The Public Shame of Australia's Ambulance Victoria

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Permalink Reply by The Cannulator on September 27, 2010 at 11:31am

So that also reflects on me.

A lot may be said of our shortcomings of late-- after all an election is coming up, why wouldn't you?

What are the solutions--I'm being serious--so many complaints, many misinformed at times but very little in the way of solutions.

More ambulances? Yes. Lets just cart more patients around. Who is going to work them? Ooodles of bums on seats doesn't help-- the workforce is becoming diluted with inexperience.

Not having a dig, but I really get riled up when the only time someone gives a toss is election and EBA time.

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Permalink Reply by Neil White on September 27, 2010 at 6:15pm

I don't get it you could do a google search and come up with the same number of news stories on any ambulance operation in the world good or bad....the nature of the work we do is inherently more risky that any other operation.

The statistics quoted seem to suggest that the service is reaching its priority KPI at 83.33% which is remarkably better than a majority of UK agencies...

http://www.ambulanceleadershipforum.org/uk_ambulance_service/nation...

Nationally we are at 76.5% for reaching priority emergencies.

North East: 75.7 North West: 74.3 Yorkshire: 69.4 East Midlands 76.0

West Midlands 75.4 East of England: 74.6 London: 75.5 South East Coast: 75.2 South Central: 72.6

Great Western 68.4 South Western 78.0 Isle of Wight 77.0

http://www.ic.nhs.uk/

Rural ambulance services are a nightmare to plan, prepare and deliver. The call volume is low, but when there is a job its going to be a good'un and you need a rapid first response, you need a transporting crew. Then you know the transporting crew is going to be out of service for double what a metro crew would be. Here most rural services are delivered by advanced practitioners now, with the ability to treat and complete on scene. Sometimes it works and sometimes it doesn't....

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Permalink Reply by Ben Waller on September 27, 2010 at 8:14pm

This is one reason I don't prefer my EMS socialized. When the rural areas can't get adequate coverage despite a national system that's supposed to provide that coverage, then one of the supposed big advantages of the socialized EMS system maybe isn't such a big advantage.

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Permalink Reply by The Cannulator on September 27, 2010 at 8:43pm

It is a statewide system, not national (we only have 6 states and Two territories). One of the many many reasons or metro and rural system combined was service delivery.

Only this year did the rural system come under AMPDS and the same dispatching system as metro

I'm not sure what you mean by socialised.

Ben Waller said:

This is one reason I don't prefer my EMS socialized. When the rural areas can't get adequate coverage despite a national system that's supposed to provide that coverage, then one of the supposed big advantages of the socialized EMS system maybe isn't such a big advantage.

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Permalink Reply by Anthony on September 27, 2010 at 9:16pm

Hi Cannulator,

This is not a reflection on the road staff, but the system that manages the use of resources. You are also right in that it is not about throwing resouce after resource, but rather the correct utilisation of that resource. You are also right that when an election is on, only then do the politicians and media take notice (to gain a few votes). Sadly this is the only time the Government will review the system.

Hi Neil,
I understand the issues of response times in the UK. It is not great. But in Victoria, in the last few years, the utilisation and management of Victoria's resources have changed. A few years ago in country Victoria, when an Ambulance left a town, great effort was undertaken to cover that town by recalling off duty staff living in the town. This worked extremely well. In fact in the town I work, we could respond 3 Ambulances in under 15 minutes. Today with a change of the utilisation of resources, we can only respond 1 ambulance from within the town despite having more staff, and the next closest Ambulance is over 30 minutes away, and the 3rd Ambulance 45 minutes. To save money, it is now considered acceptable to leave a town uncovered for many hours with the only emergency Ambulance undertaking non urgent clinic transport work, and when an emergency comes in, the next available Ambulance from 40 to 70 kms be responded, even though resources are readily available only minutes away by the use of off duty staff. The posted links to articles are only a very small presentation of a major growing issue. Whilst I am aware of the Uk problems, for Victoria, this is the worst I have seen in 25 years of Service and it only apppears to be deteriorating and no one seems to be able to stop the decline. The stress on the dedicated staff is significant.

