Ambulance Active Winter 2021

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25 2021




VOLUME 12 ISSUE 2 2021 Australasian Council of Ambulance Unions Elected Office Holders 2021 PRESIDENT Steve Fraser (HSU NSW) VICE PRESIDENT Sarah Stone (First Union NZ) John Millwood (UWU Qld) SECRETARY Jim Arneman (TWU ACT) ASSISTANT SECRETARY Erina Early (UWU NT) TREASURER Leah Watkins (AEA SA) ASSISTANT TREASURER Simone Haigh (HACSU TAS)

Ambulance Active Official Publication of Australasian Council of Ambulance Unions

REGULARS 05 From the President 07 From the Secretary 09 Industrial Reports 09 09 11 12 13 15 16

Australian Capital Territory Northern Territory Queensland South Australia Tasmania Victoria Western Australia

FEATURES 18 New South Wales 23 New Zealand 27 Northern Territory 28 Queensland 33 South Australia 39 Victoria 44 Western Australia

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Qld State Council delegates meeting

Union Survey

Adelaide Inquest

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Ambos are ‘being sent out to die’

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Helping more Indigenous Australians become paramedics

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Ambulance ramping leaves RFDS patients stuck in shed

Disclaimer: Countrywide Austral (“Publisher”) advises that the contents of this publication are at the sole discretion of the Australasian 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.


If you’re hurt at work, you need specialist help. It’s not just a matter of processing a workers comp claim. It’s about claiming absolutely everything you’re entitled to and with ambulance workers, that gets complicated. Did you know that the risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average? When it comes to NSW ambulance workers compensation claims, it would be very hard to find a more experienced solicitor than Chantille Khoury. Chantille is a principal at Australia’s largest specialist personal injury firm, Law Partners, where she specialises in emergency service worker claims. “When paramedics are injured at work, either physically or mentally, many are reluctant to seek compensation, or they don’t know who to turn to.” As a member of NSW Ambulance you put yourself at risk every day and injuries from aiding immobile patients, drug-affected patients, motor vehicle accidents and exposure to traumatic events are all too common. If you’re hurt at work, it’s important to get good advice on your options. “With ambulance workers, it’s not just a matter of processing a workers comp claim. They have their own set of rules relating to workers comp,

TPD and income protection which are unlike any other worker in NSW.” “It takes extensive experience and a thorough understanding of the system to properly manage a claim and make sure the officer receives absolutely everything they’re entitled to.” Unfortunately claims are often processed as a standard workers comp claim, and the ambulance worker will never know what they missed out on. “In particular, PTSD claims can result from exposure to traumatic events over a long period of time, so care needs to be taken to build these cases thoroughly. Many PTSD paramedics come to me in their 40s and 50s and they’re broken. They start their careers very optimistic about their future, but by the time I see them they’re changed people. They can’t continue doing the job they know and love and are at a loss, not knowing where to turn. I can at least provide them with a dedicated legal team, support them through their claims and make sure they get their full entitlements.” If you’ve been hurt at work in NSW you can call Law Partners on 13 15 15 to arrange a confidential conversation with Chantille.

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REPORTS

the PRESIDENT UNIONISM IS ABOUT BANDING together as one and creating strength through solidarity. This ethos has created a movement that has brought incredible social change and justice onto our society. Strength through solidarity is taking a different slant in a world suffering a global pandemic. The stresses and difficulties faced in this COVID crisis are magnified in those of us in the Health field. PPE restrictions and shortages. Adjusting treatment regimens to reduce the risk of infection. Triage decisions that will have huge effects on the people we care for and their families. The tension of the contamination risk we face each day and the risk our families bear. The mental pressure of presenting to work only to go home to isolation because our job forces us into close contact. These are issues and challenges that Paramedics and other Health workers face daily, these tests make the term ‘Strength through Solidarity’ even more spot-on. Unions have a history of industrial success that has seen fairer wages, sick leave, public holidays and annual leave. The cornerstone achievement the 8 hour day is a beacon of success for the union movement. Now, however we must return to some of the grass roots ideology of unionism. That is banding together to make sure that we are all OK. Please ask your union comrades, family members and work colleagues

if they are ok in this challenging and volatile environment. Reach out and check on friends who live alone and are facing the trials of lockdown. This age of digital communication can be toxic and damaging, but it can also enable us to touch each other in times of trouble with an ease that has never been experienced. Unionism is about standing and supporting each other in times of adversity. Let’s not forget that we are in a time of

great adversity and make sure that we stand together and help one another. ‘Strength in Solidarity’ is not just about fair wages and conditions it is about life and a society that cares for each other. In Solidarity

Steve Fraser

B. HSc. (PreHosp. Care) ACAU President

About Steven: Steven is an operational paramedic in Northern New South Wales. He has been a paramedic since 1981 with the Ambulance Service of New South Wales. He qualified as an Intensive Care Paramedic in 1985 and has worked extensively in both metropolitan and rural settings across New South Wales. Steve was a member of the New South Wales Special Casualty Access Team and operated as a flight paramedic with the CareFlight helicopter out of Westmead Hospital. He spent time as an educator for New South Wales Ambulance before moving to rural New South Wales. Steve is also the Vice President of the Health Services Union NSW Branch.

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REPORTS

the SECRETARY WHAT WILL THE “NEW NORMAL” LOOK LIKE? The last 18 months have been challenging for us all as individuals, as paramedic professionals, as Australians and New Zealanders and as global citizens. The COVID pandemic has turned our collective worlds on their heads. For those involved in lock downs in particular, the day-to-day realities of life have become difficult and our short and medium term futures uncertain. As paramedic professionals we have continued to provide care and comfort to our patients whilst coping with the additional layers of complexity, keeping up with ever changing guidelines, rules and PPE requirements. Many of us are increasingly wondering about what reality, what the new ‘normal’ will be, once vaccination rates rise, heard immunity is achieved and the pandemic is brought under control. Many are also thinking about what needs to change in society to fix vulnerabilities that have allowed this virus to thrive, given that new virus threats are always a possibility. Fragmented quarantine regulations and practices have been found wanting. These shortcomings continue to let virus variants into our communities, some 18 months after the pandemic began, fuelling the need for further lockdowns and restrictions on normal life in an attempt to eradicate the newer strains. A bastardised industrial relations system has resulted in vast numbers of workers in aged care and other vital industries being forced into casualised and part time work. This has seen them become vectors for virus transmission, as they’ve unwittingly spread the disease whilst travelling between multiple places of employment in attempts to earn enough to feed their families and access life’s necessities. Most importantly, from a social justice perspective, weaknesses in our social security safety nets have been exposed. Large numbers of Australian workers have found, by virtue of their employment status as casuals or due to their part time employment status, that they have been denied access to government payments and supports by a federal government with a long history of demonising anyone unfortunate enough to require welfare assistance. The federal government, a liberal/ national coalition who fundamentally oppose superannuation, disgracefully forced some workers to use their own super to fund their and their families survival. This will have a downstream impacts on the ability of workers to retire with dignity and fund their

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later years. It has also dramatically impacted on the shared super funds pool which benefits all workers via the size of dividends paid across funds. I and many others believe that the time is approaching for us to collectively think about how we can address these issues and recreate the social contract that binds us together more equitably into the future and not leave the most vulnerable behind.

Zoom catch-ups. We’ve had to sadly cancel the 2020 and 2021 annual conferences. This has denied us rich opportunities to network and consolidate our approaches to the challenges posed by the pandemic to our paramedic union members. All of these difficulties have impacted our ability to maintain continuity as a council, leading to challenges in working collectively and maintaining our cohesion.

WE DARED TO DREAM

A PAID ACAU EXECUTIVE OFFICER?

In 2007 a diverse group of unions met in Hobart to explore whether it might be possible to create a representative national body to advance our collective interests. The one thing that united us was our profession and a belief that there was much that could be achieved if we combined our collective talents and strengths for mutual advancement. A year later the National Council of Ambulance Unions, the NCAU, was born. The ensuing 13 years have seen us mount major successful campaigns in support of national registration and paramedic mental health and wellbeing. We have achieved professional rates of pay in a number of jurisdictions. We have learned off each other’s campaigns. We’ve shared intelligence on employers’ tactics and attacks on wages and conditions and what measures have been successfully employed to counter them. We have maintained contact on a regular basis, via tele-conferences initially and more recently via Zoom, to keep abreast of developments and campaigns in each other’s jurisdictions. We have held annual conferences where interstate and overseas paramedic delegates have been able to meet face to face over two or three days, appreciate local hospitality and learn from each other’s experiences. These networking opportunities have been invaluable in cementing friendships and increasing our collective wisdom. In 2019 New Zealand formally joined our collective, sparking a name change to the Australasian Council of Ambulance Unions.

