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

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

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

5. Ambulance Victoria’s Role 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)

6. Ambulance Victoria’s Resources 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%

7. Ambulance Victoria activity 2008-09 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

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 & the health system 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

10. Ambulance Response Time Components 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”)

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. Improving system performance 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 90 th 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