And Ben,
You are right. The bigger the organisation, the harder it is to control, manage and resource. A good manager in a small organisation is often overwhelmed and unable to control a significantly larger organisation where problems grow expodentially. In Victoria, over the last 25 years, 16 smaller Services have progressively been swolled up into what is now one large state wide Service. And thus the problem. Trying to manage one organisation with one policy despite many varying needs. It just doesn't work!

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Permalink Reply by Ben Waller on September 27, 2010 at 9:20pm

In a locally-based delivery system, the locals can set their own resource levels and don't have to depend upon a state or national system to allocate resources to them.

A socialized system is one in which the locals don't get to determine their local level of service, how it is funded, or what they pay for it due to the system being centrally controlled. That can be at either the state/province or national level, depending upon the system. That's not the complete definition, but it includes the most important points that relate to this particular issue.

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Permalink Reply by Anthony on September 27, 2010 at 9:41pm

Ben,

You have hit the nail on the head!!!!

Local areas have little or no impute into what they need and are forced to comply with the global statewide system approach. The varying needs in different regions of Victoria, are all being managed under one statewide policy, that does not meet the differing requirements of the city and rural, and even the differing rural environments around the state.

Only when the organisation recognises this concept, will problems begin to resolve.

Ben Waller said:

In a locally-based delivery system, the locals can set their own resource levels and don't have to depend upon a state or national system to allocate resources to them.

A socialized system is one in which the locals don't get to determine their local level of service, how it is funded, or what they pay for it due to the system being centrally controlled. That can be at either the state/province or national level, depending upon the system. That's not the complete definition, but it includes the most important points that relate to this particular issue.

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Permalink Reply by The Cannulator on September 27, 2010 at 10:26pm

We've had 3000 Ambulance regions and that didn't work.

We'll spend so much time on the consultation process nothing will get done.

Helplessness through a lack of opportunity to contribute or be heard is certain a huge barrier in our system, however that doesn't necessarily mean we go back to the status quo.

Improve communication channels, their quality, and the effective responses to it and THEN worry about a Sheriff in every town.

What specifics are different that need addressing Anthony. I need to know as much as the boss

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Permalink Reply by Anthony on September 27, 2010 at 11:57pm

Hi Cannulator,

I was around many moons ago when Victoria was 16 Regions. It wasn't perfect , but the attitude back then was, "well it's not perfect so lets make it bigger, that'll fix it', rather than looking at what the issues were and how to fix the problem at that level first. That initial growth from 16 to 8 Regions didn't work (and it actually got worse), so they said "lets make it bigger again". Again it failed to a greater degree. Again they said, lets make it a massive one single state Service. And it again failed. The dictionary's definition of stupidity is "a poor ability to understand from experience and to repeat the same mistakes".

This organisation constantly repeated it's mistakes and tried to resolve the growing problems by, you guessed it, growing. To resolve the ever increasing problems and make it easier to control, the idea has been to set one standard, one policy, one structure statewide that everyone must conform to. But the problem is, where you work and your areas needs are very different to the needs of the area I work, and where the next station is. Current Ambulance policy is we must all conform to the same rules, regulations and standards and it is not working.

As for Consultants, I have never seen one, nor has any road Paramedic in the region I work. They have no concept of the problems faced at ground level in this Region, and what I hear most other Regions. They make descisions based on information fed to them by the upper Management Structure. I fully agree that worst thing to do is to spend more money on more Consultants. The best and most simplistic thing to do is to listen to the staff.

You are probably also right in that going back to the staus quo (eg 16 Regions) may not be to answer and it is probably too late anyway. And you are definitely right in that we must be able to contribute, and be heard and this is certainly a huge barrier in our system or any large system.

