the number treated and not transported. (d) 2009, 2010 rates include standard errors for the 95% confidence interval (for example, X per cent ± X per cent), confidence intervals for prior years are not available. na. = not available / – = Nil or rounde d to ze ro. Source : Council of Ambulance Authorities 2005-2009 National Patient Mailout Satisfaction Research, Adelaide.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 79 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Figure 22: Proportion of ambulance users who were satisfied or very satisfied with the ambulance service
2005/06 2006/07 2007/08 2008/09 2009/10
100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% NSW VIC QLD WA SA TAS ACT NT Australia NZ
In 2009‐10 the overall satisfaction with ambulance services in Australia and New Zealand was again high at 98%.
The satisfaction levels continued to rise this year, with most jurisdictions recording an increase in the percentage of people who were ‘satisfied’ or ‘very satisfied’ with overall ambulance services.
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 80 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Ambulance code 1 response times (minutes) (a) NSW (b) Vic ( c) Qld (d) WA(e) SA (f) Tas (g) ACT NT NZ Statewide 50th percentile
2004/05 9.8 9.0 8.0 9.1 9.4 10.1 7.5 9.5 na 2005/06 9.5 9.0 8.0 9.7 9.6 10.2 7.5 8.5 na 2006/07 9.6 10.0 8.2 9.0 9.4 10.5 8.2 9.0 8.3 2007/08 9.9 10.0 8.3 9.3 9.4 10.3 9.1 10.1 8.7 2008/09 10.3 9.9 8.4 9.5 9.4 10.9 10.3 9.5 10.9 2009/10 10.3 10.0 8.1 9.6 9.4 11.0 10.0 10.1 10.8 Statewide 90th percentile
2004/05 19.7 17.0 16.0 15.4 17.0 20.7 12.3 21.5 na 2005/06 19.6 17.0 16.0 15.9 17.4 21.1 13.3 21.0 na 2006/07 19.7 18.0 16.5 15.2 15.6 21.5 14.2 22.0 17.1 2007/08 19.9 19.0 16.7 16.6 15.7 22.4 16.2 23.5 20.3 2008/09 20.8 19.0 17.2 17.6 16.0 22.8 16.8 19.6 22.6
2009/10 21.0 19.9 16.4 17.8 16.1 22.8 15.8 24.1 23.3 Capital city 50th percentile 2004/05 na na na na na na na na na 2005/06 9.1 9.0 9.0 9.1 9.4 9.2 7.5 8.3 7.9 2006/07 9.3 9.0 8.3 8.9 9.3 9.4 8.2 8.3 7.8
2007/08 9.7 9.4 8.4 9.2 9.3 9.6 9.1 12.5 8.0 2008/09 10.1 9.2 8.5 9.2 9.2 10.0 10.3 7.6 10.8 2009/10 10.0 9.5 8.1 9.4 9.3 10.2 10.0 8.1 10.9 Capital city 90th percentile 2004/05 na na na na na na na na na 2005/06 16.6 14 15 15.4 15.2 15.3 13.3 21 14.4 2006/07 20.0 15.0 15.0 14.9 14.4 15.6 14.2 20.5 13.7
2007/08 17.8 15.5 15.3 15.6 14.4 16.0 16.2 22.0 14.7 2008/09 18.7 15.1 15.8 15.7 14.2 16.6 16.8 14.1 19.8 2009/10 18.3 15.7 14.5 15.0 14.3 16.6 15.8 17.2 20.6 (a) Response times commence from the following time points: Vic (AV rural) - receipt of call; Vic (AV metro), SA and Tas - first key stroke; NSW, Qld (QAS) and WA - transfer to dispatch; NT - crew (b) NSW: Did not triage emergency calls prior to 2005-06. Results for code 1 cases represent '000' and urgent medical incidents. In 2005-06 the introduction of medical prioritisation has allowed for separation of emergency and urgent activity. A volunteer ambulance sector audit was undertaken in 2008-09 which led to improved reporting. (c) Vic: The basis of response time reporting changed in 2007-08 and results are not directly comparable with previous years. Metropolitan response and case times data are sourced from Computer Aided Dispatch system, prior to 2008-09 these data were sourced from patient care records completed by paramedics. Rural response times are sourced from Patient Care Records (d) Qld: Casualty room attendances are not included in response count and, therefore, are not reflected in response times data. Response times are reported from the Computer Aided Dispatch (e) WA: Ambulance first responder locations data