The Australasian College for Emergency Medicine (ACEM; the College) is calling for parties contesting the looming Western Australian election to urgently explain how they will fix the state’s ambulance ramping and hospital access block crisis.
This comes as ambulance ramping – caused by a lack of physical space in emergency departments (ED) leading to ambulances being unable to unload patients for urgent hospital care – has reached an unprecedented crisis point in the state.
Ramping means ambulances and crews have to remain at hospital entry points or driveways and continue to provide care until ED space becomes available. This not only delays the assessment and treatment of a patient in an ED, but ties up crews who are unable to respond to further calls for assistance in the community.
There have been cases in other states of patient deaths linked to ambulance ramping and associated delays.
Ramping is also a key indicator of ED and hospital overcrowding and access block – where a patient has to wait more than eight hours for admission to an inpatient bed after receiving initial care and stabilisation in the ED.
These delays increase the risk of poor health outcomes, including death. Recent research has shown that a patient who arrives at an access-blocked ED has a 10% greater chance of dying compared to someone who arrives at an ED which is not.
ACEM President Dr John Bonning said ambulance ramping is a symptom of broader healthcare system failure, brought about by patient flow, system and capacity issues among other factors.
“Ambulance ramping significantly increases risks to patients, and should not be allowed to occur under any circumstances,” said Dr Bonning.
“Unless urgent action is taken there is the very real risk that somebody will die. This is an enormously distressing situation for emergency clinicans and responders, and the community should not accept it.
“Access block in EDs is a hospital-wide resource and capacity issue manifest in the ED. It requires whole-of-system investment including more inpatient beds, staff and resources.
“The frustrating thing is that the number of presentations to EDs and the proportion of patients needing admission to hospital is, in the main, entirely predictable. There can be no excuses not to address and fix these persistent and worsening systemic issues. To blame recent delays in offloading patients from ambulances to pandemic-related respiratory streams is a false economy as these largely stopped running in EDs some four to six months ago. It is also categorically not about patients ‘who should have seen a GP instead’. It is about the seriously sick and injured who need hospital admission, not those with minor complaints.
“While emergency clinicians and the Western Australian public have long been promised action, the situation has progressively worsened.”
ACEM Western Australia Faculty Chair Dr Peter Allely said urgent solutions were needed to alleviate pressure on the state’s healthcare system and associated risks to patients.
“We call on all parties contesting the state election to provide comprehensive plans on how they will fix the state’s unacceptable and dangerous ambulance ramping, access block and ED crowding crisis,” said Dr Allely.
“Solutions must look at urgently increasing bed numbers well beyond what has already been committed as well as significant systemic and capacity improvements.
“It is, of course, important to have processes, protocols and cleaning in place to safeguard against the risk of COVID-19. However, if indeed these are contributing to unnecessary delays, there must be scope to improve these practices, to mitigate other significant risks and fix this preventable problem.
“For too long now, the Western Australian community has been facing unacceptable risks when trying to access urgent medical care. With the state election looming, we cannot afford to wait any longer for meaningful improvement.”
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au