14 2017/18
CLIMB MELBOURNE'S EUREKA TOWER IN 2018!
2nd Annual
Mental Health Strategies for First Responders Driving cultural change & enhancing preventative approaches 7th & 8th March 2018, Bayview Eden Melbourne
Key Speakers Tony Walker Chief Executive AMBULANCE VICTORIA
Dr Katrina Sanders Chief Medical Officer AUSTRALIAN FEDERAL POLICE
David Morton Director General Mental Health, Psychology & Rehabilitation DEPARTMENT OF DEFENCE
Bernie Scully Manager Clinical Services and Organisational Development QUEENSLAND FIRE & EMERGENCY SERVICES
Jon Goddard Member Support Coordinator POLICE ASSOCIATION NSW
Professor Alexander McFarlane AO Psychitiatrist & Director, Centre for Traumatic Stress Studies UNIVERSITY OF ADELAIDE
Visit the website for the full speaker line up
Benefits of attending: Engage leadership to break down stigma & drive cultural change Effectively implement preventative mental health strategies Use evidence & insights to inform best practice Challenge stigma with key case studies from emergency services, not-for-profits & leading psychologists
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REGULARS From the President 05 States of Activity 15 Contacts 31
Cover photo: Rain Histen is leading the charge for next year’s Eureka Stair Climb. Photo by David Reinhard. Turn to page 25.
VOLUME 7 ISSUE 2 2017/18
Ambulance Active Official Publication of National Council of Ambulance Unions
PUBLISHER Ambulance Active is published by Countrywide Austral. Countrywide Austral adheres to stringent ethical advertising practices and any advertising inquiries should be directed to:
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FEATURES 07
National mental health & wellbeing study of police & emergency services
09 Student paramedics conference 11 PPP in pipeline for Victoria 12 NCAU Annual Conference 2017 for change 18 Submission recognising PTSD 25 The height of mental health Board of Australia 29 Paramedicine first appointments
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25 Disclaimer: Countrywide Austral (“Publisher”) advises that the contents of this publication are at the sole discretion of the National Council of Ambulance Unions and the publication is offered for background information purposes only. The publication has been formulated in good faith and the Publisher believes its contents to be accurate, however, the contents do not amount to a recommendation (either expressly or by implication) and should not be relied upon in lieu of specific professional advice. The Publisher disclaims all responsibility for any loss or damage which may be incurred by any reader relying upon the information contained in the publication whether that loss or damage is caused by any fault or negligence on the part of the publisher, its directors and employees. Copyright: All advertisements appearing in this publication are subject to copyright and may not be reproduced except with the consent of the owner of the copyright. Advertising: Advertisements in this journal are solicited from organisations and businesses on the understanding that no special considerations other than those normally accepted in respect of commercial dealings, will be given to any advertiser.
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PRESIDENT
STEVE McGHIE, PRESIDENT, NCAU
the PRESIDENT HAPPY NEW YEAR MEMBERS AND welcome to the first edition of Ambulance Active for 2018. This year, mental health will continue to be a major focus for the NCAU. Last year we supported the beyondblue’s National Survey on Mental Health and Wellbeing of Police and Emergency Service Personnel - Answering the call. This national survey on the mental health and wellbeing of police, ambulance and fire and rescue personnel called on employees from ambulance services across Australia to participate in a short survey. Thank you to those who were selected and who chose to participate. The survey results will assist in translating the information into resources and initiatives to best support you and your colleagues to achieve your best possible mental health. The NCAU also agreed to a joint Mental Health Strategy with the Council of Ambulance Authorities (CAA). This work will be finalised during the year and we look forward to sharing our plans with you.
AMBULANCE ACTIVE
“This year is looking to be another busy
one for all ambulance unions. Many will be continuing their bargaining or campaigning for better employment conditions for our members this year. We wish them all the best in their negotiations.
”
NCAU Project Manager Jim Arneman, our representative on the CAA Mental Health committee, will keep members upto-date with the progress of this strategy through the state union delegates and Ambulance Active. This year is looking to be another busy one for all ambulance unions. Many will be continuing their bargaining or campaigning for better employment conditions for our members this year. We wish them all the best in their negotiations.
2018 will also be an exciting year for paramedics with National Professional Registration commencing in September. The Board has been selected (please see page 29) and the NCAU looks forward to having a good working relationship with the collective and individuals who are representing us on this issue. On behalf of the NCAU Executive, we hope that 2018 brings each of you great satisfaction and success.
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HEADER
REMINDER
NATIONAL MENTAL HEALTH & WELLBEING STUDY OF POLICE & EMERGENCY SERVICES By Jim Arneman NCAU Project Officer – Paramedic Registration
All NCAU members are reminded that Answering the call, the landmark National Mental Health and Wellbeing Study of Police and Emergency Services survey is now live at 29 agencies across Australia, including all Australian ambulance services. BEYOND BLUE LAUNCHED THE survey in October with research partners the University of Western Australia and Roy Morgan Research. Beyond Blue reports that they have had a fantastic response to date and are well over half way towards reaching their target numbers. NCAU has endorsed members participating in this unique survey. We want to thank those of you who have already responded. If you are eligible to participate and haven’t yet filled out the survey, have your say now. Your insight will help shape the future of mental health programs and initiatives for all emergency service agencies and their staff. This is ground breaking research and the feedback of those participating will contribute to an important movement that aims to provide appropriate mental health initiatives for all those who dedicate their time to look after communities across the country. The NCAU is requesting access to deidentified results so that our member unions can target gaps in mental health and wellbeing service provision for our members. It’s not too late to have your say. Your unique identifier access code to the survey should have been supplied by your service via email in October.
