‘Uncovered emergencies’ as ambulances enter code white again

UPDATED: Patient safety was “directly affected” across Adelaide overnight as multiple ambulance callouts requiring a response within 16 minutes were left outstanding, capping off a week of intense pressure on the state’s health system.

Mar 24, 2023, updated Mar 24, 2023
Photo: Tony Lewis/InDaily

Photo: Tony Lewis/InDaily

The SA Ambulance Employees Association (AEA) reported that at 9.30pm last night, there were “uncovered emergencies” with an “OPSTAT white” event declared across metropolitan Adelaide – the third such event reported this week.

“OPSTAT white” means the SA Ambulance Service’s operational capacity and resources are “insufficient to maintain effective service delivery for high acuity cases” and “patient safety is directly affected”.

An alert sent to ambulance officers and tweeted by the AEA stated that there was “high community demand” and “multiple outstanding P2s (priority twos)”. Callouts assessed as priority two require ambulances to respond within 16 minutes.

The alert also stated there was “ongoing hospital congestion” and “high utilisation”.

?Thur 9:30pm: SAAS OPSTAT White across Adelaide with uncovered emergencies due to high demand and ramping.

‘Operational capacity, capability and/or resources are insufficient to maintain effective service delivery for high acuity cases’ … ‘Patient safety is directly affected.

— Ambulance Employees Association (SA) (@aeasa1981) March 23, 2023

AEA  secretary Leah Watkins told InDaily that having patients left waiting for ambulances was “the most serious problem that ramping creates” .

“There has been a lot of commentary on ramping recently and concerningly, there has been one obvious omission in the discussions – the stranded patient in the community who has called triple zero needing help while that help is sitting on a hospital ramp,” she said.

“No one is looking after this patient in their time of need until an Ambulance arrives, and the longer they wait for an ambulance the greater the risk of their condition worsening.

“Paramedics are registered health professionals and when they are ramped with a patient who is clinically suitable for the waiting room this patient should be transferred to the hospital and the ambulance released from the ramp to respond to the community.

“When this practice occurs, Paramedics conduct a comprehensive medical assessment, review the patient’s clinical history, give clinical advice and/or treatment and provide a clinical handover along with clinical documentation to nursing staff.

“Patients who are moved to the waiting room are in a supervised environment so that the ambulance crew can now respond to the most at risk patients waiting in the community who have no one. ”

Watkins said the AEA would continue advocating for the safety of ambulance officers and patients “whether they are left waiting for help in the community or stuck on a hospital ramp, and particularly when our concerns are dismissed and not enough is being done to keep the SA Community safe”.

Latest SA Ambulance data shows that in February, just over half – 53 per cent – of priority two callouts were responded to on time – up from 36 per cent in January 2022.

There was also a rise in meeting priority one callout times – from 47 per cent in January 2022, to 63 per cent last month.

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However, the number of hours ambulance spent ramped outside hospitals increased slightly from 3018 in January this year to 3036 in February.

The AEA reported that “OPSTAT” white alerts were also issued on Wednesday and Monday this week, with ambulances spending over 83 hours on hospital ramps with patients waiting for a bed on Monday alone – the same day that SA Health’s electronic patient records system went down and the medical officers’ union was called in to conduct a safety inspection of a “gridlocked” Flinders Medical Centre.

A SA Ambulance Service (SAAS) spokesperson told InDaily that the service had seen an increase in respiratory illness ahead of the cooler weather, but it had also continued to see a small number of calls which weren’t necessarily an emergency.

They said where appropriate, those with less serious conditions should consider alternative care options – such as their local GP or HealthDirect – before calling triple zero.

“We continue to work hard to free up our emergency resources and get to our patients sooner,” they said.

“Currently, SAAS is managing to support the care of over 20% of our Triple Zero (000) activity through care pathways which do not require transport to an Emergency Department.

“This performance is among the best in the country and has been achieved thanks to our hardworking clinicians.

“While ramping and community demand is high, some relief is being felt on the roads due to recent metropolitan and outer metropolitan resourcing boosts, which have added over 60,000 hours of clinical capacity to our service.”

Ambulance ramping has been at the forefront of state politics this week, with the Opposition accusing the state government of attempting to “weasel” its way out of its election commitment to “fix the ramping crisis”.

Health Minister Chris Picton on Tuesday said Labor was repeatedly asked what was meant by “fix the ramping crisis” before the election, with the party saying it meant “reducing ramping to the point that we can ensure ambulances respond to priority cases as they did back in 2018”.

He said the state government had not set a target for the reduction in the number of hours ambulance spend ramped outside hospitals.

But Opposition leader David Speirs said Labor had promised to “fix ramping”, with “no asterisks” or “nuance”.

The Opposition yesterday moved a no-confidence motion against Picton – the first since the Malinauskas Government secured power at the March 2022 state election – but it was defeated along party lines, with former Liberal MPs-turned-independents Troy Bell and Fraser Ellis siding with Labor.

Meanwhile, the state government has ordered an audit of pillow and blanket supplies and distribution across hospitals, after a daughter of a 93-year-old man told reporters yesterday that her father was given no pillow when he attended Queen Elizabeth Hospital’s emergency department this week.

Picton said it was “simply not good enough” that there had been “repeated” patient concerns raised about the availability of pillows and blankets in public hospital emergency departments.

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