AMBULANCE VICTORIA STRATEGIC PLAN 2010 â 2012

PARTNERS FOR LIFE 

AMBULANCE VICTORIA 

STRATEGIC PLAN 2010 – 2012 

DRAFT FOR CONSULTATION

1. Ambulance Victoria’s Role 

Ambulance Victoria is a critical link in Victoria’s Health Care 

System. AV provides pre-hospital care for patients experiencing 

medical emergencies, and medical transport by road and air to 

ensure both emergency and non-emergency patients access 

the appropriate level of health care. The overriding aim of the 

organisation is to improve the health outcomes of Victorians. 

In summary, Ambulance Victoria’s role is to: 

Improve the health of the Victorian community 

by providing high quality pre-hospital care and 

medical transport 

2. Overview of Services 

AV operates across the State, with major administrative centres in 

Melbourne and Ballarat. We have more than 3,000 career employees 

and almost 1,000 volunteers, with over 220 road ambulance response 

locations. Air ambulance services (fixed wing and helicopter) cover 

the entire State. 

AV’s primary focus is to deliver services that meet the needs of our 

patients, their families and carers, and a range of organisations using 

our services (including public and private hospitals, the Transport 

Accident Commission, WorkCover and other health bodies). 

AV’s Services include: 

• Emergency medical response and pre-hospital care 

• Emergency medical transport by road or air 

• Non-emergency patient transport (including road and 

air stretcher transport and clinic transport for walking 

and wheelchair patients) 

• Major incident management and response 

• Retrieval of critically ill adult patients (including advice 

and bed coordination) 

• Assistance for ambulance patients to access appropriate 

care when paramedic care or transport is not required 

• Support for other health services in communities where 

the full range of services are not easily accessible 

• Community education in pre-ambulance arrival 

emergency care 

• The Ambulance Membership Scheme (ambulance insurance) 

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3. Principles 

AV is committed to a set of ten principles, which provide a guiding framework for 

our service delivery to the community and for our internal operations. 

AV is committed to: 

1. Providing an appropriate response to all requests for service 

2. Developing our services to improve patient outcomes, based on the best 

available evidence 

3. Delivering services efficiently and cost effectively 

4. Collaborating with other service providers and the community to improve 

health system performance 

5. Minimising risks to the safety of patients and staff 

6. Safeguarding patient confidentiality and privacy 

7. Identifying and addressing community concerns about our services 

8. Respecting the values of all members of the community 

9. Recognising and valuing our people and their contributions 

10. Encouraging and providing opportunities for our people to develop. 

4. Strategic Objectives 

2. Foster staff development and welfare 

Effective service delivery is critically dependent on the skills and 

well-being of AV’s staff and volunteers. Minimising the risks to staff health 

and safety and encouraging the professional development of all staff are key 

organisational commitments. 

3. Develop organisational systems and resources to support improved 

service delivery 

Service delivery is becoming increasingly complex and dependent on more 

sophisticated support systems. Ensuring information and business systems 

continue to evolve is an essential part of delivering better services to the community. 

4. Strengthen community relationships and promote community initiatives 

and policy to improve patient outcomes 

AV is committed to building on its relationships with all parts of the Victorian 

community, to ensure that it understands and responds appropriately to the full 

diversity of community needs. Initiatives to develop community capability and 

awareness can make an important contribution to improving health outcomes. 

AV’s overriding aim of improving health outcomes for Victorians is underpinned by 

four strategic objectives, relating to service delivery, staff welfare, organisational 

systems and community relationships. 

1. Improve service quality and efficiency to better meet patient needs 

Continuing development of service quality to ensure patient needs are being met 

is fundamental to delivering improved health outcomes. Improved efficiency and 

better health system integration can also play a significant role in enabling more 

effective service delivery. 

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5. The Planning Environment 

Eleven key challenges have been identified, which AV will need to address 

during the planning period and beyond. 

Increasing demand for services 

Ambulance services in Victoria have been under stress as a result of continuing 

strong growth in demand for more than a decade. Since 1999-2000, ambulance 

caseload in Victoria has grown by an average of 5.7 per cent per annum, with 

both emergency and non-emergency incidents increasing by more than 50 per 

cent. Other ambulance services around the world are experiencing similar 

demand pressures. 

Demand management has been an important focus for more than five years. 

The referral system for lower priority 000 callers in Melbourne has played an 

important role in controlling demand, with more than 7 per cent of callers not 

receiving an emergency ambulance dispatch. There is scope for expansion 

of the service and exploration of new emergency demand management 

initiatives. Management of non-emergency demand, and ensuring 

appropriate allocation of resources to meet patient needs will also be a 

priority. These strategies will assist in moderating growth, but increasing 

demand is expected to remain a key challenge through the planning period. 

The drivers of ambulance demand are similar to those affecting demand for most 

other health services. These include demographic change (ageing and population 

growth), which accounts for about 25 per cent of the increase in emergency 

demand. Trends in the health of the community play a key role, notably the 

increasing burden of chronic disease. Other factors also include changes in 

medical practice and patient management (e.g. the trend to early discharge 

and treatment in the community), social changes (e.g. the increasing number of 

people living alone), reduced accessibility to other health services in some areas 

(especially general practitioners) and rising community expectations. 