THE FUTURE OF THE AUSTRALASIAN COUNCIL OF AMBULANCE UNIONS (ACAU) The ACAU has not been immune to the challenges posed by the pandemic. All of our unions cover health care workers and other workers directly impacted by COVID. This has imposed a lot of additional work on paid officials in unions, let alone paramedic delegates. These groups make up our ACAU Executive. This in turn has disrupted our ability to schedule and attend our regular

Recently some of our stakeholders have raised the idea of the ACAU directly employing a paid Executive Officer with responsibility to oversee the day to day running of ACAU. Thoughts are that such a position would also have responsibility for coordinating campaigns and ensuring our constitutional objectives are being addressed. The pandemic has exposed the limitations of a council run and coordinated by voluntary office holders, especially when it comes to having time to campaign on and address immediate issues that impact us now, such as the provision of adequate PPE; creation of and adherence to national standards governing PPE and a host of other challenges facing members. I believe the time has come to take the next step in the evolution of the ACAU and employ a full time professional executive officer to manage our operations, coordinate our efforts and lead campaigns into the future. This will allow us to truly set ourselves up as a peak body representing paramedics industrial and other interests at a national level in both Australia and New Zealand. How we would fund such a position is a key question. If it is agreed by stakeholders that we go down this path, this will be a significant discussion point. The pandemic is teaching us that life as we know it can change in an instant. Those who are most successfully negotiating these changes are showing flexibility and innovating in how they approach challenges and tackle change. I believe the time has come for the ACAU to dare to dream again, to reinvent ourselves whilst holding on to what was important to us 13 years ago, when we first embraced the idea of acting collectively to achieve our shared hopes. Our future is again in our hands! Keep safe and continue to provide the excellence in care for which paramedics and ambulance employees generally are renowned.

Jim Arneman ACAU Secretary

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INDUSTRIAL REPORTS

INDUSTRIAL REPORTS Australian Capital Territory TWU Caucus has established a taskforce with the ACT Government to implement and monitor the 2021-2025 Accord. Comprised of ACTAS TWU Delegates working with the Minister for Police and Emergency Services the taskforce will oversee the implementation of major infrastructure and support services across the service over the next five years. The Accord between the ACT government and the TWU enhances how the ACTAS provides its services to the community with a focus on patientcentred care, creating the management capability, sufficiently skilled and staffed, to maintain and support workforce growth. The Taskforce will be responsible for enhancing support and professional development to the workforce through major commitments from the Government including secured resources for the Peer Support Program. The plan was presented to the ACT Chief Minister with delegates securing critical commitments to implement; • Fit for purpose front line management and clinical support structure: immediate 2nd Duty Officer for people leadership and support. • Immediate and short-term capital expenditure & infrastructure strategy: to address current station issues and accommodation for future growth; fourwheel drive redundancy for bushfire support and remote area ops. • Tangible commitment to staff mental health and well-being: immediate and sustained recurrent funding of the Peer Support Program; introduction of Presumptive Legislation for psychological injuries. • Immediate and ongoing ICP Training funding, to underpin and ensure ongoing critical care capabilities. • Commitment to fund the full Modernised and Sustainable Service Delivery Plan, 2021-2025, with the addition of an underpinning scalable funding model to address demandbased growth. AMBULANCE ACTIVE

TWU Delegates meet with ACT Chief Minister Andrew Barr

Northern Territory ST JOHN STAFF SURVEY CONDEMNS St John Ambulance paramedics, emergency medical dispatchers and patient transport officers expose a toxic workplace, disregard for staff welfare and lack of training in United Workers Union member survey. 2021 survey results highlight significant concerns of ambulance workers which have been ignored by the private contractor St John Ambulance NT and Government. Key findings • 78% have not been provided training or professional development, instead paying for their own training in the last two years. • 44% have been bullied, harassed, or targeted by management because they engaged in protected industrial action during the current enterprise agreement negotiations. • 64% feel there is a toxic workplace and senior management allows this toxicity to thrive.

• 81% feel St John Ambulance NT puts profit motives before the fatigue of workers. • 78% feel staff welfare is ignored in regional centres due to the current on-call rosters and the lack of fatigue management. • 56% have no confidence at all in St John NT providing effective leadership and clinical oversight in relation to prehospital care to the NT population.

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INDUSTRIAL REPORTS

Qld State Council delegates meeting with Minister for Health and Ambulance Yvette D’Ath.

• 52% disagree that St John Ambulance NT conducted effective and appropriate infection control training in preparation for and during COVID-19. • 73% feel St John NT only cares about their public image to the detriment of the ambulance service and staff. • 86% feel the NT government and opposition does not care about the issues facing the NT Ambulance service and its employees. • 78% support bringing the NT ambulance service back into public hands as no emergency service should be privatised.

Queensland EXTRA FUNDING WELCOMED Ramping, resourcing and fatigue continues to impact our members with absenteeism on the increase, shift overruns becoming the norm and any opportunity to take a meal break a distant memory. Many members across the state participated in endorsing the UWU statement to address ambulance resourcing and ramping. Our delegates presented a number of solutions to QAS and Government decision makers to consider immediate action to these situations impacting Ambulance officers. In May the Minister for Health and Ambulance Yvette D’Ath announced AMBULANCE ACTIVE

“$100 million funding to tackle the unprecedented ED demand”. The package included several of the short-term solutions proposed by UWU delegates which were external to Ambulance. • $5M funding immediately, for more TIN (Transfer Initiative Nurses) to be imbedded in more locations; • $4M to expand the mental health coresponder model over the next three years. • $4 M to support appropriate discharge of long staying patients. Ensuring these patients receive continued care in the right setting. • $15 M to permanently expand Hospital home services; • $20 M for winter bed funding and • Almost $20M to open additional beds for patients in West Moreton and parts of Metro South HHS. Whilst our delegates recognised that these were short term solutions to what is a complex problem, the hope is these initiatives will take immediate pressure off the system and UWU will continue to participate in discussions about longer term solutions. Additionally, QAS have approved up to 90 new staff to fill gaps caused by the ongoing hospital crisis. UWU demanded assurance that these 90 remain additional to the already projected 475 new officers committed to over the next four years.

FLEXIBLE WORKING ARRANGEMENTS The ongoing work demands has seen an increase in officers applying for an FWA to accommodate a better life balance. At a recent meeting of State Council Delegates in Brisbane, data was presented to fully understand the current workload experienced particularly on night shifts. This data demonstrated that while commonly commented on, the shift to some staff working on Flexible Work Agreements has not impacted on the stretched resources, in fact, the shift to different working hours has helped with demand on afternoon shifts. United Workers Union is in strong support of members accessing their industrial right to request a flexible work agreement and has been working closely with QAS to ensure more support is being provided to those having to align these requests with the operational demands of the service and the impact being felt by those continuing to work traditional rosters.

PRESUMPTIVE PTSD LEGISLATION The Workers Compensation and Rehabilitation and Other Legislation Amendment Bill 2020 passed on Wednesday 12th May 2021 allows first responders diagnosed PTSD claims to be deemed work-related. This will ensure immediate treatment and benefits under workers’ compensation.

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INDUSTRIAL REPORTS

leave claims; education, focus on mental health; occupational exposure and so on. Organisers and delegates are out talking to members and encouraging them to have their say in what they would like to see in next year’s claims. Ambulance Officers are participating in an online activity with ideas which will be consolidated to form a list for members to prioritise later in the year.

UWU representatives have been lobbying for several years to see this legislation become law. Many members were involved in discussions with politicians, contributed in surveys and appeared in the media about this very serious issue. Representatives of UWU participated in the working group convened by the Minister for Industrial Relations to ensure the legislation was as robust as possible to ensure it was as effective as it could be. This decision had been a long time coming and is a great outcome for members.

EB 2022 UWU Qld Ambulance members have begun preparations for next year’s enterprise bargaining which was initially due this year. Because of the pandemic, negotiations were deferred along with pay increases. A reminder of how we got here… • In mid-June 2020 the State Government legislated to extend the Queensland Ambulance Service Certified Agreement deferring future wages policy pay increases to set dates in 2021 and 2022. • The current agreement was extended by two years protecting all entitlements and current provisions to remain unchanged during this period. • The wages policy 2.5% increase which was due in September 2020 was deferred to September 2021, with a further 2.5% be paid in March 2022 in the lead up to negotiating a new agreement. • Your next agreement to be in place by 1 September 2022 where a further increase in line with the year’s current wages policy will be negotiated. Our State Council have been meeting to discuss potential items for next year’s bargaining. They have come up with a comprehensive list of ideas such as interstate wages comparison; finish on time; composite rate; sick leave improvements; on call improvements; PTS, EMD, MScale issues; long service