AMBULANCE ACTIVE
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STUDENT PARAMEDICS CONFERENCE By Jim Arneman NCAU Project Officer – Paramedic Registration
Delegates from the National Council of Ambulance Unions (NCAU) attended the Student Paramedics Australia International Conference (SPAIC 17) in September as a sponsor. STUDENT PARAMEDICS AUSTRALIA approached the NCAU earlier in the year to sponsor part of their upcoming conference. The NCAU Executive considered the request and agreed, seeing this as a tangible way that we could contribute back to the profession and paramedicine and our unions’ future leaders. SPAIC 17 was held at the Australian Catholic University St Patricks Campus in Fitzroy, Victoria. The well organised event comprised of a number of cutting edge workshops on day one, followed by the conference proper on day two. NCAU’s sponsorship paid for the organisers to fly Robin Davis out from the USA to conduct workshops and speak at the conference. Robin is both a highly decorated paramedic, and former police officer with extensive experience in scene safety. He gave an informative presentation on deescalation at the conference as well as conducting several workshops. These were well received by the attendees.
NCAU had an information stand present on both days of the event and fielded lots of questions about paramedic unions, why we were in attendance and the benefits of union membership. Jim Arneman gave a 30 minute presentation as part of the conference. He spoke about leadership in paramedicine, how the profession has progressed over the years and the important role unions have played in getting us to where we are now. He also touched on the vital role unions play in ensuring students have fair placements and access to clinical support officers and mentoring. The NCAU involvement was appreciated by the organisers and participants, many of whom had no concept of what union’s roles were in the profession prior to our presentation. The organisers were keen to have NCAU involved on a permanent basis. This request has been forward to the executive for consideration prior to next year’s event.
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PPP IN PIPELINE FOR VICTORIA By Bracha Rafael
The Ambulance Employees Association Victoria (AEAV) is working to bring prescribing paramedic practitioners (PPP) to the Victorian public. A UNION WORKING GROUP WAS established in 2017 to allow passionate front line paramedic members to drive this innovation in Victorian health care. This project has come about from the work of the Ambulance Performance and Policy Consultative Committee, a committee comprising representatives from the office of the Minister for Ambulance, the Department of Health and Human Services, Ambulance Victoria (AV), and the AEAV. The committee met throughout 2015 to set the agenda for wide-reaching reform within the ambulance sector in Victoria. The final report of the APPCC recommended that AV implement innovative models of community paramedicine in rural and remote areas. Enter the PPP. The idea of paramedic practitioners is not new to Victorian ambulance. Back in 2003, the union and Rural Ambulance Victoria (now AV) agreed to the introduction of paramedic practitioners in remote settings, specifically Omeo and Mallacoota. Circumstances intervened to delay the introduction of this role, and 15 years later, the AEAV is taking the lead in rectifying this situation. AMBULANCE ACTIVE
Two ALS paramedics on secondment to the AEA-VIC, Belinda Ousley and Bracha Rafael, have undertaken the initial research and consultation to develop a robust PPP model, which will commence in Victoria in a pilot program in due course. What is a PPP? A prescribing paramedic practitioner is a qualified paramedic who has undertaken substantial additional training to the level of a master’s degree. A PPP provides primary care to patients, has capacity to interpret diagnostic tests and to prescribe a wide range of medications. In areas that have insufficient access to primary care providers such as General Practitioners or Nurse Practitioners, PPPs have the potential to meet the needs of the community and to improve patient outcomes. Bairnsdale paramedic Sarah Whitechurch says that for many of her patients, it can be a four to six week wait to simply see a GP. A paramedic who has sufficient knowledge and authority to review patient medications and make referrals to other specialists will help to address the health disadvantage that unfortunately persists in many rural areas.
The model is not without precedent. Jake Donovan recently rejoined AV after two years in the UK, with the South East Coast Ambulance Service. In his time there he observed paramedics working in primary care in many different capacities. With some additional training, Community Paramedics act as a GP’s eyes and ears for home visits, prescribing common antibiotics in consultation with GPs and improving patient access and health system workflow. Master-qualified Paramedic Practitioners are also wellestablished in the UK and are highly respected. Donovan says the satisfaction for paramedics in taking on primary care roles comes from the opportunity to sit down with a patient and work on a thorough care plan that can meet a patient’s needs. AEAV secretary, Steve McGhie, is optimistic about the project. “This is the result of hard work that paramedics have put into their profession for many years now,” Mr McGhie said. “It will be great to see paramedic practitioners help meet the health care needs of all Victorians.”
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HEADER NCAU ANNUAL CONFERENCE 2017
NCAU CONFERENCE 2017 The 2017 NCAU Conference was held in Sydney on 31 August and 1 September. More than 40 NCAU members attended to hear a packed program of presentations from state delegates, particularly around themes of mental health and wellbeing and national registration for paramedics. The NCAU sponsored three delegates, Sarah Gray from ACT and Belinda Ousley and and Julie Delahunt from Victoria. Read Sarah and Belinda’s stories from the conference. Julie’s article will be published in the April edition of Ambulance Active to promote the 2018 NCAU conference.
BREAKING THE MENTAL HEALTH STIGMA By Sarah Gray Patient Transport Officer, ACT Ambulance Service Transport Workers Union Delegate I WAS FORTUNATE ENOUGH THIS year to be one of three winners to attend the National Council of Ambulance Unions Conference held in Sydney, NSW. As the delegate for the Non-Emergency Patient Transport workgroup within ACT Ambulance, I find these forums extremely valuable. It provides me the opportunity to network with other ambulance jurisdictions and gain an insight into how other organisations utilise their Non-Emergency Patient Transport service to provide a service delivery model that satisfies community demand and remains aligned with government parameters. I am also an undergraduate student, half way through my Paramedical Science degree. All themes discussed at this year’s conference where incredibly relevant to where I’m hoping my career and continued study will take me, which is into emergency operations. These topics included paramedic registration, mental health and wellbeing for emergency service personnel. As most will know there is an alarming increase in emergency or first responder personnel suffering from some form of mental ill-health. It is of no surprise that
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Ambulance Services and local Governments are starting to recognise the economical and personal impact this is having. A common theme to this year’s conference in regards to mental health, was breaking down the stigma that is attached to someone putting their hand up for help and the acknowledgment that an increase in demand for services is diminishing officers and volunteers the opportunity to ‘debrief’ with each other back at station or over a cup of coffee. Add to that mix, first responders and or volunteers attending incidents that are out of their everyday norm and those personnel not having the confidence to seek available resources only leading to exacerbate these statistics. While officers may be aware of the services available most are reluctant to seek the help. Across the board we have employees both within emergency operations, non-emergency operations, the communications room, volunteers and personnel that go through individual cases to ensure quality assurance exposed to cases and situations for, whatever reasons, having the potential to invoke strong emotional reactions.