Growth has slowed in the last eighteen months, but there is no reason to believe 

that the long-term trend has changed. Large numbers of seriously ill patients 

(about 40 per cent of triage category 1 to 3 patients in Melbourne) are not 

transported to hospital emergency departments by ambulance, indicating there 

is significant potential for further increases in demand. 

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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. A recent pilot of ECG transmission for Acute Coronary 

Syndrome patients in southeast Melbourne has yielded impressive reductions 

in the time to definitive treatment, and more widespread implementation is now 

occuring. 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. 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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Equity in Service Delivery 

There are inherent difficulties in the provision of ambulance services in remote 

areas and areas with lower population densities. The Government’s response 

time targets reflect these difficulties, with one target for population centres of 

more than 7,500 people, and a somewhat lesser target for the State overall. 

Continuing improvements in air ambulance and retrieval systems, including 

the introduction of two new helicopters in 2009, will assist in providing better 

access to appropriate levels of care across the State. 

Nevertheless, a number of key areas have been identified where differentials 

in service standards are of particular concern. Cardiac arrest survival rates in 

rural areas are well below those achieved in the metropolitan area. This is not 

surprising given the importance of rapid response in cardiac arrest outcomes. 

However, a more complete understanding of the reasons for the difference is 

needed and new strategies to improve performance need to be developed. 

Call taking, dispatch and ambulance communications systems play a 

critical role in the quality of service delivery. There have been important 

improvements in these systems across the State in recent years, but rural 

call taking and dispatch systems remain well below best practice standards. 

The introduction of a new rural system managed by the Emergency Services 

Telecommunications Authority will be a key priority for the planning period. 

Another important focus will be further development of an integrated statewide 

major incident management system, ensuring there is appropriate capability in 

all parts of the State. 

Risk of major incidents 

AV’s major incident system has been tested by a number of recent events, 

including the 2009 bushfires, and has proved its effectiveness. However, 

learning from these experiences to strengthen systems is essential to ensure 

an appropriate level of preparedness for response to all types of incident 

(including pandemic) is maintained. Monitoring risk and close collaboration 

with the relevant planning and response agencies at all levels of government 

are cornerstones of the system. Further strengthening of national links is a 

particular priority for future development of the system. Another key aspect 

is the ability to maintain normal services while managing a major incident, 

especially if it is prolonged. 

Evidence Based Practice 

The introduction of the Victorian Ambulance Clinical Information System 

was one of the most significant ambulance initiatives in the State in the last 

five years. VACIS provides a rich source of clinical data which can assist 

in driving the development of clinical practice and education. A number of 

other Australian services are now using VACIS, creating the opportunity for 

national sharing of consistent data. Linkages with hospital data are also being 

established to provide a more complete picture of patient outcomes. Ensuring 

the full benefits of this data are realised is an on-going priority. 

More generally, quality systems and performance monitoring will continue 

to evolve, with particular focus on patient outcome measures. Further 

development of AV’s role in pre-hospital research, usually in partnership with 

universities or other health services, will also assist in strengthening the 

evidence base for service improvement. 

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Advances in information and technology 

Recent developments in information management systems have created new 

opportunities to drive performance improvements, but significant challenges 

remain. Key priorities include the integration of a number of the systems 

inherited from AV’s predecessor organisations, increased real time performance 

reporting, wider dissemination of geographic information and improving access 

to information for in-field managers. Real time data linkages with hospitals and 

greater use of decision support technologies have the potential to significantly 

improve operational processes and system performance. 

Resource Constraints 

The Government provided a major injection of new funding for AV in 2008-2009, 

enabling significant recruitment for additional road response resources and 

the introduction of two new ambulance helicopters for the State. However, the 

demands on the organisation are continuing to grow and there is increasing 

competition for scarce resources within the health sector and beyond. In 

addition to the financial constraints, the recruitment of qualified paramedics may 

become more difficult as competition from other jurisdictions increases. 

Continuing improvement in the efficiency of operations is imperative in such a 

resource constrained environment. This will include maintaining the current 

focus on improving processes for patient handover at hospital emergency 

departments and further development of more dynamic deployment of response 

units. Complementing the focus on efficiency, strategies to protect and enhance 

revenue (especially from the Membership Scheme) will need to be pursued. 

Organisational Consolidation 

AV commenced operations on 1 July 2008, and integration of the key processes 

and systems of its predecessor organisations is now well advanced. However, 

a number of significant challenges remain to consolidate the transition process. 

These include further development of internal communications processes and 

completion of the transition to statewide information and business systems. An 

important benefit of the creation of the new organisation is the opportunity it 

provides for the refinement of existing processes and systems. 

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Workforce demographics and expectations 

One of the most significant recent changes affecting ambulance services has 

been the move from training of paramedics following their employment to 

recruitment of graduate paramedics who have already completed a university 

degree. This change necessitates a new focus on workforce planning and 

liaison with the universities to ensure future staffing needs can be met. It 

has also required the development of programs to support the transition 

from university to the operational environment, and further evolution of these 

programs is expected. 