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South Australia With every passing day, the effects of chronic underfunding of the Health system and Ambulance Service, combined with the outbreak of the Delta strain of Covid-19 are being realised in South Australia. We felt the Ambulance Service was unprepared, and under resourced, when Covid-19 first came to our shores in 2020. Thankfully the advice of medical experts were heeded, and South Australia went into early lockdown. As people were self-isolating and elective surgery was cancelled, the workload on the Health system and Ambulance Service decreased dramatically. This was, however, short lived. We had managed to keep Covid-19 numbers within SA low since this time, but the workload returned to previous levels and has been surpassed since. The more contagious Delta variant of Covid-19 has now reached our state, and with this, the inevitable has transpired. In the early hours of Monday 19th July 2021, a patient who had been transported to hospital by a Paramedic crew, tested positive for Covid-19. Concerned about the increasing numbers of the Delta strain of Covid-19 interstate, this one positive case resulted in the hospital’s Emergency Department being locked down, patients discharged or transferred to other hospitals, and a significant number of staff (Ambulance and Health) directed into hotel quarantine. With all other hospitals already over capacity, ‘internal disaster’s’ were declared at several, with SAAS also declaring internal disaster. By the evening, SA Ambulance Service was struggling to fill 14 of its 28 shifts – 50% of night shift crewing. Premier Steven Marshall increased social distancing restrictions to Stage Four, stopping short of declaring a lock down. By Tuesday 20th July SA Health identified the patient had the Delta strain of Covid-19 and the State was put into lockdown with Level 5 restrictions taking effect from 6pm. By Wednesday 21st July 2021 there were an additional five patients confirmed to

have the Delta strain of Covid-19, all close contacts of the first patient, taking the total of the Delta cluster to six. With one positive case impacting SA Ambulance Service crewing so significantly, there is the very real concern that if the Delta strain takes hold here in SA, our Ambulance Service will be unable to provide sufficient crewing, posing a significant risk to lives in the community. We are aware New South Wales and Victoria are experiencing even higher numbers of the Delta strain and have been in lockdown for weeks now. We send our support and encouragement to our interstate colleagues as they grapple with what is surely even more challenging circumstances. The recent mediations between the AEA and the Government resulted in a commitment of 74 extra staff, which represent the removal of on-call at several country ambulance stations, and three extra emergency crews in the metropolitan area. To date, on-call rosters have not been converted and no extra ambulances have been introduced. Members continue to chalk their ambulances in their unrelenting pursuit of safe staffing, for a safe community. So affected by this chalking, the Marshall Liberal Government has hired cleaners to clean the outside of ambulances. Perhaps the only State to do so in the middle of a pandemic. AMBULANCE ACTIVE


INDUSTRIAL REPORTS

Tasmania DISCIPLINARY EVENTS We have seen a significant increase in formal disciplinary investigations over recent months. That means issues routinely investigated by local managers are being referred to external investigators under the guise of the employer taking and applying formal sanctions. Some of these have resulted in individuals being stood down from active duty. Under the Tasmanian system, this is called an ED-5 investigation. Complaints from colleagues previously managed by a grievance process are now becoming formal disciplinary processes, and patient complaints without substance are also being run under disciplinary processes. As a result, AHPRA has been included and is then weighing in on whether it should be a concern to the regulator.

TRAVEL PAYMENTS We’ve had an arrangement (for more than 20 years) where staff could be rostered away from their home station and receive travel time and distance allowances when this happened. In late 2020, the allowances were removed overnight, but the rostering practice continued. We raised a formal dispute with the employer, but the employer largely ignored the dispute, including the status quo element of the dispute resolution process. After a very long dispute process, we are finally close to a resolution, which is to bring back the previous payment arrangements. However, the employer is refusing to pay any travel allowances for overtime shifts. We think this is a dumb decision as this will likely result in many uncovered shifts at remote stations, to the detriment of the communities that those stations serve.

RAMPING/DELAYS Ambulance ramping in Tasmania is continuing to be a significant problem. A new offload delay procedure has been introduced but largely ignored by the service/staff and hospitals, all of whom have specific duties under the procedure. We are concerned that when there is an adverse event, the employer will use this broadly ignored policy to justify a disciplinary process due to an individual’s noncompliance with it.

NINGARA REVIEW In 2018 Ningara reviewed our State Operations Centre and determined minimum staffing and rostering. This enabled recruiting new staff, at the same time when we introduced through AMBULANCE ACTIVE

bargaining a specific call-taker role, Emergency Medical Dispatch Support Officer. But the minimum staffing has never been reached, and there is no commitment given to undertaking new research about the adequacies of the resources in that environment. Surely there have been changes in the data in the past three years, so we believe there is still a massive gap between what we have and what we need.

CULTURE IN AT A recent coroners enquiry led to the airing of historical sexual abuse, harassment and bullying behaviours. It was suggested that senior staff not only accepted this type of behaviour but were often involved with it. We don’t know particulars other than what has been divulged to us directly by members. Some of these reports from members have been horrific, but they have their own agency, and it is up to

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those individuals whether a formal report should be made or not. Many of them are concerned that complaining will be a career-limiting event. The new Chief Executive, Mr Joe Acker, has engaged a provider to undertake a resilience scan intended to provide a baseline and identify issues to be addressed. We welcome this, but we remain sceptical until we genuinely see a safe workplace in our service.

RESPONSE TIMES: It’s official – in March, Tasmania reached the pinnacle of slowest emergency response times in the nation. AT has been furiously recruiting staff, both qualified staff and interns, but the service is the second smallest in the nation and spread over a large geographical area comparatively (by population spread). We rely upon an outdated service delivery model with 96-hour stations still in use at 17 locations and 24/7 split shift stations with a single responder at another 7 locations; both models rely on support from volunteers. And the volunteer numbers and coverage are in rapid decline. We have been advocating change to the service delivery model, but we’ll await what the political masters deliver in the next budget (Don’t hold your breath or need a P1 response).

EBA TIME We are about to embark on the next round of negotiations, with Tasmania’s most recent CPI seeing a 3.6% annual rise. The government no doubt will talk of their lack of ability to pay anything above 2%, whilst also seeking to claw back terms and conditions. We’ll wait and see.

Victoria RESOURCING CRISIS WAS PREDICTABLE In recent months the Victorian Government, Ambulance Victoria and ESTA have been spruiking at every opportunity that the current Covid pandemic is the reason why resources are stretched. There may be some degree of truth to this because of the impact the pandemic is having on the hospitals. Is this really the cause of the crisis though? In reality, workload is less than Ambulance Victoria’s projected figures. So, what has gone wrong and why wasn’t there enough flex in the system to absorb the impact of Covid? The AEAV believes the current resourcing issues are the result of many AMBULANCE ACTIVE

years of AV and ESTA running on bare bones and pushing paramedics and communications staff harder and harder to achieve KPI’s. Victorian paramedics, ESTA staff and the support teams have had their conditions eroded over many years with productivity efficiencies implemented with little regard for the impact on staff welfare. Meal breaks have been affected, incidental overtime increased, single officer responding increased and many other changes that have made the workplace more stressful. And all of this happened before Covid. The AEAV is working to shift the narrative to a sustainable level of resourcing. The current model results in an inefficient cycle of resourcing crisis leading to band-aid investment then back to resourcing crisis. Ambulance services around the country know that demand is increasing every year so why wait for the staff and community to be compromised before reacting. The AEAV is pushing for a resourcing model that results in ambulance services and support systems being adequate for tomorrow, not yesterday.

WORKLOAD, MEAL BREAKS AND FATIGUE AEAV members met recently with AV management to discuss the current situation regarding workload and the impact it is having on meal breaks, incidental overtime and the fatigue of the workforce. AV recently informed the workforce of their intent to implement changes to the meal break procedures. Effectively the changes were going to impact on paramedic’s opportunity to take a genuine break, eat nutritious food and prepare their own meals, by restricting their ability to return to their home branch any time during a shift. After meeting with AEAV members, AV agreed to conduct risk assessments and has delayed implementation of the changes until these are completed. At a time when burnout of paramedics is so common the AEAV believes it is irresponsible of AV to adversely impact their ability to eat well and to have the breaks that they are entitled to.

AV ADMIN STAFF FIGHT FOR THEIR RIGHTS In recent months, the AEAV has challenged AV on several fronts regarding the conditions for admin staff. Admin staff have been subjected to recurring Fixed Term Contracts with some staff having had up to 5 continuations, which have been for as little as 3 months at a time. This had meant these staff were permanently

insecure despite an obvious need for these positions. The AEAV recently challenged this approach by AV and have been provided with confirmation that the staff will be offered permanent employment in the coming weeks. In addition, the AV Financial Transactional Services (FTS) team have been fighting for a voice during a recent restructure. Of particular concern for this team are the increasing responsibilities without a fair and independent assessment of appropriate remuneration. The AEAV is working with this team to protect their rights and to have independent assessment of their work value. To read more about this matter refer to the in depth article in this publication.

ESTA STAFFING REVIEWED The ebb and flow of demand for ambulance services is being felt at the first point of contact, the Communications Centres. ESTA staff have been reporting staffing shortages for many years with little or no acknowledgement by the employer or the Victorian government. The AEAV has been in discussions with the employer, ESTA, and the relevant government Minister on appropriate levels to reduce fatigue and stress in the workplace.

AHPRA REGISTRATION DEFENDED The AEAV has successfully challenged the potential deregistration of an experienced paramedic who had defended himself against an aggressive patient. Initially AEAV challenged the suspension of Rob’s registration in VCAT and won, and then prepared a brief for the AHPRA Board in defence of Rob’s actions. Rob was recently advised by AHPRA that his case had been considered by AHPRA and no further action will be taken. Read the full story of Rob’s fight in this edition of Ambulance Active (page 43).