We need to be empowering our officers and having a robust work health and safety approach to providing adequate support, without stigma regardless of whether your within emergency operations, non-emergency operations, communications or volunteers. Some may think that continuous exposure to such events ‘hardens’ you, this could not be further from the truth and that in fact the opposite occurs. Add to this everyday stressors that are part of everyone’s personal life and the perception of superhuman responses is only a cocktail for disaster. It was encouraging to hear that a number of jurisdictions have started to advance change within this space. Some having implemented policy and procedure specific for ‘hot’ cases whilst others have noticed the importance of organising monthly, no strings attached get together over pizza. This provides a safe place where people can talk about anything they like; it just provides the opportunity to stay connected. It was unanimous however, that this is definitely a work health and safety topic and I found it somewhat comforting to know that each union has it well and truly on their radar. AMBULANCE ACTIVE
HEADER NCAU ANNUAL CONFERENCE 2017
REGISTRATION, HEALTH, WELLBEING By Belinda Ousley ALS Paramedic, Ambulance Victoria
I WAS FORTUNATE TO ATTEND THE 2017 National Council of Ambulance Unions (NCAU) Conference in Sydney on 31 August and 1 September. Both days were filled with presentations from representatives of each of the states and territories, as well as our New Zealand counterparts. We also had visits from Federal Labor politicians Brendan O’Connor and Tanya Plibersek, who gave interesting insights into the effects of economics and politics on our members’ working conditions. The respective union representatives spoke about the various issues their members are currently reporting. Safety, workload, resourcing, meals and overtime were common themes. The two major focuses for all parties in the coming 12 months are paramedic registration and member health and wellbeing. Paramedic registration is coming in 2018. The Australian Health Practitioner Regulation Agency (AHPRA) is currently in the process of appointing a Board to oversee the entire process. Once this occurs and decision-making commences, unions will have more information to circulate to members. Members have expressed concerns about the process of registration and in response AHPRA has released a FAQ document, which can be accessed from the website, www.ahpra.gov.au I encourage all members to read this document to gain a better understanding of the registration process and expected timelines. It is important to recognise that registration is a natural next step in the evolution of the paramedic profession. The expectations of a registered paramedic will align with the informally accepted standards for currently employed paramedics. Members’ health and wellbeing is of great concern, with all unions AMBULANCE ACTIVE
“Members’ health and wellbeing is of
great concern, with all unions reporting ample anecdotal evidence of PTSD, anxiety, depression, substance abuse (including alcohol), suicide, relationship breakdowns and significant financial difficulties amongst members.”
reporting ample anecdotal evidence of PTSD, anxiety, depression, substance abuse (including alcohol), suicide, relationship breakdowns and significant financial difficulties amongst members. Thankfully, this anecdotal evidence has led to several research projects being undertaken that will provide comprehensive statistical evidence to support future member health and wellbeing initiatives. The NCAU is pleased to have collaborated with the Council of Ambulance Authorities (CAA) and Ambulance NZ, under guidance from beyondblue, to develop a 10-point strategy to address member health and wellbeing issues. It can be accessed t the CAA website, www.caa.net.au Unions have also provided resources to facilitate member meetings, support groups, walking groups and social activities in an effort to assist members to address and manage their health and wellbeing in addition to the support services offered by their employers. It is hoped that such initiatives will expand to more locations over the coming months.
Finally, as reported by Jim Arneman in the last Ambulance Active journal, statistical evidence is emerging that organisational factors have a significant impact on member health and wellbeing. It is now believed that by addressing predictable stressors associated with our work (eg. fatigue, meals, workload), members are better placed to demonstrate resilience and healthy coping strategies in response to unpredictable stressors (eg. trauma, threats to safety). This highlights the critical importance of unions and their collaborations with ambulance services to achieve satisfying and supportive conditions for all of their members who undertake incredibly unique and challenging roles as paramedics, transport officers, dispatchers, clinicians, managers, administrators and many more. I look forward to using the knowledge gained during the conference in my upcoming secondment to the Ambulance Employees Australia – Victoria office over the coming months and to collaborating with other unions to improve conditions for all members nationally.
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NCAU ACTIVE
ACT ENTERPRISE AGREEMENT Bargaining for the new enterprise agreement has been underway since November 2016. The Labor Government 0re election commitment was to maintain wages at least in line or slightly above CPI. Unions have rejected the initial wage offer which equates to less than 2 per cent per year over 4 years. As part of the EA process, the TWU have commenced Agency Specific negotiations with ACTAS to provide for greater career pathways for front line staff, in particular for Paramedics. The TWU are committed to finding solutions to enable staff to develop their skills and enhance their profession.
RESOURCING The TWU recently met with the Chief Minister to seek assurances ahead of the 2018 ACT budget regarding ambulance resourcing. The State Government has committed funds to peer support and welfare programs and two additional 24 frontline crews; the TWU had made it clear that ACTAS requires significant injection of between an additional 30-50 frontline staff to fill attrition and increase crewing levels. Further, ongoing sustained staffing increases will be required, which take into account increasing demand for services as well as an adequate relief factor, to cover leave and staff development. Discussions are ongoing.