There has been a major emphasis on improving the health, safety and welfare of 

the workforce in recent years, and this will continue with further development of 

systems to facilitate early intervention and identification of the root causes 

of problems. 

The new recruitment and education model is also affecting workforce 

demographics, with increasing numbers of younger paramedics and women 

employed. At the same time, the number of paramedics in older age cohorts 

(greater than 50) is also increasing, especially in rural areas. 

These changes, as well as more general social trends, are affecting workforce 

attitudes and expectations. In particular, staff concerns about work/life balance 

will need to be addressed if AV is to remain an employer of choice. This is 

likely to involve increased access to part-time work and continuing development 

of alternative roster options. Promoting a constructive culture and further 

developing internal communications and consultation will also assist in meeting 

emerging staff expectations and improving organisational effectiveness. 

The availability of appropriate opportunities for professional development 

is another key aspect of meeting legitimate staff expectations, as well as 

strengthening organisational capability and facilitating succession planning. 

The focus on workforce development includes ensuring that opportunities are 

available for volunteers, especially those wishing to become career paramedics. 

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Community expectations and capabilities 

There is a clear recognition in the Victorian community of the contribution 

paramedics make to its well-being. However, there are opportunities to 

improve services and increase access for specific communities through a 

better understanding of their needs. 

Environmental responsibilities 

Environmental change has the potential to impact on AV service delivery, 

most obviously by increasing the risk of major incidents such as bushfire or 

pandemic. More subtle impacts on the patterns of demand may also occur. 

These impacts clearly need to be factored into AV planning. 

There have been a number of recent initiatives to improve links with 

Culturally and Linguistically Diverse communities and the Aboriginal 

community and to improve staff awareness of community diversity. 

Work will continue with these groups to further strengthen relationships; 

collaborations with patient groups with special clinical needs will also be 

extended. Working with the Department of Health and local communities 

to identify opportunities to improve ambulance services and contribute to 

better health system performance in specific geographic locations will be 

another important priority. 

Engagement with the community has also been focused on improving 

community capability and preparedness to manage an emergency. 

Current programs include targeted promotion of CPR skills and a range of 

schools programs, and these will continue to develop. 

At the same time, AV has placed increasing emphasis on implementing more 

environmentally sustainable practices. However, there is significant scope for 

improvement to ensure the organisation meets appropriate environmental targets. 

. 

There are more than twenty five Community Emergency Response Teams 

across the State, providing invaluable access to early initial treatment and 

support for career paramedics. Ambulance Community Officers also play 

a critical role in AV’s emergency response in more remote areas. Further 

developing support systems to ensure the sustainability of AV’s volunteer 

response capability will be a high priority during the planning period. 

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6. Strategic Framework 

A set of strategic themes, each linked to one of four strategic objectives set out in section 4, complete the framework for the Strategic Plan 

The strategic themes identify the primary aim of the specific initiatives within the plan. Each of the themes is related to one or more of the key 

issues outlined in the previous section, and the initiatives linked to the theme are designed to address these issues. A visual representation of 

this framework is included on page 26. 

Objectives Strategic themes Key issues 

1. Improve service quality and 

efficiency to better meet patient needs 

1.1 Demand management: 

Improve matching of patient needs & services 

1.2 Process efficiency: 

Increase the efficiency of resource use to deliver 

improved services 

1.3 Health System integration: 

Further develop collaboration with other health service 

providers to improve health system performance 

1.4 Emergency Services coordination: 

Further develop collaboration with emergency service 

organisations to improve effectiveness of ambulance 


• Increasing demand for service 

• Resource constraints 

• Community expectations 

• Health System developments 


• Advances in technology 

• Equity in service delivery 

• Risk of major incidents 

• Environmental responsibilities 


• Evidence based practice 



• Risk of major incidents 



1.5 Standard and scope of care: 

Enhance clinical care to improve patient outcome 




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2. Foster workforce development 

and welfare 

3. Develop organisational systems 

and resources to support improved 


2.1 Workforce capability: 

Support workforce development to increase organisational 

effectiveness 

2.2 Workforce health and safety: 

Improve workforce health & safety 

2.3 Workforce wellbeing: 

Further develop working environment to promote 

workforce well-being 

3.1 Performance Monitoring 

Refine measurement of performance to drive improved 


3.2 Information Management 

Further develop information systems to support 

improvements in service delivery 

3.3 Financial Management 

Strengthen the organisation’s financial position to support 

service delivery development 

• Workforce expectations 











• Organisational consolidation 





3.4 Business Systems and processes: 

Further develop business systems to support consistency 

and quality of service 




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3. Develop organisational systems 

and resources to support improved 

service delivery (continued) 

3.5 Research: 

Increase research to support innovation in service delivery 

3.6 Environmental Sustainability: 

Reduce the environmental impact of AV activities 


• Health system developments 



4. Strengthen community 

relationships and promote community 

initiatives and policy to improve 

patient outcomes 

4.1 Community capability and awareness: 

Increase community awareness and skills to manage 

medical emergencies and collaborations with the community 

to improve patient outcomes 

4.2 Community relationships and accountability: 

Strengthen relationships with the community, 

improve understanding of the AV role and fulfil broader 

social responsibilities 







4.3 Policy and system development: 

Further develop the ambulance role in contributing to 

broader health policy and systems 

• Health system developments 



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7. Strategic Initiatives 2010 to 2012 

Strategic initiatives have been developed to address the four organisational objectives and the aims expressed in the strategic themes. Target outcomes have 

been specified for each of the strategic initiatives. The initiatives and targets are described below, grouped according to the relevant AV service delivery area. 