are not available for 2007-08. (f) SA: figures have been revised retrospectively to more directly align with definitions, except for in 2004/05. Code 1 response times are now calculated from SA Ambulance CAD data and are more aligned to the definitions provided by the CAA. Prior to 2006-07 code 1 response times were calculated on all responses to category 1 and 2 cases and based on patient case cards. Code 1 response times from 2006-07 have excluded second and subsequent vehicles arriving at an incident and exclude incidents where the category of dispatch was upgraded. (g) Tas: The highest proportion of population is in small rural areas, relative to other jurisdictions, which increases average response times. na - Not available
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 81 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
Cardiac arrest survived event rate (a), (b), (c), (d), (e), (f), (g) Unit NSW (h) Vic (i) Qld WA (j) SA Tas ACT NT (k) Aust Adult cardiac arrests where resuscitation attempted
2005/06 Cardiac Arrests no. na 1592 1369 364 na na 67 na na 2005/06 Survival Incidents no. na 426 248 31 na na 23 na na 2005/06 Survival Rate % na 26.8 18.1 8.5 na na 34.3 na na 2006/07 Cardiac Arrests no. 1875 1655 1505 380 633 na 59 53 na 2006/07 Survival Incidents no. 387 463 242 45 151 na 14 7 na 2006/07 Survival Rate % 20.6 28 16.1 11.8 23.9 na 23.7 13.2 na 2007/08 Cardiac Arrests no. 2438 1702 1577 389 620 83 64 111 6984
2007/08 Survival Incidents no. 476 473 293 35 157 29 17 24 1504 2007/08 Survival Rate % 19.5 27.8 18.6 9 25.3 34.9 26.6 21.6 21.5
2008/09 Cardiac Arrests no. 1821 1772 1533 355 631 131 69 72 6384 2008/09 Survival Incidents no. 337 586 364 48 149 42 23 12 1561 2008/09 Survival Rate % 18.5 33.1 23.7 13.5 23.6 32.1 33.3 16.7 24.5 2009/10 Cardiac Arrests no. na 1 742 1 552 329 565 170 53 86 4 497 2009/10 Survival Incidents no. na 601 349 38 132 47 18 15 1 200 2009/10 Survival Rate % na 34.5 22.5 11.6 23.4 27.6 34.0 17.4 26.7 Adult VF/TF cardiac arrests
2005/06 Cardiac Arrests no. na 577 470 118 na na 23 na na 2005/06 Survival Incidents no. na 228 143 20 na na 8 na na
2005/06 Survival Rate % na 39.5 30.4 16.9 na na 34.8 na na 2006/07 Cardiac Arrests no. 403 510 458 121 194 na 19 10 na 2006/07 Survival Incidents no. 164 214 138 33 90 na 7 1 na 2006/07 Survival Rate % 40.7 42 30.1 27.3 46.4 na 36.8 10 na 2007/08 Cardiac Arrests no. 487 508 436 133 161 29 26 31 1811 2007/08 Survival Incidents no. 183 232 144 22 69 11 10 10 681 2007/08 Survival Rate % 37.6 45.7 33 16.5 42.9 37.9 38.5 32.3 37.6
2008/09 Cardiac Arrests no. 453 566 430 114 172 48 25 na 1808 2008/09 Survival Incidents no. 149 290 179 30 81 25 11 na 765 2008/09 Survival Rate % 32.9 51.2 41.6 26.3 47.1 52.1 44 na 42.3 2009/10 Cardiac Arrests no. na 530 436 107 143 45 18 na 1 279 2009/10 Survival Incidents no. na 281 158 25 64 21 8 na 557 2009/10 Survival Rate % na 53.0 36.2 23.4 44.8 46.7 44.4 na 43.5 Paramedic witnessed adult cardiac arrests 2005/06 Cardiac Arrests no. na 261 266 54 na na 8 na na 2005/06 Survival Incidents no. na 92 82 12 na na 1 na na 2005/06 Survival Rate % na 35.2 30.8 22.2 na na 12.5 na na 2006/07 Cardiac Arrests no. 191 246 292 36 84 na 3 9 na 2006/07 Survival Incidents no. 71 98 93 8 44 na 1 3 na 2006/07 Survival Rate % 37.2 39.8 31.8 22.2 52.4 na 33.3 33.3 na 2007/08 Cardiac Arrests no. 246 323 299 49 65 16 8 17 1 023 2007/08 Survival Incidents no. 83 131 99 14 31 5 4 11 378 2007/08 Survival Rate % 33.7 40.6 33.1 28.6 47.7 31.3 50.0 64.7 37.0 2008/09 Cardiac Arrests no. 262 357 278 58 104 17 12 na na 2008/09 Survival Incidents no. 70 154 94 19 45 9 4 na na 2008/09 Survival Rate % 26.7 43.1 33.8 32.8 43.3 52.9 33.3 na na 2009/10 Cardiac Arrests no. na 364 291 39 74 30 8 na na 2009/10 Survival Incidents no. na 174 104 12 30 14 3 na na 2009/10 Survival Rate % na 47.8 35.7 30.8 40.5 46.7 37.5 na na