LEADERSHIP A new ACTAS Leadership Framework has now been finalised as a result of extensive consultation. It covers what staff believe are essential leadership behaviours and capabilities for ACT Ambulance. It will inform recruitment, staff selection and promotion as well as staff and performance development into the future. Implementation will commence in early 2018 and is aimed at building a leadership culture in ACTAS and enhancing professionalism.
WELLBEING A comprehensive suite of staff wellbeing products are being prepared for rollout in early 2018. A draft Mental Health and Wellbeing Plan has been prepared. A peer support system, based on the QAS model will be a feature. We are also implementing psychological first aid (MANERS) training. Respectful Workplace and Difficult Conversations training are also scheduled as part of the programming.
QUEENSLAND QUEENSLAND CERTIFIED AGREEMENT 2017 United Voice members won significant commitment from State Government to support a comprehensive enquiry into their pay. Mercer Consulting was awarded the tender who was co-funded by United Voice and the Qld State Government. Throughout November 2016 and February 2017, approximately 10% of the workforce across diverse areas and job classifications spoke directly with the Mercer team from the majority of LASN’s across Qld. To enable all staff to have a say in the inquiry, Mercer conducted a survey which saw almost 2200 staff participate. The report was finalised and delivered to United Voice and QAS in June. continued on page 17
BLUEPRINT FOR CHANGE The implementation phase of the Blueprint for Change process is now underway and will accelerate in early 2018, including the introduction of flexible work, leadership and wellbeing initiatives.
FLEXIBLE WORK A new Flexible Work Arrangements policy has been introduced. Initially it is focusing on innovative ways of undertaking flexible work arrangements through part time work. A series of additional guidelines are being developed which will cover a range of opportunities to work flexibly as the project continues.
AMBULANCE ACTIVE
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NCAU ACTIVE
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AMBULANCE ACTIVE
NCAU ACTIVE
continued from page 15 Key findings showed that although QAS compared well regarding conditions and allowances it delivered a finding that QAS was the lowest paid service on most job classifications State Council endorsed the Mercer report agreeing it should form the basis for negotiating an improved wages and classification structure to bring Queensland up to comparative levels with other services. State council resolved a preference for a new certified agreement. In August, ten United Voice delegates representing members from across all QAS disciplines began negotiations with QAS for a new certified agreement. Both parties have now reached an inprinciple agreement with an operational date of 1 September 2017. The agreement will deliver to members, pay parity with enhanced classification structures; restored meal overtime allowance and an aggregate rate payable on long service leave. On 6 November the ballot opened for QAS staff to vote on their agreement. 84.2% of staff participated in the ballot. At the close of the ballot 27 November, 98% had voted YES in favour of their Certified Agreement. A great win for United Voice members!
SAFETY TASKFORCE The Safety Taskforce continues to meet on a monthly basis to ensure the implementation of the fifteen taskforce recommendations into paramedic safety remain on track and within the agreed timeframes. This year has seen • the majority of acute vehicles outfitted with duress monitoring systems; • duress functionality applied to analogue radios; • duress availability on PTT satellite radios; • SAFE2 training refresher course rolled out to operational staff; • Caller Journey training for EMD’s the establishment of Managing Challenging Situations and Callers Program • ACP’s trained to administer sedation drug Droperidol • Introduction of ICEMS – inter-agency CAD electronic system with QPS to enhance officer safety and reduce calls between agencies on joint cases
AMBULANCE ACTIVE
“United Voice continues to support
Graduates through issues around rosters, pay queries, resources, mentors, annual leave and work place health and safety issues.”
INDUSTRIAL OUTCOMES The 1983 amended Holidays Act saw members receive an extra penalty whilst working on Christmas day 2016 which fell on a Sunday. Several new Industrial laws enacted to reverse changes made by previous government included changes to • Restored independence to industrial commission • Reverse award stripping • Reintroduced ‘good faith bargaining’ • Allowed for ‘interim wage increases’ • Includes protection against workplace bullying • Improves job security • Declared Easter Sunday a public holiday
DOMESTIC AND FAMILY VIOLENCE United Voice welcomed Queensland Ambulance Service’s initiative adopting the HR policy regarding support for employees affected by domestic violence. QAS has committed to providing up to ten days per year paid special leave to assist employees with matters arising from domestic and family violence.
FLIGHT PARAMEDICS United Voice fortified QAS to secure extra cover for flight paramedics on operational flights. Up to $3 million payable which is additional to existing benefits available under various legislation such as worker’s compensation
SUPPORT FOR GRADUATES Concerns have been identified with graduate placement uncertainty, inconsistency and transparency in the Graduate Paramedic Program (GPIP) United Voice demanded a major review which resulted in significant changes to the program now known as the Graduate Paramedic Internship Program GPIP) Changes contain, • Clarification of the graduate’s role and drivers of success within the program;
• The overlay of a detailed performance development framework that includes performance standards; • Includes changes within the program to meet the performance (milestone) standards requirements; • Includes a revised management process for graduates ‘at risk’ of not meeting the requirements of the program; • Includes additional clinical supervisor resources; • Development of an electronic platform. United Voice continues to support Graduates through issues around rosters, pay queries, resources, mentors, annual leave and work place health and safety issues.
PATIENT TRANSPORT PTO’s have had several work place health and safety issues addressed including the replacement of orange lights on PTS vehicles with red lights. They have also secured an undertaking by QAS to source powered stair chairs to assist in the transport of clients to their vehicles.