1. Improve service quality and efficiency to better meet patient needs 

Emergency Response 

Strategic themes Strategies Outcomes 

Demand management: 

Improve matching of patient needs 

and services 

• Continue to refine 000 call prioritisation and ensure 

consistency of prioritisation statewide 

• Further develop the metropolitan Referral Service, 

increasing the referral options available and the scope of 

calls handled, and extend the Service statewide 

• Undertake further analysis of the drivers of demand 

and work with DH to identify new demand management 

strategies, including strategies to improve service delivery 

to specific patient categories and improved links to 

primary care services 

Improved identification of patient needs at the time of 

000 call for better targeted response 

Increased availability of appropriate alternatives to 

emergency ambulance response for lower priority 

000 callers 

Development of innovative strategies to address demand 

• Collaborate with nursing homes and other service 

providers to ensure a more appropriate ambulance response 

to nursing homes 

More appropriate matching of response to the needs 

of nursing home staff 

• Review planning criteria and methodology for 

emergency response resources in rural and remote areas 

Equitable basis for prioritising investment in response 

resources 

• Develop a long-term plan for statewide emergency 

response resources, taking into account demographic 

change and other drivers of demand 

Sufficient emergency response capacity to meet 

demand and achieve performance targets 

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Process efficiency: 

Increase the efficiency of resource 

use to deliver improved services 

• Improve the efficiency of the response process by: 

> Reducing case times 

> Improving the efficiency of logistic support processes 

> More dynamic deployment of resource units, building on 

current use of the Siren decision support system 

> Improving the management of urgent (Code 2) cases 

> Improving the efficiency of the interface with hospitals 

• Review dispatch rules (in conjunction with refinement 

of 000 call prioritisation), and ensure consistency of 

dispatch practice statewide 

• Complete implementation of a new operational 

front-line management model 

• Transfer rural call taking and dispatch to a single 

Communications Centre operated by ESTA, using a new 

Computer Aided Dispatch system 

• Continue to work with ESTA to improve call taking and 

dispatch processes 

• Develop and implement a statewide rostering system 

and paramedic placement model 

• Refine coordination processes for the management of 

time critical patient transfers 

Increased availability of response units and improved 

response times 

Better matching of dispatch with patient needs and 

more effective use of resources 

More effective management and improved 

operational performance 

More efficient and effective rural call taking and dispatch 

More efficient and effective call taking and dispatch 

More cost effective use of operational workforce and 

improved consistency of service delivery 

More efficient and timely transfer of time critical patients 

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Health system integration: 

Further develop collaboration with 

other health service providers to 

improve system performance 

• In conjunction with DH and the major health services, 

develop and implement improved processes for selection 

of hospital destinations 

• In conjunction with health services, further develop and 

implement systems for en route transmission of clinical 

information to receiving hospitals to enable early activation 

of the hospital response 

Better access for patients to definitive care 

Improved access for patients to definitive care 

• Continue development and implementation of an 

integrated strategy for acute coronary care patients, 

including early access to primary coronary angioplasty 

services and in-field thrombolysis where appropriate 

• Identify patient care pathways which provide a potential 

alternative to attendance at a hospital ED and explore 

options to improve their accessibility to paramedics 

Improved outcomes for acute coronary care patients 

Earlier access for patients to appropriate care 

• Work with DH and health services to evaluate and 

refine the current ambulance role in the response to 

mental health patients 

Improved service delivery for mental health patients 

• Work with DH regions to develop and implement strategies 

for improved integration and coordination of ambulance 

and health services 

Improved integration with regional health services 

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Emergency services coordination: 


emergency service organisations to 

improve effectiveness of service delivery 

Standard and scope of care: 

Enhance clinical care to improve 


• Evaluate the pilot Country Fire Authority Emergency 

Medical Response program in outer Melbourne (involving 

simultaneous dispatch of AV and CFA resources to 

suspected cardiac arrest cases) and, subject to the outcome, 

implement the EMR program in appropriate areas statewide 

• Further develop the AV Clinical Risk Management System, 

including sentinel event and clinical incident systems 

• Strengthen systems for review of the Clinical Practice 

Guidelines by drawing on VACIS data, including 

establishment of links with hospital (and other) data to assist 

outcome analysis 

Improved cardiac arrest outcomes 

Identification of opportunities for system improvement 

Stronger evidence base for clinical practice 

• Improve systems to facilitate the clinical development of 

paramedics based on VACIS data 

• Review the current paramedic scope of practice and 

develop appropriate new model(s) of paramedic practice, 

taking into account the needs of the specific communities 

served by AV, health system developments and experience 

in other jurisdictions 

Improved clinical support and development 

for paramedics 

Evaluation of new models of paramedic practice to 

support improved health system performance and 

(if appropriate) initial implementation of new model(s) 