The basic problem is the ultilisation of resources that attempts to treat every Branch the same. Just like everyone is an individual that needs to be treated differently and with respect, so to are the Ambulance Branches in Victoria.

So the simplistic answer to Victoria's problem, and to other Services with similar problems is, for the organisation to consult with ground level, accept that there are varying needs throughout the State, respect these varying needs, and address them at local levels rather than a single statewide policy. Until then such systems will fail and the end loser is the pateint we are all here to care for.

So why did I even post this discussion and expose the deterioration of this Service. Basically so others may learn and not repeat Victoria's blunders. You don't want to go where we are going.

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Permalink Reply by Neil White on September 28, 2010 at 7:41am

To save money, it is now considered acceptable to leave a town uncovered for many hours with the only emergency Ambulance undertaking non urgent clinic transport work, and when an emergency comes in, the next available Ambulance from 40 to 70 kms be responded, even though resources are readily available only minutes away by the use of off duty staff.

Don't want it to sound like a whose ambulance service is worse contest, but this has been the situation facing us for many years. I will accept that the mathematics that goes into deployment plans are incredibly accurate in terms of what cover needs to be provided where. And you will have priority standby points (areas that will always have to be covered) and because of the call volume you'll have rural areas that can go uncovered until the base vehicle returns and the dispatcher plays russian roulette with this, 99% of they time they'll be right and then its the 1% that makes it into the newspapers.

If off duty staff are willing to respond, why not form a volunteer community responder group, okay you won't be able to use vehicles ect but you will be able to at the very least provide BLS + AED to your local community. With the press as you suggest, fund-raising for equipment should really be no problem. I know its not a fix all solution and I know people will moan that it should be the agencies role to sort this and provide proper cover but sometimes as has Ben mentioned a locally controlled resources offer better solutions.

In the position I am currently working in, We cover a rural area spanning some 40+ miles...2 medium sized market towns with the largest population being 3,500 and lots of little villages (populations like 40ish scattered about the place). 1 paramedic 24x7 in a fly car, with the nearest transporting crew anything between 15-30 miles away. At the time the model was mooted (going from a transporting crew to a single medic) it was widely and I mean angrily unpopular and now with a non transport rate as high as 50% (so treatment completed on scene) patients DO NOT want to go back to how it was.

It works because we are stationed inside the local family doctor's office, every patient we serve is registered with the doctors. We work as a team, if the doctor receives a home visit that he feels need immediate response we can be tasked to visit. If we attend an emergency we can refer to the doctor who will arrange appropriate treatments or admission bypassing ER.

We do have a socialised/nationalised model but we do vary based on the individual patient needs...

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Permalink Reply by Anthony on September 28, 2010 at 7:25pm

Hi Neil,

Thanks for your ideas.

The issue over hear about setting up a volunteer response system is that it can only be activated by the Ambulance Service due to the dispatch system in use in Victoria. At our Station for example we did attempt setting up a rapid response vehicle at no cost to the Service with off duty staff and utilising a sedan that was not being used, but it was stopped by the Ambulance Service. Such a system is unacceptable by the Ambulance Service as they see it as an actual admission that they are failing to provide appropriate use of the resources they have.

Further it is the utilisation of resources by a metro management that has no understanding of issues faced in the rural areas that are causing problems. Again at the Station I work at, the number of full time staff have increased threefold, , our wages bill has increased threefold, but our available resources have decreased threefold. It doesn't take a brain surgeon to workout that the processes being introduced based on Metro principles are costing a fortune with a massive loss of resources in rural and the result is a reduction in KPIs being met. In private industry, this would result in sackings for mismanagement. The Russian Roulette of only missing 1% of cases you quote we would love. Sadly the statistics are significantly higher and at the Station I work at which covers approx 16,000 people, now only has 1 Ambulance available instead of the 3 that used to be available.

Reality is we once had a good service, with response times worth being pround of. The shame is that despite a massive increase in the budget and resources, the processes being introduced are failing, and there is a failure by those in charge to recognise why and how to fix it.

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