GRIFFITH UNIVERSITY RESEARCH PROJECT Last year United Voice reported a successful partnering in a three year research project to research and investigates employment conditions to identify issues around services and support provided to staff. Pilot study results found operational workloads placed strain on the capacity for paramedics to perform roles which also contributed to psychological stress People management systems and support mechanisms could be better designed to manage the impact of these stressors A two part survey is currently being conducted on a random pool of United Voice members. Over 400 members have volunteered to participate in the survey.
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RECOGNISING PTSD
SUBMISSION FOR CHANGE RECOGNISING PTSD HACSU TAS has shared its submission to the Tasmanian Government, seeking a change to the Tasmanian Workers Compensation Act to recognise Post Traumatic Stress Disorder as a presumptive condition. With support from the Tasmanian Labor Party in changing the Act in hand, a response is still being sought from the Liberal and Green parties. The following contains some personal stories, which are sensitive and may be confronting for some readers. 18
AMBULANCE ACTIVE
RECOGNISING PTSD
SUBMISSION TO PARLIAMENT That Post-Traumatic Stress Disorder (PTSD) is defined as a presumptive illness for Ambulance Paramedics under the Workers Rehabilitation and Compensation Act 1988 (Tas). That the cumulative nature of PostTraumatic Stress Disorder with respect to Ambulance Paramedics be recognised. The State of Tasmania includes a clause with retrospective effect so that an Ambulance Paramedic’s claim denied prior to the enactment of presumptive legislation can be resubmitted with updated medical evidence for reassessment.
DISCUSSION Post-Traumatic Stress, often called PostTraumatic Stress Disorder (PTSD), occurs after a particular set of reactions that can develop in people who have been through a traumatic event which threatened their life or safety, or that of others around them. This could be a car or other serious accident, physical or sexual assault, war or torture, or disasters such as bush fires or floods. As a result, the person experiences feelings of intense fear, helplessness or horror. This can manifest itself via a range of psychological conditions, including depression and or anxiety.
PTSD IS CHARACTERISED BY THREE MAIN TYPES OF SYMPTOMS: • Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares. • Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma. • Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered including emotional detachment.
PTSD HAS LINKAGES RELATED TO VARIOUS INPUTS: • Exposure to actual or threatened death, serious injury, or sexual violation. • Directly experiencing the traumatic events. • Witnessing, in person, the traumatic events. • Learning that the traumatic events occurred to a close family member or close friend. • Cases of actual or threatened death. • Experiencing repeated or extreme exposure to aversive details of the traumatic events (examples are first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Case Study: Steve Hickie People outside this work environment think that trauma we are exposed to is blood and guts. Blood and guts is normal to us. That’s what we’re trained for; we work with that all the time. The trauma for us is when you go to someone who’s lost their loved one of 50 years. Or something unexpected happened. A 35 year old with stage 4 melanoma, his wife’s there and his two little kids are running around. You look at him and he’s actually seizing. Not moving, but an absent seizure and I know he’s going to start a tonic-clonic seizure and I know I’m not going to be able to stop it and I know he’s going to die. And there’s kids, their two little kids. And you have to tell his wife “It doesn’t look good, I’ll do everything I can…” I went to a job with a little 4 year old, she was seizing too. Posturing in a “decorticate” position, which is a pretty good sign her brain is incredibly irritated. She was really sick. I picked her up, and she looked like my daughter. I lost it. Gone. On the Workers Comp claim they asked me “what was it,” and I said it was that job, but it wasn’t. My psychologist thinks the single incident on my Workers Comp claim probably has very little to do with the actual pathology of my disease, that job was just the one straw that broke the camels back. I responded to this thing and for whatever reason my brain just went “Oh, I know, I’ll go and go crazy.” And it did, and that’s what happened. I can’t put it down to one thing. It’s not like a broken leg. If I fell over and broke my leg, I could point to the gutter and say, “I tripped over that and that’s where I broke my leg.” That’s easy. A psychological injury doesn’t often just happen. It’s an accumulation thing. I have PTSD. I’ll have it for the rest of my life. I inappropriately respond to situations. I can’t have people walking behind me. I don’t go into rooms without checking everything out in it first, I don’t like people getting too close to me in crowds. I can’t go into a child’s room with dolls lying on the floor, I have to pick them up and move them out of the way. I know they’re not children lying there, and that it’s not normal, but that’s what I’ve got. I used to be a nice, quiet person who wasn’t really bothered by anything. I was casual. But I’m not that way any more. It’s what you get from doing this type of job. Workers Comp doesn’t recognise that. If I have another relapse, I have to start another claim and go thorough the whole process again. There’s no recognition that this is an ongoing thing and I’m going to need treatment for the rest of my life. They’ve closed their files and that file on me has been put away. I’m fixed; I’m now normal again. Maybe if I’d have broken my leg. But I didn’t, and I’m not.
continued on page 20 AMBULANCE ACTIVE
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RECOGNISING PTSD
continued from page 19 Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless exposure is work-related, for example reviewing footage related to events. First responders, particularly police, fire fighters, ambulance paramedics and other emergency volunteers who attend scenes plus emergency response dispatchers or call takers, have an increased level of exposure to and experience of traumatic events. People exposed to unusual events have normal and abnormal reactions. So too do emergency service (EMS) workers. Research is vast and varied, but there is general consensus that first responders are likely to suffer at least some level of PTS due to the nature of their work. EMS workers can experience trauma directly or vicariously through their work. The work they perform is amongst the most challenging work available in our community. Rushing to aide and assist individuals in varying emergency or life threatening situations. From a community perspective these jobs are invaluable. Assisting their fellow Tasmanians whilst in a time of crisis is a very rewarding experience. However, sometimes the work they undertake is at extreme personal risk and despite their training to minimise risks, not every situation that they deal with can be classified as safe. There are a wide range of tasks which can be traumatic in the general nature of EMS work and obviously not limited to these examples, which are linked to PTSD triggers: • Entering a burning building. • Attending a rescue or searches in all kinds of adverse weather. • Undertaking operations as a result of adverse weather such as flooding, entering fast following water, for the purpose of saving life, securing debris etc. • Entering a wreck with the possibility of ignition to secure and save a victim of a vehicle crash. • Undertaking a physical confrontation with and without weapons. • Participating in a vehicle pursuit. • Consoling callers, or providing instructions to “000” callers while awaiting for service personnel to arrive. • Rushing at high speed to an event are amongst routine EMS tasks. Emergency services workers can be exposed to more trauma in a single shift than most Tasmanians in a lifetime. Psychological injury amongst this work-group is high and in our view
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“Research is vast and varied, but
there is general consensus that first responders are likely to suffer at least some level of PTS due to the nature of their work.”