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INDUSTRIAL REPORTS

Western Australia PARLIAMENTARY INQUIRY INTO THE DELIVERY OF AMBULANCE SERVICES IN WESTERN AUSTRALIA The Public Administration Committee of the Legislative Council has called for an Inquiry into the delivery of ambulance services in Western Australia. The Chair of the Committee, the Hon Pierre Yang MLC, announced the commencement of the inquiry on the 23rd of June, and said that: “Ambulance services constitute a vital part of our health system, directly impacting hundreds of Western Australians every single day. For this reason, ambulance services are always topical for the community. Recognising this, and consistent with the Committee’s role to oversee systems of public administration within the State, the Committee resolved on 17 June 2021 to inquire into the delivery of ambulance services in Western Australia.” The terms of reference include: a. how 000 ambulance calls are received, assessed, prioritised and despatched in the metropolitan area and in the regions. b. the efficiency and adequacy of the service delivery model of ambulance services in metropolitan and regional areas of Western Australia. c. whether alternative service delivery models in other jurisdictions would better meet the needs of the community. d. any other matters considered relevant by the Committee. We did not ask for this inquiry, but we welcomed it. We agreed with St John’s reported position that the inquiry

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seems timely given West Australians’ understandable focus on health care in the context of COVID-19 and increasing pressure on all emergency health services, including ambulance services. There are certain issues we hope are investigated by the parliamentary inquiry including: 1. The way in which the ambulance service is funded by the government to ensure that funding increases to be more aligned with funding provided to other Australian ambulance services on a per capita basis. 2. Better oversight and accountability attached to the contracted ambulance service that includes more targeted KPIs relating specific to patient outcomes, staff wellbeing and organisational culture. 3. The way in which 000 calls are handled and how ambulances are dispatched, especially to patients in the low acuity end of the spectrum, included ways in which the ambulance service could better manage patients of low acuity or non-urgent chronic health conditions. 4. Staffing levels to ensure paramedics have adequate breaks in the shifts as well as improving ambulance standby capacity ensuring ambulance can better meet response times. We currently have a number of asks on Government in relation to the service contract and improved KPIs, particularly in the areas of patient care and staff wellbeing, and those asks align with the terms of reference of the inquiry. United Workers Delegates and members believe improvements can be made to the way in which ambulance services are delivered in WA and look forward to engaging in the inquiry process.

BARGAINING Bargaining is still continuing – we are making some gains in relation to some existing entitlements (job share and special leave). We are far from the pointy end at this stage, but we’ll keep our colleagues in other jurisdictions appraised of our progress.

PERMANENT ALLOCATION OF 2 X 27 AND 2 X 47 VEHICLES This is a huge win for members. United Workers Union had entered into a formal dispute settlement process with St John in relation to the permanent allocation of some 27 and 47 vehicles that had been rostered consistently from the same depot for periods of at least 12 months. The current Enterprise Agreement stipulates that where it is evident that a permanent vehicle is required, then St John will make that vehicle a permanent one. UWU Delegate, Scott Fitzpatrick, painstakingly reviewed rostering data going back approximately three years, and he was able to identify that indeed it was evident that some vehicles had been rostered so consistently, that St John should make them permanent. On Friday the 25th of June, UWU received confirmation from St John that St John would: • Complete the process to permanently allocate 47 vehicles to Cowcher (CWC42) and Shenton Park (SPK41). • Commence a process to permanently allocate 27 vehicles to Osborne Park (OPK24) and Shenton Park (SP23). For our members, this means that eight people will now have the opportunity of getting a permanent station to work from. This is no mean feat, particularly as St John are hoping to do away with allocated positions in the current EBA negotiations.

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NEW SOUTH WALES

NSW PARAMEDICS GET PAY RISE, BUT STILL LOWEST PAID IN THE COUNTRY NSW ambulance paramedics will remain the lowest paid in Australia despite a State Government Budget pay rise, with unions claiming it is only a matter of time before a mass exodus of paramedics puts lives at risk. NEW DATA OBTAINED BY THE DAILY Telegraph shows that the average weekly base pay of NSW paramedics will rise from $1456 to $1492.69 under the Government’s 2.5 per cent pay rise – still leaving them languishing at the bottom of the nation’s pay scale. This compares to $1702 in the ACT, $1659 in Queensland, $1514 in the NT, $1579 in South Australia, $1622 in WA, $1624 in Tasmania and $1624 in Victoria. NSW Treasurer Dominic Perrottet announced the increase to the pay rise cap for government workers, including paramedics, over the next four years in Tuesday’s Budget. He also handed out cash to move the ambulance headquarters from Eveleigh in the inner west to a new modern complex at Sydney Olympic Park. The $1.4 billion funding package will also include a fleet of medical jet planes to be introduced over four years and the training of 246 paramedics in intensive care, with two-thirds of that cohort to service regional and remote communities. But the Health Services Union argues paramedics’ pay will still be woefully inadequate. HSU NSW Secretary Gerard Hayes warned the number of paramedics moving interstate – or overseas, as offshore recruiters poach them offering better pay in the UK – will increase. “Year after year, we see the Productivity Commission report come down saying paramedics are the highest injured, the lowest paid and most under-resourced in the country,” Mr Hayes said. “They’re exhausted, they’re burnt out and feeling they’re not as respected as their colleagues in other states.” It comes after ambulance workers across the state on Tuesday refused to attend

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Paramedic Steve Fraser says ambulance officers are undervalued. Picture: NCA NewsWire / Gaye Gerard

less serious jobs like broken arms, minor fractures and hospital transfers and vowed only to attend life-threatening incidents in a pay protest. Nambucca Heads paramedic Steve Fraser earns $1700 a week – slightly more than other paramedics because he is a station manager and intensive care paramedic with 40 years’ experience.

“We’re really undervalued by this Government ... (we’re) the lowest paid in the nation. It’s ludicrous,” he said. “I really love my job but when you can go interstate or into the private sector and earn more money, you really have to reconsider what you’re doing.”

Georgia Clark

The Daily Telegraph AMBULANCE ACTIVE


NEW SOUTH WALES

SOUTHWEST SYDNEY AMBULANCE CRISIS HAS POLICE DRIVING TRIPLE-0 PATIENTS TO HOSPITAL NSW police are being forced to act as ambulance officers and transport patients to hospital in a growing trend aimed at plugging holes in the health system. POLICE OFFICERS IN SYDNEY’S southwest have complained they are increasingly being used as de facto paramedics because a lack of ambulances mean they are taking too long to respond to triple-0 calls. They say the overstretched health system is putting a strain on frontline policing in the area. “It is becoming more and more frequent that the community are calling triple-0 requesting an ambulance – not police – yet due to a high workload the jobs are being flicked to police to attend,” a police officer wrote in a letter to the NSW Police Association. “We attend and either wait for extended period of time for an ambulance to be attached to the job or we end up transporting the patient to hospital (normally mental health). “The fact that we are plugging a serious hole in the system and conveying patients in police vehicles simply because we are frustrated at the time delay raises some serious concerns for our officers if something was to happen while transporting the patient.” The officer, who wished to remain anonymous, said it was not an isolated incident. NSW Ambulance said it was addressing the issue of a shortage of ambulance officers. “To help meet increasing demand, NSW Ambulance will deploy 100 paramedics earlier than planned as part of the NSW government’s commitment to recruit 750 new paramedics and control centre staff over four years from 2018,” it said on Sunday. The shortage meant there were no ambulances on standby at two recent large AMBULANCE ACTIVE

Police have claimed they are losing up to three hours a night doing ambo duties.

fires on commercial premises which is normal practice in case of injuries suffered by firefighters. The police source said the ambulance operations centre would often “flick” a job to police if it involved a mental health assessment or a potentially aggressive situation. At a recent call-out police found “no person to be aggressive” and as the family “wouldn’t take responsibility for the patient ... we had to stay on scene waiting,” he said. “Police ended up conveying the patient to hospital and then waited for an hourand-a-half for the hospital to provide a security guard so police could leave. Total time lost was about three hours for the crew and this was just one incident for the night,” he said.

Union sources said they were aware of the situation and said it was part of a broader problem confronted by police every day. “There is a danger that the patient goes into delirium and can die in extreme circumstances,’’ the source said. “No one is blaming the ambulance service, it’s unfortunate that they just don’t have the resources but it falls on the police to do tasks that they are not experts, have drugs available to calm patients down and also just puts enormous drain on their ability to protect the community in the way they should.”

Mark Morri

The Daily Telegraph

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NEW SOUTH WALES

SYDNEY STROKE AMBULANCE – LATEST IN URGENT STROKE CARE More Australians will receive urgent stroke treatment after the weekend’s announcement of a new stroke ambulance for Sydney. FOR THE FIRST TIME IN NEW SOUTH Wales, a modified ambulance loaded with a portable CT scanner, will take the emergency department to the patient, saving vital minutes when treating this time-critical emergency. The NSW State Government has committed $10 million to the project as part of its upcoming budget to be announced tomorrow. A similar vehicle has been operating on the streets of Melbourne for three years and has treated ten times the number of patients within the ‘golden hour’, compared with a conventional hospital pathway. It has shaved-off an average of 41minutes from diagnosis to treatment. Stroke needs to be treated as quickly as possible, so an accurate diagnosis is essential. The on-board CT scanner tells the medical team whether the stroke

is caused by a bleed or a clot – at the scene of the stroke. As well, telemedicine ensures a diagnosis can be confirmed and treatment can begin – before travelling to the emergency department. “The results can be quite extraordinary,” says Professor Stephen Davis, a neurologist who travels on Melbourne’s mobile stroke unit. “If a clot-busting drug is given to the patient within a strict window of time, the patient can make an excellent recovery. This is all about reducing life-long disability and mortality,” he said. Prof Davis and his colleague, neurologist Professor Geoffrey Donnan, are global pioneers in stroke treatment. Together, they established the Australian Stroke Alliance to improve urgent stroke care, designing brain scanners for road, helicopter and jet ambulances, and supported by digital telehealth.