• Investigate statewide variation in cardiac arrest outcomes 

and develop strategies to reduce differences 

Improved cardiac arrest outcomes 

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Non-Emergency Transport 




and services 

• In conjunction with DH, review and refine the current 

criteria for use of non-emergency transport 

Improved matching of resource type with patient need 


Increase the efficiency of resource use 

to deliver improved services 

• Develop and implement a statewide non-emergency 

services strategy, with a particular focus on options for rural 

service delivery and appropriate use of non-emergency 

resources for high acuity transports 

• Complete statewide implementation of a non-emergency 

scheduling and vectoring system 

More efficient fleet management and improved 



Further develop collaboration with other 

health service providers to improve 

system performance 

• Explore options to assist hospital discharge processes in 

collaboration with DH and health services 

• Develop relationships with non-government agencies to 

assist with rural low acuity patient transport 

Improved patient flow in hospitals 

Improved allocation of resources and service delivery 

to rural and low acuity patients 

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Air Ambulance 




and services 

• Continue to refine dispatch criteria to ensure appropriate 

use of aircraft 

Better matching of dispatch with patient needs and more 

effective use of resources 


Increase the efficiency of resource use to 

delivery improved services 

• Prepare a strategy for the long term development of 

air ambulance operations and implement the strategy 

progressively 

More efficient and effective air ambulance operations 





• Work with rural and regional health services to improve the 

timeliness of aircraft activation 

Earlier access for patients to appropriate care 

Retrieval Services 



Increase the efficiency of resource use 

to deliver improved service 

• Implement the ARV service improvement plan and 

benchmark performance with other jurisdictions 

Improved service delivery for adult medical retrievals 





• Collaborate with DH and the non-adult retrieval services 

(peri-natal, neo-natal and paediatric) to improve the 

interface between the services and air ambulance 

Improved service delivery for non-adult medical 

retrievals 

• Continue to work with DH and health services to improve 

the management of access to critical care beds 

Improved accessibility of critical care beds 

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Major Incident Preparedness 




and services 


Increase the efficiency of resource use to 

deliver improved services 

• Continue close monitoring of the risks of all types of major 

incident, and ensure appropriate AV capability is developed 

and maintained 

• Continue development of major incident response 

processes to ensure statewide consistency of approach 

AV major incident capability meeting Government 

and community expectations 

Integrated and consistent statewide response to 

major incidents 





• Continue major incident planning, liaison and coordination 

with all relevant national and State response and planning 

bodies 

Improved coordination of major incident response 

agencies and strengthened system capability to 

respond to a major incident 

Emergency services coordination: 


emergency service organisations to 

improve effectiveness of service delivery 

• Continue work with inter-state ambulance services (via the 

Council of Ambulance Authorities) and emergency services 

organisations to ensure appropriate ambulance involvement 

in national major incident planning 

Improved coordination of major incident response 

agencies and strengthened system capability to 

respond to a major incident 

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2. Foster workforce development and welfare 


Workforce capability: 

Support workforce development to 

increase organisational effectiveness 

• Develop a long-term workforce plan which identifies future 

organisational workforce needs and assists universities to 

plan student intakes 

• Support national initiatives on paramedic course 

accreditation through the Council of Ambulance Authorities, 

and continue AV liaison with universities regarding their 

selection procedures and curricula of paramedic courses 

Assured future supply of appropriately qualified 

paramedics 

Continuing development of paramedic education to meet 

service delivery needs 

• Review the current program for graduate paramedic 

recruits and explore options to improve their transition into 

the workforce 

Improved pathway for paramedic graduates to obtain 

the experience required to practice independently 

• Promote the career development of paramedics, including 

progression to specialist roles (MICA, Clinical Instructor, 

Clinical Specialist, Clinical Support Officer, Flight Paramedic 

etc) 

Improved AV clinical performance and workforce 

satisfaction 

• Further expand opportunities for all members of the 

workforce to develop their management and technical skills 

and strengthen the succession planning framework 

Improved management capability and succession 

planning 

• Develop and implement new strategies to attract and retain 

paramedics in regional and rural areas 

Improved retention of rural operational workforce 

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Workforce capability: 

Support workforce development to 

increase organisational effectiveness 

(continued) 

• Further develop strategies and support processes to ensure 

the engagement, sustainability, reward and recognition of the 

volunteer workforce 

• Further support the professional development of Ambulance 

Community Officers and Community Emergency Responders 

(including development of pathways to paramedic education) 

• Further develop and implement flexible learning options 

(e.g. on-line systems) 

• Further develop programs to promote workforce awareness 

of the needs of CALD and Aboriginal communities 

• Promote continuing development of a constructive and 

consistent organisational culture, including further 

development of mechanisms for workforce engagement, 

communication and consultation 

Improved integration of volunteers with AV operations 

and better patient outcomes in communities served by 

volunteers 

Improved level of service to rural communities and 

supply of paramedics in rural locations 

Improved workforce access to training and education 

programs 

Improved service delivery for CALD and Aboriginal 

communities 

Constructive attitudes and behaviours focused on 

common objectives 

Workforce health and safety: 

