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Summer 2004

The future of Tasmanian Ambulance Services

Ambulance services are increasingly under pressure.

Changes to the organization of the acute, sub acute and primary and community support health care sectors draw on the need for ambulance services to provide essential support.

Developing patterns of emergency presentations at hospitals almost identically translate to patterns of growth in ambulance emergency demand.

In its last two budget submissions the Tasmanian Ambulance Service forecast increased demand at approximately 5% per annum.

HACSU Ambulance members have reported an increased incidence in recent times of call outs relating to mental health and alcohol and drug related issues.

In Tasmania, the ambulance service has conceded that ambulance demand growth is almost certainly linked to;

• the extent to which general practitioners will bulk bill patients,

• increased average out-of -pocket expense associated with GP services,

• availability of GPs after hours,

• availability of other health services (such as community nursing, palliative care services, mental health crisis teams) in particular areas or at particular times.

Thus, it is very likely that ambulance service demand levels are determined to a large degree by trends in the health system overall, which add to growth in demand, driven by an ageing population.

A number of factors are associated with relatively greater or lesser use of ambulance transport, for instance ambulance usage increases with age (people aged 75 or more are four times more likely to use ambulance than those aged between 15 to 24).

In a recent study in Queensland it was found that people diagnosed with mental disorders were about 2.4 times more likely to access ambulance services.

The Tasmanian Ambulance Service has also suggested that the high instance of patients presenting with mental health disorders may be attributed directly to de-institutionalisation.

Ambulance members who work in stations close to group homes report an increase in the usage of ambulance in their area since the closure of major institutions in their catchment area.

Last year the Tasmanian parliament finalised a Joint Standing Committee report on ambulance services in Tasmania.

In its submission to the inquiry, the Tasmanian Ambulance Service recognized growth in demand as a serious challenge.

The Ambulance Service CEO informed the committee that:

"Increasing demand is the most important question in ambulance service delivery in Australia. One of the biggest dilemmas for the ambulance service is that many changes in the health system impact on us. Less doctors bulk billing means more people calling on ambulance services to get to the hospital and emergency department to get free treatment. De- institutionalizing people with mental illness/ intellectual disability has also had an impact. There are more people out in the community who, when they have an acute episode, the ambulance is called on. The aged are the biggest users of ambulance services so, we have a demographic time bomb."

Since 1977 ambulance caseload in Tasmania has more than doubled.

Ambulance staffing during that same period has not seen increases in staffing that match the increase in demand.

Recently, the State Government commissioned the first ever, independent analysis of ambulance resources in the North West of Tasmania. This resulted in an increase of 25 staff in that region.

The North West now has the same staffing numbers as the South of the State, servicing less than half the population.

What this highlights is the need for a real analysis of ambulance services across those other Regions.

HACSU Ambulance Employees Sub Branch members have identified their next priority as ensuring the level of services provided to the Tasmanian Community across all regions is of the highest possible quality. Also, that ambulance officers, paramedics and communication staff receive the highest quality training.

The reduction of fatigue and ensuring that staff do not get burned out is of critical importance to ambulance members. This can also be addressed by ensuring that adequate staff are employed to reduce the incidence of stress related to workload.

HACSU members will continue to lobby and campaign for additional resources in ambulance services.

Funding is needed to support our aging citizens, people with mental illness' and disabilities in accessing appropriate services, particularly after hours.

The Government's current review of the health system, driven by the Richardson Review, must develop a plan for the provision of health services in a way which reduces the usage of ambulance as a safety net.