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 82 PROVIDING LEADERSHIP FOR THE PROVISION OF AMBULANCE SERVICES
(a) Rates are the percentage of patients aged 16 years or over who were in out-of-hospital cardiac arrest (excluding paramedic witnessed) for: (1) all adult cardiac arrests where any chest compressions and/or defibrillation was undertaken by ambulance/EMS personnel, where the patient has a return of spontaneous circulation (ROSC) on arrival at hospital; and (2) adult Ventricular Fibrillation (VF)/Ventricular Tachycardia (VT) cardiac arrests (a further breakdown of cardiac arrest data) where the arrest rhythm on the first ECG assessment was either VFor VT, where the patient has a ROSC on arrival at hospital. For the out of hospital setting, survived event means sustained ROSC with spontaneous circulation until administration and transfer of care to the medical staff at the receiving hospital (Jacobs, et al. 2004). Note that this does not reflect the proportion of patients who will survive to be discharged from hospital alive. (b) For each of the indicators used a higher or increasing rate is a desirable outcome. (c) Successful outcome is defined as the patient having ROSC on arrival to hospital (i.e. the patient having a pulse). This is not the same as the patient surviving the cardiac arrest, as having ROSC is only one factor that contributes to the overall likelihood of survival. (d) The indicators used to measure outcomes for cardiac arrests are not directly comparable as each are subject to variations based on differing factors used to define the indicator which are known to influence outcome. A recent review of the data across jurisdictions has highlighted a level of uncertainty that all jurisdictions are utilising a consistent definition in the denominator presented with the Cardiac Arrest data. These discrepancies are currently the subject of further review. (e) The indicator 'Adult cardiac arrests where resuscitation attempted' provides an overall indicator of outcome without specific consideration to other factors known to influence survival. (f) Patients in VF or VT are more likely to have better outcomes compared with other causes of cardiac arrest as these conditions are primarily correctable through defibrillation. (g) Paramedic witnessed cardiac arrests are excluded in the indicators reported as these cardiac arrests are treated immediately by the paramedic and as such have a better likelihood of survival due to this immediate and rapid intervention. This is vastly different to cardiac arrests occurring prior to the ambulance arriving where such increasing periods of treatment delay are known to negatively influence (h) NSW: data collected for Ambulance Service NSW are based on recorded protocols as instigated by in- field paramedics. (i) Vic: excludes patients with unknown rhythm on arrival at hospital. (j) WA: data are provided for the capital city only. (k) NT: VF/VT arrests are not available due to a change in systems. na - Not available
COUNCIL OF AMBULANCE AUTHORITIES INC. 2009‐10 REPORT Page 83
The Council of Ambulance Authorities Inc The Council of Ambulance Authorities Inc.
POPO Box Box 1116, 1116, Flinders Park Park SA SA 5025 5025
235235 Grange Grange Road,Road, FindonFindon SA SA 5023 5023
Ph.:Ph: 0808 8243 19341934
Fax:Fax: 08 08 8243 8243 0259
E‐Email:‐mail: [email protected] [email protected]
Web:Web: www.caa.net.au www.caa.net.au