Improve workforce health and safety 

• Develop and implement an integrated AV Occupational 

Health and Safety Strategic Plan, with a focus on: 

> Health check and immunisation programs 

> Early intervention 

> Appropriateness of equipment 

> Manual handling injuries 

> Managing aggression/assault 

> Stress 

> Fatigue 

> Monitoring of trends and root cause analysis to identify 

underlying issues 

> Benchmarking with other jurisdictions 

Reduced workforce injuries and lost time 

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Workforce well-being: 

Further develop working environment to 

promote workforce well-being 

• Develop further initiatives to provide greater flexibility in 

working arrangements, including increased availability 

of part time options 

• Continue exploration of alternative rosters, taking into 

account workforce welfare impacts and service delivery 

requirements 

• Continue program of branch refurbishment to improve 

employees’ working environment 

Increased opportunities for a better work/life balance 

Identification of a suite of preferred future rosters 

Improved working environment for both operational 

and administrative workforce 

3. Develop organisational systems and resources to improve service delivery 


Performance monitoring: 

Refine measurement of performance to 

drive improved service 

• Continue development of AV performance measures and 

targets (including operational, clinical and support services 

measures) and extend benchmarking with comparable 

services 

• In consultation with ESTA, further develop CAD 

performance measures for ambulance, reflecting both the 

speed and quality of call-taking and dispatch 

More complete view of AV performance and value 

Refined set of call-taking and dispatch performance 

measures, reflecting service delivery needs 

• Establish links with external data sources to facilitate 

further development of patient outcome measures 

• Work with DH and health services to develop measures of 

health system performance (including an AV component) 

Improved understanding of AV impact on 


More complete view of system performance and 

AV contribution 

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Information mangement: 

Further develop systems to support 

improvements in service delivery 

• Develop and implement a comprehensive Information 

Management Strategic Plan with a focus on: 

> Identification of future information requirements 

> Further integration of data from internal and external sources 

> Extending use of GIS data 

> Provision of real time management information 

> Real time transmission and receipt of clinical and management 

data with hospitals (e.g. pre-arrival ECG, projected arrivals, 

hospital status) 

> Infrastructure requirements to support systems development 

> Organisational consistency 

• Complete implementation of integrated statewide 

information systems for key processes, including 

financial, human resource, payroll, time and attendance, 

and clinical systems 

Increased accessibility, completeness, reliability and 

timeliness of management information to support 

improved decision-making 

Consistent management processes 

Financial mangement: 

Strengthen the organisation’s financial 

position to support service development 

• Explore opportunities to refine the current funding model and 

increase clarity about future funding 

• Continue development of strategies to improve the 

performance of the Membership Scheme (including the 

introduction of new products) 

• Develop and implement strategies to increase the capacity 

to fund new initiatives internally 

Increased certainty about future financial position 

to support longer term service planning 

Increased revenue from Membership Scheme 

Increased ability to implement service innovations 

22


Business systems and processes: 

Further develop business systems to 

support consistency and quality of 


Research: 

Increase research to support innovation in 


• Further develop AV quality and risk management systems, 

including business continuity systems 

• Explore opportunities to establish further data links with 

business partners 

• Implement improved logistics management systems (for fleet, 

medical equipment, supplies etc) 

• Ensure AV clinical data is effectively used to support 

innovations in practice and promote the national roll-out 

of VACIS to facilitate national ambulance research and 

benchmarking 

• Continue to build research collaborations with universities, 

health services and other research bodies 

• Monitor international research and innovation in ambulance 

and the broader health sector to identify opportunities to 

improve service delivery 

Increased reliability and consistency of service delivery 

Increased efficiency of business processes 

Increased efficiency and effectiveness of operations 

support processes 

Further evidence-based development of practice 

Increased research to identify clinical and operational 

service improvement opportunities 

Early identification of options to improve services 

Environmental responsibilities: 

Reduce the environmental impact of 

AV activities 

• Implement an organisational plan to reduce the 

environmental impact of AV activities 

Reduced environmental impacts and improved 

environmental sustainability 

23

4. Strengthen community relationships and promote community initiatives and policy to improve patient outcomes 


Community capability and awareness: 

Increase community awareness and skills 

to manage medical emergencies and 

collaborations with the community to 

improve patient outcomes 

• Continue to develop community CPR skills, with a focus 

on at risk groups, CALD communities and the Aboriginal 

community 

• Collaborate with partner organisations (including 

community safety organisations and first aid providers) to 

reduce preventable injuries and increase the community 

uptake of first aid training 

Increased community capability in CPR, contributing 

to improved cardiac arrest survival rates 

Increased community capability in injury prevention and 

first aid 

• Develop strategies for community engagement to improve 

the community/ambulance response for specific clinical 

conditions (e.g. asthma, stroke, diabetes, mental health 

and cardiovascular) 

Improved patient outcomes 

Community relationships and 

accountability: 