“We certainly welcome this announcement. It is a tremendous signal to other states and territories that urgent stroke care should be available to all Australians, especially those in rural and remote environments,” said Prof Donnan. “We look forward to working with our NSW colleagues as we standardise urgent stroke care across Australia.” Stroke Alliance partner, David Waters, the chief executive of the Council of Ambulance Authorities, welcomed the news: “This decision means that hundreds, if not thousands of patients in Sydney will now return home to their families to continue their lives without the long-term debilitating effects of stroke. It sets a great example for state ambulance services to embrace Australian ingenuity – while saving lives,” Mr Waters said.

NO AGREEMENT AMID NSW PARAMEDIC STRIKE A PAY DISAGREEMENT AND “complex entitlement issues” separating NSW paramedics and the state government are no closer to being resolved, with the union retaining the option for fresh strikes in the future. NSW paramedics on Thursday went on strike, attending life-threatening jobs but eschewing less serious incidents like a broken arm. The strike was not approved by the NSW Industrial Relations Commission, meaning the Health Services Union could potentially face fines. The HSU said it did not take the move lightly but supported the strike because the state’s paramedics were underpaid and disrespected. Union secretary Gerard Hayes said a meeting with Health Minister Brad Hazzard amid Thursday’s strike failed to reach a breakthrough on pay,

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but the paramedic strike would still conclude at day’s end. However Mr Hayes said more strikes in the future were possible, telling AAP Thursday’s action was the “first step in a longer program”. Treasurer Dominic Perrottet earlier on Thursday said he’d gone over several issues with the HSU on Wednesday, many without progress. He said his government had not yet settled on a wage policy for public servants, which will be revealed in the June 22 NSW budget. The government sought to freeze public sector wage rises at the height of the COVID-19 pandemic, instead allocating funds to stimulus packages. “I’m disappointed they’re going on strike today,” he told 2GB radio. “There are issues there that aren’t going to be resolved overnight.”

Paramedics are upset they’ve effectively been given a pay cut despite working on the front line during the COVID-19 pandemic. This year’s proposed 1.5 per cent pay offer was less than inflation, which NSW Treasury forecasts at 2.2 per cent for the coming year. Premier Gladys Berejiklian said on Wednesday that her government wanted to help frontline workers and urged everyone to “wait for the budget”. Mr Hayes said that response wasn’t good enough. “Once the budget is set, the budget is set,” he said. “We can’t negotiate around it.”

Angelo Risso AAP

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NEW SOUTH WALES

Jeremy Veness in the hot and heavy paramedic flight suit. Picture David Swift.

AMBOS ARE ‘BEING SENT OUT TO DIE’ Strike threat over old-style hot flight suits. THEY ARE CHARGED WITH RESCUING victims of shark attacks and roadside accidents but the state’s “helicopter” paramedics are being hospitalised – because their flight suits are too hot. While overheating in the uniforms has long been an issue, three recent incidents where the aeromedical critical care paramedics themselves had to be flown to hospital with heatstroke – one catastrophically – has made the situation critical. The paramedics say while Ambulance NSW has also acknowledged the problems with the uniforms, even trialling a more appropriate replacement, the organisation has failed to swap the suits. Their union is now threatening industrial action should Ambulance NSW fail to act. Heath Services Union (HSU) delegate Jeremy Veness said while the suit itself was already hot to work in, the situation was made worse with paramedics having to also wear 8kg of rescue and survival equipment while also carrying medical gear along with Vocid-19 masks. “The issue is we get too hot, especially in Western Sydney on a 40C day. AMBULANCE ACTIVE

There have already been three incidents and a few near-misses,” he said. The demands for a new suit followed a paramedic being left with serious side effects from overheating on the job in 2016. The incident triggered a SafeWork improvement notice to Ambulance NSW on March 7, 2016, warning that the organisation had endangered the health and safety of worker “from hear-related illness” and “failed to provide and maintain safe systems of work for workers in hot conditions”. A Work Health and Safety risk assessment that Ambulance NSW conducted in 2019 acknowledged that its aeromedical crews were at a “major” risk of suffering hear stroke, especially on days of temperatures more than 40C. Working with the Ambulance NSW uniform contractor, the paramedics themselves developed a safer, cooler uniform using cutting-edge materials and improved design. However, Ambulance NSW has so far refused to roll it out. This is despite the operators of the helicopters – Toll – using the new suit for pilots.

The union is now demanding Ambulance NSW adopt the new uniform by July to ensure its paramedics could be fitted out before summer. HSU secretary Gerald Hayes said it was “unfathomable” that helicopter pilots were wearing the new safe flight suits but the paramedics and doctors were still waiting. “Paramedics are risking catastrophic injuries while faceless ministry officials are fiddling with lines on a spreadsheet,” he said. “This is horrifying and unacceptable.” Since the incidents, Ambulance NSW has put several measures in place. A spokesman said: “NSW Ambulance undertook an extensive process to address heat fatigue issues in relation to aeromedical operations. This included not only addressing uniform arrangements but also the installation of air conditioning into all operational helicopters. A prototype flight suit that was proposed has been identified as not fit for purpose by the manufacturer. NSW Ambulance will formulate retrialling of an appropriate uniform over the coming months.”

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NEW ZEALAND

GOVERNMENT TOLD TO INCLUDE FULLY-FUNDED AMBULANCE SERVICE IN HEALTH REFORM The government is being told its huge health system overhaul should include a fully funded ambulance service. IN COUNTRIES LIKE THE UNITED Kingdom and Canada, ambulances are paid for by their governments – but here in Aotearoa the St John service service relies in part on donations and volunteers. First Union said the upcoming Health New Zealand initiative – which will see the district health boards turned into a single entity – was an opportune moment for change. Funding from the government for St John is about 80 percent with about $190 million provided for the life-saving service each year. But the union’s spokesperson Jared Abbott said bridging the remainder was essential for both ambulance workers and public health. Rolling the services into Health NZ was key, he said. “At the moment it’s no different to the various DHBs in terms of the postcode lottery – you do get a different service depending on where you live in the country. “It’s our view that by bringing it in house we will get more consistency in terms of how [ambulance services] are brought to the public.” The “quasi-charity funding model” which St John operated under would never be accepted for emergency departments and other health services, Abbott said. “It’s not just about the 30 percent covering in terms of the full funding, it’s about them being responsible for the service that’s being provided and it doesn’t make sense to us that the current ambulance service is contracted out when all other health services are conducted in house.” However, these changes would require a major funding overhaul, but delaying it longer could have significant health implications, he said.

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The St John ambulance service relies in part on donations and volunteers.

‘ON THE STREETS SHAKING TINS’ Jeff, who moved to New Zealand from the UK, said he’d be happy to pay more in taxes to fund ambulances. “I’d be totally in support of it. What I’ve grown up with in the UK … is that we’re paying for the service and that is able to grow and develop as it needs to. “It doesn’t have to rely on people out on the streets shaking tins,” Jeff said. Auckland resident Colleen agreed and said it was strange the ambulance still functioned as a charity. But St John itself didn’t go as far as to say that it wanted to operate fully under government funding. In a statement to RNZ it said it hoped improvements to ambulance services would be an important part of the healthcare reform.

“We believe the new system provides opportunities for St John Ambulance to make an increasing contribution as part of a more integrated and equitable emergency and primary care system that will benefit all New Zealanders.” A 2020 independent review into St John found the organisation was struggling with underfunding and lacked financial sustainability. It also noted “serious financial risk” and highlighted the need to ensure its longterm financial health.

Adam Jacobson www.rnz.co.nz

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NEW ZEALAND

ST JOHN COMPLETES ‘ROADSHOW’ TO QUIZ STAFF ON CALL-OUT REVIEW A review of how ambulance staff respond to emergencies could see intensive care paramedics get their own cars, instead of being attached to an ambulance. ST JOHN AMBULANCE HAS JUST completed a national “roadshow”, consulting with staff about possible changes to the way their highest-qualified paramedics respond to serious call-outs. Tasman District operations manager James McMeekin said the review was to ensure the organisation was meeting the needs of patients and communities throughout New Zealand. “We have recently completed a roadshow with our people to seek their input ahead of making any decisions on how we deploy ICPs in future,” McMeekin said. “In general, our approach sees ambulance-based ICPs moving into Rapid Response vehicles equipped with additional clinical tools, meaning they are better able to respond to and support critically ill patients.” If the proposal went ahead, paramedics and ambulance officers would continue to double crew ambulances, while the intensive care paramedics would attend call-outs in rapid response vehicles. “We will be able to share more about this approach in the coming months,” McMeekin said. Grey Power secretary Graeme Faulkner, based in Blenheim, said a proposal to free up better qualified staff made “perfect sense”. Senior patients made up a large proportion of call-outs for ambulance crews. “It is sadly a fact of life that this is one service that we will use as we age, so the thought of having a more rapid response from qualified paramedics is a very good move,” Faulkner said. “We in Grey Power will support any move that will help the response times and attention that our older members get.” Renwick Medical Centre general practitioner Dr Buzz Burrell said any improvement to the speed at which paramedics arrived at call-outs was welcomed.

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St John Ambulance district operations manager James McMeekin says intensive care paramedics may get their own transport to call-outs following a review of their roles and deployment this year.