there is a significant under-reporting which is culturally based. The culture overtly encourages non-reporting, and it is clear to staff associations that injury management under existing practices is poorly managed within service agencies. PTSD remains an ever-present risk. Impairment from PTSD is varied, from a lack of functionality when it comes to personal triggers through to complete inability to perform routine functions. This can occur in both an individual’s personal and work life. In severe cases the hearing of a siren can be a trigger for an adverse psychological reaction even when an individual is at home or on holidays. Psychological reactions can manifest into physical symptomology, including cardiac arrhythmia, sweating, shortness of breath, gastric disorders and other more serious manifestations where there is often a causal linkage defined.
Psychological injury includes cognitive emotional and behavioural symptoms that interfere with ‘normal life’ it effects how an individual feels, how they interact with others or how they think.
THE LAWS & REGULATIONS The purpose of workers compensation laws (WCLs) is to support workers in the event or a workplace or work-related injury. Often however there is an adversarial process to try and access elements of these laws. Ideally WCLs assist employers create healthy workplaces, including identifying early signs of psychological distress and enabling suitable response and suitable support. Early intervention processes are defined in some jurisdictions, with specific duties and obligations which must be met or liability and fines can be increased, this includes guidance or compliance with claims management and return to work programs. AMBULANCE ACTIVE
RECOGNISING PTSD
Most WCLs only provide for compensation if the injury arose out of or in the course of the employment. Disorders such as PTSD can build overtime due to ongoing or regular or simply reexposure to a particular event. WCLs normally are structured for a specific incident or accident where an injury occurs, such as a specific physical injury to a specific body part(s). WCLs normally quantify or qualify the laws to only find a liability where the injury is affected significantly, materially, or substantially the contributing factor for the injury developing. This unfortunately then becomes an issue of opinions. Insurers and employers obtain Independent Medical Assessments (IMAs) of individual claimants which often result in a different causal link to the injury when compared to the primary treating practitioner or the workers medical advice. Legislatures should put in place processes where IMAs are truly independent. Doctors and other health professionals sourced by insurers are normally paid for by insurers; some doctors do not have private practices, they simply work for insurers. It is widely accepted that medical practitioners who predominantly work for insurers find more often than not in favour of a counter medical view than the workers primary treating practitioner. Practices which provide assessments
Case Study: Lauren Hepher It was a stormy day and I was working out of HQ with my partner. We were sent lights and sirens to a case outside of town, and on the way there it was so windy I couldn’t keep traction on the road. The vehicle was alarming at me, we were doing 40 up Macquarie Street and I was slipping on the road. We got to the accident, where a tree had fallen onto a car. He had been driving along, minding his own business. He had basically popped open, his head had burst and there was blood and brain tissue on the ground. There was a whole row of trees that one had fallen from, and I can remember the roar of the wind through those trees, any one of them might have fallen down next. I have honestly never been more scared of anything in my life than at that point in time. My colleague was out walking around, and I remember yelling at him over the wind telling him to get out of there, it wasn’t safe. Every time it gets windy, I get a flash back of that scene and I can hear the roar of the wind through those trees. If it’s too windy I’m on edge all day, and I can’t sleep at night. When I was training we had a buddy program with the local special school. While on placement I got responded – I had no idea – to my buddy’s house, he’d had a cardiac arrest overnight and died. His family woke up in the morning but he was already dead. I’d worked with this kid for a couple of months, and I had to deal with his family, they had no idea who I was or that I’d been his friend at school. It’s little things like that that stick with you. Ambulance Tasmania offers us a service that doesn’t fit. So instead of having someone that the service could provide, I found a private provider who I got on professionally quite well with. That’s a burden to my bank account that wouldn’t be there if I hadn’t been exposed to these events at work. If someone was on site, or easily accessible through the system, it would be part of “normal” routine to have a check in every couple of months to see how we are travelling. I think that would improve our culture and the stigma of mental health enormously. I wouldn’t ever make a Workers Compensation claim if I could get around it. I think the concept of having to prove that you’ve got a psychological injury while you’re already unwell is appalling. I see my workmates, my friends try to navigate the Workers Compensation process, and some of the stories are pretty bad. The system seems to have no appreciation of the human side of it; you just seem to get labeled as a troublemaker, it’s up to you to prove to the system that you’re injured or unwell while you’re trying to navigate your own experience of mental illness. It’s not right.