Strengthen relationships with the 

community, improve understanding of the 

AV role and fulfil broad social 

responsibilities 

• Further develop mechanisms for community engagement, 

including the Community Advisory Committee and auxiliaries 

• Continue to develop community relationships to improve 

access and equity, with a particular focus on CALD 

communities and the Aboriginal community, including the 

development of an AV Reconciliation Plan 

• Explore options to increase public awareness of appropriate 

ambulance use 

• Refine public reporting of AV performance, including 

additional reporting of clinical outcomes and clinical incidents 

Improved understanding of community needs 

Improved responsiveness to specific community needs 

More appropriate use of ambulance services 

Increased public accountability 

24


Health policy and system 

development: 

Further develop the ambulance role in 

improving the health system performance 

• Provide policy input to DH to ensure unintended 

impacts of health system developments on ambulance 

service delivery are minimised 

• Collaborate with DH and health services to identify 

opportunities and develop strategies to improve the health 

system response for specific categories of high acuity patients 

• Strengthen links with the primary health care sector and 

explore options to improve service delivery via partnerships 

with other service providers, particularly general practitioners 

More effective and appropriate use of 

ambulance services 

Better coordination of ambulance and health 

services and improved outcomes for high 

acuity patients 

More appropriate use of ambulance services and 

improved patient outcomes 

• Work through the Council of Ambulance Authorities to 

improve the recognition of the ambulance role and issues 

at a national level 

Increased national recognition of the ambulance 

contribution to health system performance 

25

AV Strategic Framework 

AV role and principles 

Strategic objectives 

Improve Service 

Quality & Efficiency 

Foster Staff 

Development & 

Welfare 

Develop Systems & 

Resources 

Strengthen 

Community 

Relationships & 

Promote Initiatives 

Planning environment and issues 

Strategic themes 

• Demand Management 

• Process Efficiency 

• Health System Integration 

• Emergency Services Coordination 

• Standard & Scope of Care 

• Workforce Capability 

• Workforce Health & Safety 

• Workforce Well-being 

• Performance Monitoring 

• Information Management 

• Financial Management 

• Business Systems & Processes 

• Research 

• Environmental Sustainability 

• Community Capability & Awareness 

• Community Relationships & Accountability 

• Policy & System Development 

26

8. Performance measurement 

AV monitors its organisational performance using a suite of 

performance indicators grouped into four broad categories, which 

are closely aligned to the four strategic objectives outlined above: 

> Service delivery standards 

> Workforce development and welfare 

8.1 Service delivery standards 

These performance indicators measure the quality of AV service delivery 

Performance 

Indicator 

Measures 

> Resource management and cost effectiveness 

> Health system and community capability 

Further development of the indicator suite is proposed during the 

planning period, with particular focus on refinement and expansion 

of service delivery indicators including measures of response time, 

clinical outcome and non-emergency performance (see Section 7 

above). Where necessary, more specific measures will also be 

introduced to evaluate the effectiveness of each of the strategies 

outlined in Section 7. 

Existing performance indicators and related measurement 

definitions are detailed below. Specific targets are set for each 

measure every year in the AV Annual Plan. 

Call taking and 

dispatching times 

Emergency 

response times 

Standard of care 

Percentage of 000 calls answered within 5 seconds 

Percentage of Code 1 incidents with total time 

to dispatch within 150 seconds 

90th percentile response time to suspected 

cardiac arrests (Priority 0) 

Percentage of Code 1 incidents responded to 

within 15 minutes 

Percentage of Code 1 incidents responded 

to within 15 minutes in urban centres with 

population greater than 7,500 

Percentage of audited cases meeting standards 

(compliance with Clinical Practice guidelines) 

> emergency cases 

> non-emergency cases 

> CERT 

27

Performance 

Indicator 

Patient outcomes 

Measures 

1 

Percentage of adult cardiac arrest patients 

with vital signs at hospital 

Percentage of adult cardiac arrests patients 

surviving to hospital discharge 

Mean reduction in pain score for 

> ischaemic chest pain 

> traumatic pain 

Percentage of patients with initial severe cardiac 

relief or traumatic pain who receive significant 

pain relief 

Percentage of potential major trauma patients 

(non-trapped) with scene time less than or 

equal to 20 minutes 

1 

8.2 Workforce development and welfare 

These performance indicators measure the effectiveness 

of strategies to promote workforce development, health 

and safety 

Performance 

Indicator 

Workforce 

education and 

training 

Workforce health and 

safety 

Measures 

Average days of training per employee per year 

Sick leave rate 

> operational employees 

> non-operational employees 

Average annual days lost through work-related injury 

per operational employee 

Patient satisfaction 

Percentage of patients (or their carers) 

satisfied or very satisfied with service 

Number of complaints per thousand cases 

> total complaints 

> substantiated complaints 

Percentage of members satisfied or very 

satisfied with the Membership Scheme 

Workforce 

satisfaction 

Average full shift overtime per week (operational 

employees) 