“It’s a no-brainer if it means an ICP can go to an area more quickly in their own vehicle, and if the vehicle is capable of transporting a patient, that’s absolutely fantastic,” Burrell said. The Marlborough GP, previously based on the West Coast, had helped to write a manual for training rural doctors and nurses as first responders, for a scheme called Prime Response in Medical Emergency. Often rural primary practitioners were first on the scene at remote accidents, to support patients while they waited for an ambulance to arrive. “I’m just hoping this initiative isn’t robbing Peter to pay Paul,” Burrell said. “We don’t want to see something being cut in order to fund this initiative. It should be as-well-as, not instead-of.” First Union ambulance co-ordinator Faye McCann said the union was in discussion with St John about the proposals, as some staff were worried about whether jobs would be affected. Staff were also worried about whether they would be paid appropriately for

the extra skills required for these roles. “In the past St John has fallen behind in these areas,” McCann said. “We have also heard of concerns regarding the mental health effects having a single-crewed ICP will have, with the reduction in ability to debrief with another colleague.” Blenheim and Picton ambulances became double-crewed after extra government funding in 2017. Previously, staff shortages meant crews were sometimes volunteers, or sometimes just one person, which made it difficult to treat people while driving, and carried safety concerns for the sole crew member. About three quarters of the organisation’s funds came from central government, and the rest from donations, fees and fundraising, with the charity often running at a deficit. A new funding model is expected to be announced later this year.

Jennifer Eder www.stuff.co.nz

AMBULANCE ACTIVE


NEW ZEALAND

Wellington Free Ambulance wants to introduce a new roster pattern, but not all staff are onboard.

WORKSAFE CALLS ON WELLINGTON FREE AMBULANCE TO ADDRESS WORKER FATIGUE Wellington Free Ambulance staff say they’re being pushed to the brink over staffing shortages , as the country’s workplace health and safety regulator, WorkSafe, demands fatigue management issues are fixed. THE AMBULANCE STAFF ARE ALSO worried about proposed changes to rosters. WorkSafe held a meeting with representatives of the ambulance service, First Union and the Amalgamated Workers’ Union on Friday, after the government agency issued WFA with an improvement notice. As a result, the only emergency ambulance service serving the greater Wellington and Wairarapa region has until July 30 to introduce a policy to reduce the risk of fatigue , as well as introduce checks to ensure changes to rostering were working. While the situation wasn’t resolved on Friday, WFA and the unions will meet next week for further negotiations to hash out a resolution. A worker, who was named by RNZ as ‘Rachel’, spoke about her concerns for her workmates, saying her colleagues were getting “slammed”, describing the days as gruelling, tiring and emotionally draining. WFA wants to introduce 10-hour shifts, staggered over five days with differing start times, but Rachel feared a change from the current 12-hour shift, eight-day roster would provide worse outcomes for staff. First Union represents 30 ambulance staff, about 90 per cent of the Wairarapabased staff. The union’s Jared Abbott said most of its members didn’t want roster changes. “The company has been trying to move away from this shift pattern AMBULANCE ACTIVE

Sarah Dalton, Association of Salaried Medical Specialists (ASMS) Toi Mata Hauora executive director, is calling on the Government to urgently commit to proper workforce planning in light of issues at Wellington Free Ambulance.

for quite a number of years now and there is concern [WFA] has encouraged WorkSafe to issue [the improvement notice] to try and push them through. “There’s a requirement from the company to get staff to agree to change the shift pattern, but at this stage, it doesn’t appear to be forthcoming,” Abbott said. While the resistance wasn’t unanimous, many were against the changes due to concerns it could lead to “a lot more work” and less annual pay, he said. At present, the four days on, four days off, 12-hour shift pattern averaged at around 42 hours a week over the course of a year, but the change would see that drop to 38.9 hours meaning workers could lose around three hours’ pay a week.

WorkSafe carried out a workplace assessment at WFA last month after fatigue management issues were raised. “Fatigue is one of the risks that WorkSafe expects businesses to manage, and is part of the risks identified in our position statement on mentally healthy work,” WorkSafe’s NZ health and technical services general manager Catherine Epps said. When approached on Friday, WFA said no one was available for an interview, but referred Stuff to a statement from acting chief executive Sarah Lewis, acknowledging staff workloads had been “increasing over a number of years” and were “unsustainable going forward”. “We will respond to the notice and continue our work to protect all our workers, patients, community and whãnau from harm as our primary duty of care,” Lewis said. Association of Salaried Medical Specialists executive director Sarah Dalton said fatigue due to staffing shortfalls weren’t confined to the ambulance service. “The Government seems to think we can continue to burn through health workers and more will pop up. That’s simply not the case. We need a health system in which people want to work,” Dalton said. The association was calling on the Government to urgently commit to proper workforce planning.

Katarina Williams www.stuff.co.nz

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NORTHERN TERRITORY

ST JOHN AMBULANCE PARAMEDICS ‘BULLIED, HARASSED’ BY MANAGEMENT: UNION SURVEY More than three quarters of NT paramedics say St John Ambulance puts profits ahead of the welfare of workers and nearly half say they have been bullied and harassed by management for engaging in protected action during bargaining negotiations, a union survey has found.

THE UNITED WORKERS UNION NT survey also found that 86 per cent of paramedics feel that the “NT government and opposition does not care about the issues facing the NT Ambulance service and its employees”. It also revealed that 78 per cent of staff who responded feel their welfare is ignored in regional centres due to the current on-call rosters and the lack of fatigue management and that 78 per cent also said they have not been provided training or professional development which they have been paying for over the last two years. Nearly 150 staff members took part in the survey, the union said. United Workers Union NT secretary Erina Early reiterated the group’s call to move the management of NT’s ambulance service to government hands and said the survey should be concerning for every Territorian. “The outcomes of this survey should send a chill down every Territorian and reinforces the fact that no emergency services should be privatized,” Ms Early said. “It’s time to listen to the strong voices of our NT paramedics, emergency medical dispatchers and patient transport officers as they call for the ambulance service to be brought back into public hands.” The survey also found that 81 per cent of workers feel St John Ambulance NT puts profit motives before the fatigue of workers. While 64 per cent feel there is a toxic workplace and senior management allows this toxicity to thrive, while 44 per cent said they have been bullied, harassed, or targeted by management because they engaged in protected industrial action during the current enterprise agreement.

AMBULANCE ACTIVE

ST JOHN SAYS UNION DID NOT RAISE THE TOXIC WORKPLACE ISSUES WITH THEM St John Ambulance privately runs the Northern Territory and Western Australia’s ambulance services, while elsewhere in Australia ambos are government-run. Ms Early said Territorians should be concerned that a medical service is “being run like a business”. But St John NT CEO Judith Barker said that the union had not provided management with any details regarding the survey before releasing publicly last Friday. She said the company would investigate workplace bullying and harassment allegations.

“The union has made claims of bullying in our workforce but has not once provided us with any details. We have no tolerance for workplace bullying or harassment, so please let us know,” Ms Barker said. “We have been in negotiation regarding our Enterprise Bargaining Agreement with the United Workers Union since November 2018 and met with them more than 30 times. Our current offer provides a range of benefits valued at $2.57m including 10 per cent wage increase over four years, a sign-on bonus and back pay, a number of leave entitlements and professional development benefits. “The longer the union delays, the longer our staff have to wait to receive these benefits.”

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QUEENSLAND

THE UNIQUE TRAINING PROGRAM HELPING MORE INDIGENOUS AUSTRALIANS BECOME PARAMEDICS A paramedic cadet program in Queensland is helping boost Aboriginal and Torres Strait Islander representation in the state’s ambulance services, particularly in remote communities. THE TORRES STRAIT IS A UNIQUE environment to work as a paramedic. The region is home to a series of islands scattered over a stretch of ocean spanning 48,000 square kilometres from the tip of Queensland’s Cape York, towards Papua New Guinea, and over to Indonesia. Most of the staff at the Thursday Island ambulance station, where the area’s main hospital is located, are trained to fly on a rescue helicopter. On a busy day, the flight paramedics could be required to do back-to-back jobs across the 18 inhabited islands. They, along with the helicopters, are on standby 24 hours a day. It’s a life Majella Filewood, who grew up on Thursday Island herself, is working towards. The 43-year-old is enrolled in the Indigenous Paramedic Program (IPP), run by the Queensland government, designed to boost Aboriginal and Torres Strait Islander representation in the Queensland Ambulance Service. Ms Filewood, who has both Aboriginal and Torres Strait Islander heritage, has progressed through the first two hurdles of the course and currently works as a technician on Thursday Island. The single mother-of-four now just needs to finish her bachelor of paramedical science before she will be fully qualified. “[It’s] a great opportunity for me to be in a position where I can give back to community,” she told SBS News. “I’ll be able to go to the outer islands to pick up patients, or go to the ships and be bridged down and help people that are sick on vessels, or do search and rescues throughout the Torres Strait.” Ms Filewood said it was important to her to be able to serve her community.

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Majella Filewood Source: Abbie O’Brien

“This is my backyard. I pretty much know everybody we attend to. So offering that initial patient care when we get to a scene, I offer a little bit of reassurance as somebody that can understand their cultural backgrounds, somebody [who] can understand protocols in their time of need,” Ms Filewood said.

