Ambulance Employees Association rebukes SA Health ramping decree

SA Health’s extraordinary set of rules to cut ramping times has been derided by the ambulances union, which says it will cause as many problems as it solves.

SA Health plans to ease ramping with new legal directions to speed up transfers to hosptials and to impove flow inside hospitals have fallen flat with the ambulance officers’ union.

SA president of the Ambulance Employees Association Leah Watkins said paramedics were notified of the changes through a memo on Thursday.

She said the directions stated patients would no longer have preference about what hospital they are taken to.

“Our crews are somewhat concerned that this will become a more common experience of patients, of having to drive in between hospitals,” Ms Watkins said.

“And they’ll be directed to certain hospitals based on the demand, not about which is clinically the most appropriate hospital for them to go to.”

She said more resources were needed within hospitals.

Ambulances entering the Royal Adelaide Hospital. Picture: NCA NewsWire/Brenton Edwards

“I don’t see how they could achieve it to be honest. If it was that easy, I think the government should have had a responsibility to give this direction years ago, not 20 months into a pandemic,” she said.

“It goes some way to address the risk for patients who have yet received an ambulance, I think it then creates a whole other level of risk for patients and staff within the hospital.”

She questioned who would police this new “law”.

“Who is ultimately responsible for that, if they have broken the law?,” she said.

“Simply declaring it or directing that it be so doesn’t necessarily make it so.”

The SA Salaried Medical Officers Association (SASMOA) warns the directions “will result in unsafe care of patients by overriding clinical priorities needed for safe and effective care.”

The union’s members say, with no needed resources, it won’t fix ambulance ramping and is “a naive act which endangers the people of SA.”

Ramping at the RAH last month.

Tough new rules in ambo ramping crackdown

SA Health chief executive Dr Chris McGowan has issued extraordinary legal directions ordering faster offloading of patients from ambulances and other measures to tackle ramping.

Describing Covid as “an existential threat,” he said now was the time to seize the opportunity of 392 extra beds and 1920 extra staff being recruited to massively improve patient flow and build capacity for long-term change.

The legal order applies to boards of Local Health Networks (LHNs) then to their chief executives and clinical department heads. While there is no financial or penal penalty for failure, they face the sack if they do not comply.

The executive power rarely has been used – once was to fast-track elective surgery after it was cancelled during the pandemic – but Dr McGowan believes orders to improve efficiency have the potential to turn the 392 extra beds under plans for Covid “into the equivalent of 1000.”

Dr Chris McGowan, Chief Executive, Department for Health and Wellbeing. Picture: NCA NewsWire / Naomi Jellicoe

The legal direction under the Health Care Act 2008 means 75 per cent of patients in ambulances must be transferred to EDs within 30 minutes of arrival, compared to the current average of 34 minutes, “and no longer than 60 minutes.”

SA Health has a goal of 90 per cent of ambulance arrivals being transferred to an ED within 30 minutes – but this is a “target” rather than a legal direction.

Demand surges mean Dr McGowan cannot not guarantee the order will end ramping but he says: “I am optimistic about it.”

Other legal directions are:

■ DIRECT admission to wards for intra-hospital transfers, bypassing EDs unless clinically required, to ease pressure on EDs and further ease ramping;

■ PATIENTS ready to move from an acute ward to community care must be transferred within 24 hours of a placement being found, to free up beds;

■ ONCE clinically ready, patients will be transferred to their “home” LHN within 24 hours once a place is available.

Leah Watkins, president for the Ambulance Employees Association SA said paramedics were notified of the changes through a memo from South Australian Ambulance Service’s CEO David Place on Thursday.

She said the directions stated patients would no longer have preference about what hospital they are taken to.

“Our crews are somewhat concerned that this will become a more common experience of patients, of having to drive in between hospitals,” Ms Watkins said.

“And they’ll be directed to certain hospitals based on the demand, not about which is clinically the most appropriate hospital for them to go to.”

She said more resources were needed within hospitals.

“If it was that easy, I think the government should have had a responsibility to give this direction years ago, not 20 months into a pandemic,” she said.

“It goes some way to address the risk for patients who have yet received an ambulance, I think it then creates a whole other level of risk for patients and staff within the hospital.”

She questioned who would police this new rules. .

“Who is ultimately responsible for that, if they have broken the law?” she said.

“Simply declaring it or directing that it be so doesn’t necessarily make it so.”

Dr McGowan conceded “the system is tired and it has been working at capacity for some time.”

However, he said these orders will crystallise what is needed to improve patient flow, build capacity, cement such goals as policy and ensure “people work smarter rather than harder.”

He said the decision to issue the order now, rather than in the build-up to opening borders, was due to the opportunity to significantly increase patient flow based on the 392 extra beds and 1920 extra staff coming online.

“We want to create flow in the system and this can go a long way to increasing capacity,” he said.

Ramping has hit record levels, and occurred at the Women’s and Children’s Hospital for the first time this week.

However, Dr McGowan noted such occurrences were relatively rare and were caused by issues including some people using ambulances “as taxis” when they couldn’t get to their GP.

It comes as all unvaccinated taxi and rideshare drivers are no longer able to work in SA.

The new jab mandate was introduced on Monday night and requires “point-point” drivers to have at least one Covid-19 vaccination by November 25.

Originally published as Ambulance Employees Association rebukes SA Health ramping decree