AMBULANCE VICTORIA STRATEGIC PLAN 2010 – 2012

Health System development
Ambulance service delivery in Victoria has become an increasingly
well-integrated part of the wider health system in recent years. This process
will continue during the planning period, placing new demands on AV as well
as creating new opportunities to improve services.
There is a clear trend of increasing specialisation of hospital facilities for high
acuity patients, driven by infrastructure costs and the clinical benefits of high
levels of exposure for practitioners. Timely access to these facilities can have
a significant bearing on patient outcome. This may involve ambulances bypassing
the closest hospital to transport a patient to the most appropriate level
of care as quickly as possible. Victoria’s system for managing major trauma is
a well established example of this approach.
Transmission of clinical information from the scene can also assist in
reducing the time to access definitive care by facilitating early activation of
specialist hospital teams. The recent introduction of ECG transmission for
Acute Coronary Syndrome patients in southeast Melbourne, Geelong and
the Southern Calder region has yielded impressive reductions in the time to
definitive treatment, and more widespread implementation is now occurring.
Improved system approaches for stroke patients is another likely development
during the planning period.
There is a long-term trend for reduced length of stay in hospital and a wide
range of demand management strategies designed to prevent or minimise
hospitalisation have been implemented in recent years.
At the same time, there is increasing pressure on primary care services.
As noted above, access to a general practitioner is difficult in some areas,
particularly in rural Victoria.
These changes tend to increase ambulance demand, but there is potential
for paramedics to play a part in managing this demand more effectively.
A number of ambulance services have introduced paramedic or emergency care
practitioner roles in recent years, generally on a trial basis. There is significant
variation in how these roles have been defined, but most involve an extension
of the paramedic scope of practice, with an emphasis on increased assessment,
referral and primary care skills. In Victoria, new roles have been developed in
two remote communities focused on increased support for the local community,
but with no change in clinical practice.
Further exploration of the relevance of these new models of care will be an
important priority during the planning period, focusing on the potential to
improve both ambulance service delivery and wider health system performance.
Hospital specialisation also tends to increase the requirement for patient
transfers between facilities. AV’s air ambulance and adult retrieval services
play a critical role in high acuity transfers, particularly in rural Victoria.
Coordination of these patient movements can be complex and further
development of systems to minimise delays will be a continuing focus for AV.
A second important system trend affecting ambulance services is an increasing
emphasis on care in the community as an alternative to hospital care.
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