‘IT MAKES SO MUCH DIFFERENCE’ Paramedic and Gimuy Walubarra Yidinji man Claine Underwood helped get the IPP off the ground about 10 years ago. “For our own people to be delivering the services, it makes so much difference to the patient,” he said. “We’re in emergency care and the health journey starts from there. If we can get off on a good foot, building that rapport and trust with people who are a little bit vulnerable, injured or sick, we can start

Claine Underwood helped launch the Indigenous paramedic program and is now mentor to the cadets. SBS News/Abbie O’Brien

things off good and try to see it through as far as we can.” Mr Underwood said the idea for the cadet program stemmed from shortages at Yarrabah, a remote community in far-north Queensland where he served as officer in charge for 10 years. “I thought it was important that we advocate to get some local people employed at Yarrabah to fill in that service delivery gap. We used that as a bit of a pilot to see if it would go okay – and it did,” he said. “From there, it just spread out. I think at the moment we’ve got about 43 cadets across the state at about nearly 30 stations. It’s really grown.” Mayor of the Torres Shire Council, Vonda Malone, said she hopes to see even more of the community represented in the region’s health services soon. AMBULANCE ACTIVE


QUEENSLAND

Paramedics in the Torres Strait Islands are trained to fly on a rescue helicopter. Abbie O’Brien

new to both of us and completely foreign to what we had experienced previously in our careers,” he said. Ms Burnett has completed jobs on all 18 of the inhabited Torres Strait islands, where the culture and language is distinct across different communities. “I’ve retrieved patients from all of those places, and I’ve done quite a few jobs on Cape York as well,” she said. Ms Burnett said she cannot understate the advantages of having locally trained cadets to help while on the job. “It’s absolutely important to serving these communities,” she said. “For things like language barriers, they really lead the way and show us how to engage with the community. We really value their presence.” Ms Filewood said understanding traditional languages and culture while out in the field is “very important”. “Growing up, we obviously did speak the native tongues, [so it’s great] being able to sort of break that language barrier. I’m able to break things down for [the patient] so that they understand and are reassured too, and I can intervene if there’s frustration,” she said.

THE NEXT STEP

Married couple Paul and Vicky Burnett are both flight paramedics based on Thursday Island. Abbie O’Brien

“It’s important that we have our own people to be able to go into these professions and provide that culturally safe care. It’s been great that we’ve had an uptake of our young people,” she said. “I hope there’ll be more Magella’s able to take on those roles and other roles that are really critical to serving in health.” Mr Underwood, who began his paramedic career as a student Yarrabah in 1995, said the initiative is “creating opportunities that probably wouldn’t otherwise be there.” “In the early days, we were lucky the ambulance service was still doing in-house training. But [it’s] since swapped over to university qualifications. So people who want to be paramedics now, they have to do a three-year degree and then apply for a job.” As part of the IPP, trainees are employed from day one, after which they progress AMBULANCE ACTIVE

up the ranks through both on-the-job and educational training. “We’ve been able to allow the opportunity for Indigenous people to be employed by the ambulance service first. It allows them to be employed to get the practical experience plus the educational requirements as well,” Mr Underwood said.

‘UNLIKE ANY OTHER JOB’ Married couple Paul and Vicky Burnett are two of the flight paramedics at the Thursday Island ambulance station. Previously based in Brisbane, they made the move north two years ago. Mr Burnett is the officer in charge at the station and said the job is unlike any other he has worked in. “The helicopter training that we had to undertake is something that is completely

Mr Underwood, who was one of the first Indigenous officers in charge at a Queensland ambulance station, said he would like to see better representation in senior roles, which at the moment is lacking. “We need to progress [Indigenous paramedics] into management, into officer in charge roles and into education roles. “At the moment, we’ve got a couple of people in those roles, but we need more.” And that’s certainly a long-term goal for Ms Filewood, who hopes to become the first Indigenous paramedic to head the station at Thursday Island. “To work towards becoming an officer in charge, that would just be the ultimate goal and dream for me,” she said. “But Australia-wide, I think it would be great to have more Indigenous representation within the health profession.” NAIDOC Week (4-11 July) celebrates the history, culture and achievements of Aboriginal and Torres Strait Islander peoples. This year’s theme – Heal Country! – calls for all of us to continue to seek greater protections for our lands, our waters, our sacred sites and our cultural heritage from exploitation, desecration, and destruction.

Abbie O’Brien www.sbs.com.au

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QUEENSLAND

TERMINALLY ILL MAN’S DYING WISH TO SEE HIS WIFE ONE FINAL TIME GRANTED BY ‘ANGEL’ PARAMEDICS A team of “angel” paramedics took an elderly man to see his wife for a final goodbye days before he passed away at home surrounded by family. A TEAM OF PARAMEDICS HAVE BEEN labelled “angels” for granting an elderly man his dying wish to see his wife one final time. Paramedics Allan, Samantha and Joshua were transporting terminally ill man Danny Rowland back to his Torbanlea home, on the Queensland Fraser Coast, last weekend when they overheard him talking about his wife, Shirley. After a brief trip to hospital to have an issue with his medical equipment solved, Mr Rowland, who had endured a long cancer battle, was being transported home to spend his final days surrounded by family. According to the Queensland Ambulance Service, he had already “accepted that a conversation months ago would serve as the final goodbye with the woman he shared his life with”. “Facing the end of his battle with cancer, a courageous Danny took solace in the fact he was leaving on his terms; in his own Torbanlea home and surrounded

30

by family,” a post to the ambulance service’s Facebook read. “There was one piece missing however, with his wife Shirley receiving care in a nearby nursing home.” When the paramedics became aware of Mr Rowland’s heartache, they decided they would make sure the pair were reunited for a final goodbye. “Allan and Samantha were returning Danny home when they overheard his inability to see Shirley. Realising Shirley was close to their route home, the officers sought permission for a brief detour,” the post read. The pair were soon together again, even if just for a brief moment, with a heartwarming picture showing them laying in their hospital beds hand-in-hand. A few days later, Mr Rowland passed away, “comforted by the memory of holding his wife’s hand and a promise his love would last forever”. The “missing piece” was put into place as a result of the “compassion, patience

and humanity” shown by the paramedics. The “touching moment” was one the Rowland family and health staff will remember for a long time, the QAS post said. More than 1200 people have commented, sharing their condolences and praising the paramedics on the post, which has been shared 1700 times in less than 24 hours. “This is just such a beautiful gesture by these superheroes. Thank you for being so human to this elderly gentleman and his wife,” one person wrote. “How beautiful the Ambos went above and beyond to help someone at the end of their time so he could see his true love for one last time,” another said. “So beautiful. I love the empathy shown here by QAS officers,” a third wrote.

Brooke Rolfe www.news.com.au

AMBULANCE ACTIVE


QUEENSLAND

UWU delegate John Millwood was in a beautiful part of top end Queensland proudly supporting the community at the Laura Quinkan Dance Festival during NAIDOC week. Held on the traditional and respected Bora ground, people from communities across the Cape came together to celebrate aboriginal culture through music, dance, singing and cultural performances.

Despite Covid putting a stop to any 2020 Labour Day celebrations, 2021 Labour Day enjoyed huge crowds and beautiful autumn weather. Ambulance members marched with other proud union members to celebrate solidarity, strength, fairness and diversity. All things that make a proud union member.

AMBULANCE ACTIVE

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SOUTH AUSTRALIA

A South Australian paramedic writing on her ambulance in 2018. (Ambulance Employees Association)

ADELAIDE MAN WAITED TWO HOURS FOR AN AMBULANCE BEFORE HIS DEATH, INQUEST HEARS A man waited more than two hours for an ambulance before his death on a night of significant ramping and unusually high call volumes, a coronial inquest has heard. THE INQUEST – BEING HEARD BY Deputy Coroner Ian White – is examining whether the delay in ambulance crews arriving contributed to the death of Craig Malcolm Files in Norwood, in Adelaide’s east, on the morning of January 30, 2019. Mr Files was suffering from multiple medical conditions, including alcoholic liver disease, at the time he had a fall and called for medical help. The first triple-0 call was made on his behalf shortly before 12:30am, but an ambulance did not arrive at the Norwood address until close to 2:30am. Paramedics attempted to resuscitate the 54-year-old, who had gone into cardiac arrest, but he died at the scene. He had been listed as a “priority three” case, which carried a key performance indicator (KPI) of a 30-minute response time. SA Ambulance Service (SAAS) operations manager Richard Larson told the inquest there had been a combination of events “over the flow of the evening that contributed to the delay”. He said those events included periods of unusually high triple-0 call volumes, AMBULANCE ACTIVE

and significant ramping at the state’s public hospitals. Mr Larson told the inquest the volume of calls had dropped below “predicted demand” around midnight on January 30, but that the ambulance service was still “playing catch up” on other jobs from earlier in the evening when Mr Files’ case came through. “A large number [of calls] were being held over ... or banked ... waiting for a crew to be available to respond,” he said. “Ideally there shouldn’t be any being held. “They should be tasked at the time they’re coming in.” Mr Larson told the inquest that at the time of the first call regarding Mr Files, 19 ambulance crews were sitting ramped at metropolitan hospitals. “[There were] three crews that night where they were able to find a record of a break being taken,” he said. The inquest heard SAAS operators did not perform a “call-back” for Mr Files’ case despite the significant delay, possibly due to “confusion” following a second call made on his behalf at around 1:30am. It heard the call-back system at the

time of the incident created a list of cases in reverse-chronological order, meaning the oldest cases were continually pushed further down the list. That system has since been switched to show the “oldest” cases requiring a callback first in the list.

