AMBULANCE VICTORIA 2010-2011 ANNUAL REPORT

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Clinical Interventions As well as measuring the number of emergency calls and our response times, we measure the effect of our clinical interventions on the immediate and longerterm medical condition of our patients. This allows us to understand the significance of our interventions and, where beneficial, change our clinical practice to improve future patients’ medical outcomes. In recent years, for example, we have made important changes to the way paramedics treat patients suffering cardiac arrest, heart attack and severe traumatic brain injury, which have led to significant improvements in the number of people who survive. In 2010–2011, we surpassed our targets on all our key clinical outcomes, including the percentage of adult patients who survive after a VF/VT cardiac arrest, with 26.3 per cent of patients surviving to hospital discharge. The increasing survival of these patients illustrates AV’s central strategy, which is based around the patient and their medical outcomes. To this end, we collect comprehensive electronic data on each patient, and work in partnership with hospitals to conduct important medical research. Our medical research has attracted international attention, notably through awards and key publications during the year. This helps us identify which interventions produce better patient outcomes, and these become our standards of care. The focus on patient medical outcomes is proving to be most beneficial to the community and meets our obligation to ‘improve the health of our community’. Response times On 6 October 2010, a report by the Auditor-General entitled Access to Ambulance Services was tabled in the Victorian Parliament. AV publicly welcomed the report, which identified areas where response times could be improved, including funding, staff rostering issues and the time it took for patients to be handed over at hospital. The report also recognised AV’s competence, the achievements since amalgamation, the good performance record on quality indicators such as cardiac arrest outcomes, and the fact that AV outperformed New South Wales, its nearest comparable service. AV remarked that the report provided a fair and accurate assessment of the state’s ambulance services, and the Board and management supported the Auditor-General’s recommendations. During the year AV continued to strive to improve response times through a series of measures, including managing demand. Central to this strategy is AV’s Referral Service, which deals with 000 calls classified as low medical priority, where the patient’s condition indicates that an ambulance may not be necessary. The aim is to ensure the caller gets the medical help that resolves their issue, which may mean a referral to more appropriate care – such as seeing a doctor or selftreating the condition. The strategy reduces emergency ambulance response demand by around 8 per cent in the metropolitan region, and we have developed plans to expand the program when funding is available. This referral service managed 42,484 emergency calls during the year, an increase of more than 8.4 per cent, and referred 31,781 callers to alternative care, almost 10 per cent more than the previous year. We also continued to work with the Department of Health and health services to improve the time it takes to transfer patients to hospitals in the metropolitan area, because of the impact this has on ambulance availability and, subsequently, our response times. The audit focused on ambulance responsiveness, following concerns in some quarters that response times were increasing, and that this was linked to the merger of the state ambulance services in July 2008. 10 AMBULANCE VICTORIA 2010 - 2011 Annual Report
Air Ambulance Our five helicopters and four fixed-wing planes experienced another busy year, with a record number of emergency cases. AV operates five emergency response helicopters: HEMS 1 (standing for Helicopter Emergency Medical Service, and based at Essendon), HEMS 2 (LaTrobe Valley) and HEMS 3 (Bendigo), HEMS 4 (based at Warrnambool) and HEMS 5 (a medical retrieval and emergency response helicopter based at Essendon) ensuring rural communities have rapid access to our highest level of care and transport to major specialist care in the Melbourne metropolitan region. In 2010–2011, our helicopters transported 1,682 patients, 87 more than the previous year. Most helicopter work is pre-hospital time critical emergencies, which are often trauma and paediatric cases, with the balance mainly inter-hospital transfers (with a small amount of search and rescue, and transporting remote patients). Our four pressurised, twin engine turbo-prop aeroplanes based at Essendon were also busy during the year, flying 4,536 patients. The planes mainly flew patients from regional Victoria to Melbourne, providing access to specialist medical and hospital facilities. This service includes transporting people for regular treatments such as oncology and dialysis. We also fly patients with acute medical conditions requiring surgery, transfer injured patients from regional hospitals and retrieve critically ill patients from regional hospitals to specialist care, such as cardiac care and intensive care. As well as providing transport for patients at the scene of an emergency, AV provides inter-hospital transfer of seriously ill patients through Adult Retrieval Victoria (ARV). ARV uses doctors, paramedics and MICA paramedics to move critically ill patients between hospitals, using road ambulances, planes and helicopters. ARV also provides telephone advice on the clinical care of critically ill patients (mostly to smaller hospitals), coordinates critical care beds in the hospital systems and manages the state’s Trauma Advice Line. Rural Staff During the year we increased paramedic resources in the rural regions, in recognition of a shortfall of staff outside the metropolitan area. Our strategy includes providing new dedicated nightshift crews in some areas and extra day crews in other areas, and is aimed at improving community access to ambulance services, while also addressing issues of paramedic fatigue and workload. We continued to support the emergency medical response in more remote rural communities, including the training and deployment of Ambulance Community Officers (ACOs) and Community Emergency Response Teams (CERTs), and the training and support of Remote Area Nurses (RANs) as co-responders to serious cases. ACOs are employed on a casual basis to work mainly in small communities where it is not practical to maintain a permanent paramedic crew. They also support paramedics in some communities. There are about 430 ACOs who are active in their local communities in responding to emergencies and promoting health care. CERTs are located in less populated and more remote areas of the state and are co-responded with the nearest ambulance to provide immediate care until the ambulance arrives. At 30 June 2011, there were 28 teams with a total of 435 volunteers. During the year, CERTs attended more than 3,100 emergency cases, and arrived before an ambulance in 87.6 per cent of cases. RANs operate from Victoria’s 14 Bush Nursing Centres, and can be called on to be first responders or co-responders in a 000 emergency. The nurses’ scope of practice is comparable to that of an Advanced Life Support paramedic, with special legislation enabling the nurses to administer a range of medications in an emergency without a doctor’s order. These volunteers and staff provide a faster response in medical emergencies, with early intervention and support for patients. 2010 - 2011 Annual Report AMBULANCE VICTORIA 11
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