continued on page 22 AMBULANCE ACTIVE
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RECOGNISING PTSD
continued from page 21
Case Study: Peter James I was there at Port Arthur. The police told me, “The person that goes into the Broad Arrow Café won’t be the same person who comes out.” You walked in and blood was coming up over the rim of your shoes from the carpet. People were mid-stride with burgers and things, but the back of their heads were gone. It’s all vivid. I can see it every day. I could see where he’s put a footprint outside where he steadied himself to kill a couple having a picnic. He shot the wife and then the old guy got up to see what’s going on. He waited until he got to her, and then he shot him as well. I’ll always remember that footprint there. And I remember seeing this guy – his shoes stuck out underneath one of the sheets. They looked like my dad’s shoes and I had to look to make sure it wasn’t him. It was extremely distressing. Trauma’s followed me throughout my career. Whenever there’s a big job, I seem to be around for it. I went to a murder suicide, it was domestic violence thing. The husband had shot the mother and the baby then blew his head off. That’s when it started, this downhill slide with PTSD. And then Port Arthur 12 months later. Ten years later, I was at Beaconsfield. Then Christchurch in 2011. The kids get you after a while. There was a little girl, her mother had cut her fingers off, broke both of her legs and arms. She had cigarette burns from head to toe and she had a fractured skull. She’d been in foster care and she’d just been given back to her mother. And she killed her daughter. I’ve been a paramedic for 41 years, and after that long it’s all a soup, and it all comes back at different times of the day and night. You remember jobs you thought you’d forgotten. I feel as though I’ve seen and experienced things that no human should experience. I’ve been diagnosed with Chronic PTSD. It’s a creeping, insipid disease. It becomes part of the fabric of who you are, you don’t see it in yourself, but others do. I have become mistrustful of my coworkers and ambulance management. I don’t participate in any social functions. I feel isolated and mistrustful of others, and I feel very uncomfortable in public places. I feel isolated in a crowded room. There’s not much support at all. Ambulance Tasmania just seem to tick the boxes: you’ve got your rehab provider, your work certificates, the paperwork’s done, our job’s done. I’ve still had to prove that I’ve got it after 41 years of doing this job. It’s as obvious as dog’s balls that after that time you’ve got to be carrying some baggage. But I’d do it all again tomorrow.
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for workers compensation matters only or predominantly in our view should have their funding linked to the applicable tribunal and not be at the behest of the insurer(s). Where the outcome or findings are withdrawn from the potential link to ongoing funding. WCLs provide for payments: • Medical expenses - seeing doctors or allied health practitioners • Income replacement (with step downs) • Rehab costs • Retraining costs if absences are substantial or return to different duties or jobs are required • Lump sum payments relating to the injuries Claims for psychological injury are significantly disputed; generally not accepted if there is any potential or link to a ‘reasonable action taken by a manager’ related to a dismissal, a retrenchment, a transfer of location, amended rosters, performance assessments/appraisals or disciplinary action. Notification issues can arise around dispute of psychological issues, there is with WCLs strict rules about making a report to the employer and or the insurer within a specific time frame after the injury; in Tasmania the law requires this to be as soon as reasonable practicable. Case law has on at least one occasion determined that 48 hours is too long a delay resulting in a rejected claim.
SUBSTANCE ABUSE Multiple surveys of EMS workers report alcohol and other illicit and non-illicit drug use is higher amongst EMS workers than the general populous and there are varied reasons why this happens. A constant surveyed theme is these substances are used for self management in regards to psychological instability. Access to illicit and non-illicit drugs is varied amongst these work groups.
FATIGUE EMS workers report an inability to sleep well. This is multi-faceted in that it relates to the nature of their work, shiftworking environments, requirements for sleeping in anti circadian rhythm periods, and social disturbances such as noisy neighbours or families. Many EMS employers provide sleeping quarters for pre- and post-shift sleeping and fatigue management napping during down times on shifts. However there is vast disparity in the facilities provided and fatigue management issues are real within the sector. AMBULANCE ACTIVE
RECOGNISING PTSD
“Individuals
suffering from PTSD which affects their ability to sleep well need to be protected by their employers in terms of exposure to fatigue based incidents and accidents.”
Fatigue events (falling asleep without intent) and ongoing fatigue management processes can also relate to psychological stability and coping mechanisms. Individuals can be vastly affected by whether there are systemic fatigue management programs in place. Such programs include monitoring of rosters and workloads, sleep-wake models, surveying staff and establishing benchmarks around individuals and work environments, as well as having reporting mechanisms to monitor responses to fatigue and to track fatigue related incidents and accidents. Lack of fatigue systems often lead to individual blame for failing to work effectively, blame apportioned about lack of preparedness for the work or other responses of a similar nature. Individuals suffering from PTSD which affects their ability to sleep well need to be protected by their employers in terms of exposure to fatigue based incidents and accidents. In the case of EMS workers this can result in serious motor vehicle accidents, mistakes using various technologies and/or heavy equipment, or clinical mistakes; this is a burden upon the Tasmanian economy and directly adversely affects the victims of such failures. Fear of a fatigue event as a result of things such as warnings or lawful directions being issued as a panacea to resolve the fatigue issues can further compound issues in terms of coping mechanisms and or drive those events and accidents into nonreported arenas. AMBULANCE ACTIVE
Case Study: Anonymous As a new student, I was working with a paramedic who had just come back to work from stress leave after attending numerous paediatric deaths. We were called to attend a young boy who had been hit by a car on a country road and was undergoing CPR. I had not studied trauma or paediatrics at this stage of my training, but the paramedic told me that she couldn’t deal with the patient so I was to provide care. I was terrified. I tried my best but unfortunately the boy was deceased and had massive head injuries. I was hugely traumatised by this job and tried to get my colleague to debrief with me afterwards, but she refused to. At the time, I blamed myself for the child’s death. I considered leaving the service for a time. I persisted and felt okay about it until 3 years later when I was about to qualify. I suddenly felt like I couldn’t do the job. I confided my fears in a trusted Clinical Support Officer and told him about the job I had attended 3 years earlier. He was horrified that I hadn’t been supported at the time. I have to drive past the spot where the boy was killed by a car quite frequently. I cannot drive past it without feeling distressed and without seeing the images of his broken body in my mind, and wondering how his family is going. I’ve attended numerous SIDS cases and other paediatric deaths over my 12 years with AT. Since having children myself I find these cases the hardest to deal with and will always carry the memory of these children with me, whether I want to or not. When I was pregnant with my second child I attended a SIDS case and had to push an intraosseous needle into a newborn’s leg bone. This baby lived quite close to my own home and I see her house every day, so I think of that baby girl every day. We were unable to resuscitate her. When I’ve attended stressful paediatric jobs, I find that I often have nightmares afterwards, usually involving my own children being injured/sick. When my children were newborns I was excessively worried about SIDS. I found it to be a highly stressful time rather than a joyful time. Many years ago I accessed the Employee Assistance Program after attending a stressful incident. It was a total waste of time. I spent half the time explaining to the counsellor what paramedics do and the other half consoling her as she was distressed about what I had told her. PTS has definitely compounded over time. The longer you are a paramedic, the more stressful incidents you are exposed to, and the more your bucket of horrible memories and images fills up.
