Enhancing Public Hospital Performance: Ambulance Victoria Presentation

1. Inquiry into Public Hospital Performance Ambulance Victoria Presentation 2 December 2009

2. Greg Sassella Chief Executive Officer Tony Walker General Manager Regional Services Mark Rogers General Manager Specialist Services Alex Currell General Manager Strategy & Planning Ambulance Victoria representatives

3. Creation of Ambulance Victoria • Government announced the creation of Ambulance Victoria in April 2008 • Three previous services to merge into one: • Alexandra and District Ambulance Service (ADAS) • Rural Ambulance Victoria (RAV) • Metropolitan Ambulance Service (MAS) • Integration activities included: • Implementation of $187m new initiatives announced by govt. • Negotiate EBA • Begin integrating business and finance systems/IT • Implement new organisational structure

4. Part 4 – Ambulance Services 15. Objectives of ambulance services The objectives of an ambulance service are – To respond rapidly to requests for help in a medical emergency; To provide specialised medical skills to maintain life and to reduce injuries in emergency situations and while moving people requiring those skills; To provide specialised transport facilities to move people requiring emergency medical treatment; To provide services for which specialised medical or transport skills are necessary; To foster public education in first aid Ambulance Services Act 1986

5. Ambulance Victoria is a critical link in Victoria’s health care system and aims to improve the health of the Victorian community by providing high quality pre-hospital care and medical transport AV provides the following services: Emergency medical response, pre-hospital care & transport Non-emergency patient transport Major incident management & response Air ambulance Adult retrieval services Community education Ambulance Membership Scheme (insurance) Ambulance Victoria’s Role

6. Career staff (FTE) Over 2,400 operational paramedics Approx 275 operational managers & support staff Approx 320 administrative staff Approximately 1,000 volunteers Over 550 ambulances & patient transport vehicles 4 fixed wing aircraft & 5 helicopters 224 response locations $507 total revenue (2008-09) Operating Revenue; 54% Government, 18% Transport Fees, 17% Memberships, 1% Other Non Operating Revenue; 8% Capital, Other 2% Ambulance Victoria’s Resources

7. Total of 720,891 incidents requiring dispatch Total of 593,398 patients transported Road ambulance operations: 433,549 emergency incidents 280,813 non-emergency incidents 587,405 patients transported Air ambulance operations: 4,606 fixed wing transports 1,387 helicopter transports Adult Retrieval Victoria (ARV) operations: 1,584 medical retrievals Ambulance Victoria activity 2008-09

8. Ambulance Victoria performance measures • Response time • Measurement includes call answer to arrival at scene • Quality of care • Audits of paramedic treatment • Satisfaction surveys • Patient Outcomes • Patient medical outcomes • Satisfaction • Community • Health sector • Patients

9. Ambulance is an integral part of the health system Initial access to care for many emergency patients Emergency demand Average 5.5% pa since 2004-05 Ambulance/ED presentations 26% of ED presentations by ambulance (major hospitals) 41% of Triage Category 1 to 3 Ambulance role in demand management Metropolitan referral service for low priority callers No emergency ambulance dispatch to 7% of callers Meet patient needs, reduces ED and ambulance demand Ambulance & the health system

10. Telstra “000” call-taking and ambulance dispatch Emergency Services Telecommunications Authority (ESTA) Call answer Prioritise Dispatch Response process Activation (crew alerted and responding) Reflex (travel to the scene) At scene (locate, treat, load patient) Transport (from scene to hospital) At hospital (triage, patient transfer and cleared time) Response Time (“Call Answer” to “At Scene”) Total Case Time (“Dispatch” until “Cleared”) Ambulance Response Time Components

11. Ambulance/ED interface • Performance at the ambulance/ED interface • Direct impact on time for patients to access care • Impact on ambulance availability & response time for next emergency • Key current processes to manage interface • Hospital bypass • Hospital Early Warning System (HEWS) • Patient transfer escalation process • Access & arrivals • Pilot system currently under development (Arrivals Board) • Real time sharing ambulance arrival & hospital capacity data • Early preparation for arrival & early warning of delays

12. Patient Transfer Time- Escalation Process • The time from ambulance arrival at ED to the time patient is transferred from ambulance stretcher to ED bed • Delays at this interface affect ambulance availability • Escalation of issues is dealt with in real time • Ambulance Communications Centre alerted • Frontline ambulance managers attend ED’s • Patients cared for by paramedics when delays experienced at ED

13. Victoria’s trauma system Ambulance triage to Major Trauma Service (MTS) if within 30 minutes Minimise time to appropriate medical care Reduction in risk of mortality from major trauma Over 80% major trauma patients receive definitive care at an MTS Acute Coronary Syndrome patients Transmission of 12 lead ECG from scene to hospital Pilot completed in 2008 & now rolled out to 9 hospitals Early activation of hospital cardiac team Ave ‘door to balloon’ time reduced from 106 min to 56 min at 90th percentile (pilot) Funding received for statewide expansion of model Stroke patients Less formal arrangements to transport to specialist stroke units Improved paramedic identification of stroke Improving system performance