Percentage of workforce satisfied (or better) working 

at AV 

> operational employees 

> non-operational employees 

1. Adult cardiac arrests not witnessed by a paramedic, presenting in VF/VT where resuscitation attempted 

28

8.3 Resource management and cost effectiveness 

These performance indicators measure the effectiveness of 

resource and cost management and of financial strategies to 

support service delivery 

8.4 Health system & community capability 

These performance indicators measure the effectiveness of 

other health care providers, partner organisations and the 

broader community in contributing to emergency outcomes 

Performance 

Indicator 

Measures 

Performance 

Indicator 

Measures 

Service delivery costs 

Overhead costs 

Cost per case for each service delivery category 

> emergency road 

> non-emergency road 

> air ambulance rotary wing 

> air ambulance fixed wing 

> adult retrieval 

Percentage of operating expenditure spent on 

administration 

Management of low 

priority 000 callers 

First responder 

programs 

Percentage of 000 callers receiving health 

advice or service from another health 

provider as an alternative to emergency 

ambulance response 

Percentage of suspected cardiac arrest cases 

(Priority 0) where (non-AV) first responder 

arrives first 

Generation of 

non-government 

revenue 

Financial liquidity 

Percentage of population (excluding pensioners 

and health care card owners), who are members 

of the Membership Scheme 

Administrative cost per member of the 

Membership Scheme 

• Quick asset ratio 

• Current asset ratio 

Community first aid 

skills 

Community 

satisfaction 

Health sector 

satisfaction 

Percentage of incidents where CERT is 

dispatched and arrives first 

Percentage of witnessed cardiac arrests where 

bystander CPR is undertaken 

Percentage of community satisfied or very 

satisfied with AV performance 

Percentage of health sector stakeholders 

satisfied with AV performance 

29

9. Ambulance Victoria in 2012 

AV’s strategies to 2012 build on the significant development of Victoria’s 

ambulance services which have occurred over the last ten years. 

The creation of a single statewide service in 2008 was a major step 

in a continuing process of transformation. On-going work to ensure 

consistency and integration of services and systems will be a continuing 

theme during the planning period. 

Major developments in service delivery by 2012 will include: 

• Rationalisation of rural communications centres, and statewide 

consistency in call taking and dispatching 

• Progress towards more consistent patient outcomes across the 

State (particularly cardiac arrest outcomes) 

• Continuing improvement in coordination and integration with the 

broader health sector, including improved performance at the hospital 

interface and extension of referral options 

• Evaluation of options for extending the scope of paramedic 

practice and (if appropriate) initial implementation of new model(s) 

• More efficient and dynamic management of emergency response 

resources 

• Strengthening of statewide major incident response systems and 

capability 

• More consistent statewide approach to the provision of nonemergency 

patient transport 

• More efficient and effective air ambulance services 

• Improved levels of service for adult retrievals statewide 

There will be a continuing focus on workforce development and welfare through 

the planning period. This will include promotion of a positive and consistent 

organisational culture and further development of mechanisms for workforce 

engagement and consultation. 

Strategies to minimise health and safety risks to the workforce will remain a key 

priority, and options to provide more flexible working arrangements will be developed. 

The program of facilities refurbishments will continue across the State. 

AV will work closely with the universities to ensure paramedic education meets 

organisational requirements and there is an appropriate future supply of qualified 

workforce. 

Organisational information systems will continue to evolve, with particular focus on 

integration of systems and data across the organisation, more real time reporting, 

more effective use of GIS data and better linkages with relevant external data. 

Use of VACIS data to support more evidence based approaches to clinical practice 

and training, and research to drive innovation will be significant priorities. 

Reducing AV’s environmental footprint will be an important objective for the planning 

period. 

AV is committed to further strengthening community relationships across the State, 

with a particular focus on improving its responsiveness to special needs and increasing 

the capability of communities to manage emergencies prior to ambulance arrival. 

30

Glossary & abbreviations 

ACO 

ARV 

AV 

CAA 

CAD 

CALD 

CERT 

CFA 

CPG 

DH 

Dispatch Code 

ECG 

ED 

EMA 

ESTA 

GIS 

MFB 

MICA 

MTS 

Single 

Responder 

Ambulance Community Officer 

Adult Retrieval Victoria 

Ambulance Victoria 

Council of Ambulance Authorities Australia 

Computer Aided Dispatch 

Culturally and Linguistically Diverse 

Community Emergency Response Team 

Country Fire Authority 

Clinical Practice Guidelines 

Department of Health 

Priority of ambulance dispatch (From 1 to 3; Code 1 means a 

time critical dispatch, with a response using lights and sirens) 

Electrocardiogram 

Hospital Emergency Department 

Emergency Management Australia 

Emergency Services Telecommunications Authority 

Geographic Information Systems 

Metropolitan Fire Brigade 

Mobile Intensive Care Ambulance 

Major Trauma Service (The Alfred Hospital, Royal Melbourne Hospital & Royal Children’s Hospital) 

MICA paramedic or Ambulance paramedic response unit 

without transport capability (usually a sedan) 

SHERP 

State Health Emergency Response Plan 

Triage Category Priority assigned to patients in hospital emergency departments (from 1 to 5) 

VACIS 

Victoria Ambulance Clinical Information System 

VACU 

Victorian Ambulance Counselling Unit 

31

AMBULANCE VICTORIA STRATEGIC PLAN 2010 â 2012

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AMBULANCE VICTORIA STRATEGIC PLAN 2010 â 2012