MEDICAL OPINIONS/ ADVERSARIAL OUTCOMES With most WorkCover/insurance claims the nature of the system provides for independent medical assessments and for challenges to claimants for a number of reasons. Insurers can cease compensation payments, including medical expenditure coverage and payment of weekly wages, by way of a ‘reasonably arguable case’ or contrary ‘medical opinion’. This does not need to be tested before the claimant is put under financial pressure. The outcome of this either requires the individual to abandon their claim or return to work on the basis that they had no other option from a financial viewpoint. Returning to work is likely to make the issue worse, and legally make it more difficult to prosecute their position of incapacity by way of disease attributed to work.
BEST PRACTICE SOLUTIONS Moving PTSD into the realm of a prescribed disease whereby there legislation would provide for presumptive recognition would greatly assist those affected by the condition. Fighting to maintain protection by the legislation when you are least able to have the fight is currently a blight which needs correction. HACSU calls on the Tasmanian Government and all political parties to recognise that Ambulance Paramedics need legislative assistance to enable PTSD to be prescribed in the Workers Compensation Act whereby there is presumption related to that condition so diagnosed. Currently in the Act, illnesses related to firefighting are prescribed in Schedule 5 and presumption is then described in section 27. HACSU sees no reason why a similar structured clause could not be introduced for PTSD specifically related to Ambulance Paramedics.
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(L-R) Ambulance Victoria CEO Tony Walker and ALS Paramedic Rain Histen get ready for the 2017 Eureka Stair Climb.
THE HEIGHT OF MENTAL HEALTH Managing and maintaining positive mental health is a key focus for ambulance unions across the country, and delegates work hard to support their members’ health and wellbeing. Photos by David Reinhard
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Paramedics from Victoria made up the largest group of emergency services personnel at the 2017 Eureka Stair Climb.
RECENTLY, A GROUP OF PARAMEDICS from Ambulance Victoria took part in climbing the world’s 11th highest building as part of Melbourne’s annual Eureka Stair Climb. But, this race between emergency services agencies wasn’t really about who made it to the top first, personal bests or outdoing fellow paramedics in a race. It was about camaraderie, health and teamwork – a great recipe for improved mental health in this challenging profession. Ambulance Victoria ALS Paramedic from Bayside Rain Histen has now climbed the 88 flights of stairs seven consecutive times, and was instrumental in rallying her colleagues to pull on their gear and take part in 2017. “I put up a little pin-up note on the wall of our hospitals, wrote letters to our colleagues in rural areas, sent some emails, made phone calls, and the word spread that we were looking to put together the highest represented emergency services team for this year’s climb,” she said. The result was overwhelming with representatives from across the state, and
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from the top down with AV CEO Tony Walker also participating. “This event is so much more than just a stair climb,” Rain said. “It is about camaraderie, increased mental and physical health and being a team. “The stair climb is great for paramedics, you can go at own pace, take your time, and measure your improvement year-onyear.” Ambulance Victoria is looking for more paramedics to join the Eureka Stair Climb in 2018, and Rain is aiming to double this year’s numbers and climb alongside 300 paramedics from across Australia and New Zealand. “My goal is to have a national group of paramedics together in uniform doing the climb,” she said. “We all do the same job. We face the same challenges and it would be so great to see paramedics from all over Australia, and my home nation of New Zealand - also a member of the NCAU - standing side-byside at this fantastic event.” Ambulance Victoria supported the climb for the first time in 2017 by sponsoring
Rain is ready to race to the top!
each participant’s entry fees, and a team singlet to unify the paramedics. “It was such a great thing for Ambulance Victoria, and the paramedics who trained hard for months in the lead up and turned up on the day – it had a truly electric vibe about it,” Rain said. AMBULANCE ACTIVE
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Paramedics from all over Australia and New Zealand are invited to join the Eureka Stair Climb in 2018. For information about this year’s climb, visit the Ambulance Victoria Eureka Stair Climb facebook page, Instagram Teamambulanceparamedic or email rain.histen@ ambulance.vic.gov.au
The day has an ‘electric’ vibe.
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PARAMEDICINE BOARD OF AUSTRALIA FIRST APPOINTMENTS IT HAS BEEN ANNOUNCED BY THE COAG HEALTH Council on 19 October 2017 of the establishment of the inaugural Paramedicine Board of Australia with the first appointments of the Chair, practitioner and community members. This is a nine member board made up of: • Associate Professor Stephen Gough ASM as practitioner member from Queensland and National Board Chair • Ms Clare Beech as practitioner member from New South Wales • Mr Keith Driscoll ASM as practitioner member from South Australia • Associate Professor Ian Patrick ASM as practitioner member from Victoria • Miss Angela Wright as practitioner member from Western Australia
• Mr Howard Wren ASM as practitioner member from a small jurisdiction – the Australian Capital Territory (ACT) • Ms Carol Bennett as community member from the ACT • Mrs Jeanette Barker (nee Evans) as community member from New South Wales • Ms Linda Renouf as community member from Queensland On behalf of the National Council of Ambulance Unions (NCAU) we extend contgratulations to the successful appointees of the inaugural board and look forward to working with them for the betterment of the Paramedic industry and all who work in it.
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