RAMPING WORSE, UNION SAYS The inquest into Mr Files’ death has been joined with the inquest into the death of Virginia Anne Weekes, who died after waiting for an ambulance in April last year. Outside the inquest, Ambulance Employees Association state secretary Phil Palmer said the situation had “deteriorated” since 2019, and that “ramping was worse”. “I haven’t heard anything that surprised me today,” he said. “People are dying waiting for ambulances ... and those cases will quite likely end up in the Coroner’s Court [too]. “This won’t be the last of the cases investigated.”

Isabel Dayman www.abc.net.au

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SOUTH AUSTRALIA

STROKE PATIENT WAITS 40 MINUTES FOR AMBULANCE: PARAMEDICS A patient suffering a stroke was forced to wait more than 40 minutes for an ambulance, while another person with chest pain waited an hour during “a critical lack of resources”, according to paramedics. THE UNION SAYS THERE WERE several life-threatening delays as the SA Ambulance Service declared an “OPSTAT White” event at 8.30pm, signalling “insufficient” resources and a risk to patient safety. The Ambulance Employees Association chief this morning said the southern suburbs were left with “no ambulances” and just one single responder available between the city and Victor Harbor. “This placed local communities at significant risk,” AEA state secretary Phil Palmer said. “There were multiple lights and sirens emergency cases left waiting with no ambulance available to send.” The union said at 7.30pm, a patient suffering a stroke at Gawler East called

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for an ambulance, which was eventually sent from Parafield but took more than 40 minutes to arrive. The patient was taken to the Royal Adelaide Hospital for treatment. Meanwhile, a Norwood patient with chest pain called triple zero but an ambulance didn’t arrive for more than an hour, the union said. “Chest pain is a serious lifethreatening emergency and triaged as a Priority 2 where the SA Ambulance Key Performance Indicator requires an ambulance arrival within 16 minutes,” Palmer said. He said a North Brighton patient suffering a seizure waited more than seven hours for an ambulance to arrive – in a Priority 3 case that should be seen within 30 minutes.

In Black Forest, another “emergency lights and sirens Priority 2 case” waited for more than an hour, the union said. Palmer said every metropolitan hospital emergency department was at or over capacity just after 9pm, with the Women’s and Children’s Hospital “over 219 per cent capacity”. “Winter is the busiest time of year for our health system with increased respiratory illnesses – if the system is unable to cope on the first day of winter what will occur in the middle of winter?” Palmer said. Opposition Leader Peter Malinauskas said “last night was yet another horror night for those South Australians who are relying on our ambulance service…” “The reports last night that we had Priority 2 cases, which are life-threatening AMBULANCE ACTIVE


SOUTH AUSTRALIA

“Winter is the busiest time of year for our health system with increased respiratory illnesses – if the system is unable to cope on the first day of winter what will occur in the middle of winter?

– Phil Palmer

emergencies, not being responded to for up to an hour represents a real undermining of our hospital and emergency health system that leaves patients behind,” he said. “When a South Australian calls triple zero looking for ambulance during their time of crisis – particularly where there is a life-threatening emergency – they expect it to roll up on time.” In a statement, the SA Ambulance Service confirmed it experienced “a significant build-up of cases during paramedic shift changeover”. “This was further impacted by increases in ambulance demand and transfer of care delays, resulting in a change in operational status (OPSTAT) to ‘white’ for the metropolitan area by 8:28pm,” a spokesperson said. The spokesperson confirmed many of the details in the delayed cases highlighted by the union but said a SAAS clinician “remained in regular contact” with those patients experiencing lengthy waits. “We recognise the increasing demand for ambulance services across South Australia and understand the distress to our patients and families, our staff, and our communities when an ambulance does not arrive as quickly as we or they would like,” the spokesperson said. AMBULANCE ACTIVE

“SAAS remains patient-focused at all times and able to deliver high quality, safe patient care.” The spokesperson said each call was prioritised “and the sickest patient seen first”. “Any patient requiring urgent emergency care will be seen to by SAAS’s highly-skilled staff, regardless of the OPSTAT level,” the spokesperson said. “We recognise the increasing demand for ambulance services and it is challenging for both our paramedics and our communities when isolated surges occur. We are working to boost our response capacity in areas of priority. “As was experienced last night, ambulance availability is a concern during periods of high demand and often coincides with the time most paramedics are trying to finish their shift and attending only the very sickest patients. “This is a consistent pattern and highlights the need for us to do things differently – including roster reform – to improve our response capacity. “We are looking forward to making those changes, including welcoming 74 additional paramedics and reforming our roster patterns to spread start and finish times across the day and night, following an overwhelming vote by staff to accept an agreement put forward by the Government of SA.” The details emerged as a stoush continued over paramedics “chalking” protest messages on ambulances. The Ambulance Service has ordered the protest action to stop, following a deal between the Government and the union to hire an extra 74 paramedics. But the union has vowed to continue with the messages to highlight members’ concerns. Treasurer Rob Lucas said some ambulances had been “forced off the road and into panel beaters to repair thousands of dollars of significant damage – including dented bonnets – caused by staff climbing on top of the vehicles to deface them as part of union’s ‘chalking’ industrial action”. Palmer accused the Government of trying to “silence our members”. “Our members care deeply for their communities and will continue to

highlight the critical safety risks to South Australians by chalking messages on ambulances,” he said. “First it was meal breaks, then it was rosters and now it is chalking. “The Marshall Government continues to blame ambos and their conditions instead of their failure to act.” Lucas said “to have staff physically climbing on top of the vehicles to chalk is not only dangerous, but in some cases, I’m advised it’s caused significant damage such as a severely dented bonnet, which will cost more than $2,000 to repair”. “Of particular concern is the distress these slogans are having on some people, including elderly and vulnerable patients, with SAAS advising that some say they would be too frightened to get into an ambulance with the word ‘unsafe’ scrawled across it,” Lucas said. “It’s time for… Phil Palmer to advise his members to follow the lawful direction of their employer, SAAS, and cease chalking immediately.” Opposition health spokesman Chris Picton said “it is appalling the Marshall Liberal Government is more focused on stopping our ambos from telling the public about the ramping crisis than actually fixing it”. “It is chilling to think last night South Australians were calling triple zero with lifethreatening emergencies and there were no ambulances available,” he said. InDaily has asked SA Ambulance Service for a response. A State Government spokesperson said “there are now more nurses, doctors, midwives and paramedics than ever before in the state’s history”. “The State Government has also embarked on an unprecedented expansion of emergency services at every major suburban hospital, including transforming the Flinders Medical Centre Emergency Department into the biggest in the state,” the spokesperson said. “We are getting on with hiring an additional 74 ambulance officers and are working on critical reform to ensure that rosters line up with patient demand.”

By Jemma Chapman InDaily, June 2, 2021

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SOUTH AUSTRALIA

REGIONAL AMBOS AT BREAKING POINT The Ambulance Employees Association has warned the South Australian Ambulance Service (SAAS) was at breaking point with Limestone Coast crews covering distances of 20,000km2 to deal with increasing caseloads amid a lack of staff and resources. AMBULANCE EMPLOYEES ASSOCIATION Limestone Coast state councillor Andrew Shouksmith said systemic staffing problems had been exacerbated in recent years, with workloads increasing it the region by up to 7pc per annum, while resourcing levels remaining the same. The service comprises of two ambulances in Mount Gambier, one in Naracoorte and one in Millicent, with career staff supported by volunteers in Robe, Lucindale, Padthaway and Kingston. Mr Shouksmith said a Mount Gambierbased regional transfer vehicle, which was intended to undertake intra-hospital transfers – was effectively used as a third emergency car used to respond to call outs in Mount Gambier. “We are seeing a shift in Mount Gambier where crews used to have four or five contacts during a shift, they are now having eight to 10 contacts,” he said. “As the increase in urgent work goes up, the lower acuity work keeps on being pushed further and further behind. “It really is a resourcing issue because resourcing has not kept up with demand.” Mr Shouksmith said in instances where volunteer crews were not available in Lucindale, Padthaway or Kingston, Naracoorte paramedics were responsible for covering 20,000km2 with one vehicle. “The same would be for Millicent, if there are no volunteer cars at the Coorong, they would be covering distances as far as Kingston,” he said. “Plus with the lack of services at the Millicent Hospital, they are feeding just about everything to Mount Gambier. “The minute they get to Mount Gambier, there’s an overwhelming load of cases there and then the Millicent vehicle then spends the next two hours or so working in Mount Gamier. “If there’s an emergency in Millicent, then the vehicle has got to come from Mount Gambier or they’ll send a volunteer car from Robe or a single responder from Beachport. “It’s band-aid stuff.” Mr Shouksmith said an immediate addition of 20 full time staff was required to address the systemic staffing problem in AMBULANCE ACTIVE

the Limestone Coast and ensure the region was provided access to the best of care. “We immediately need at least another emergency crew in Mount Gambier, plus another regional transfer team in Mount Gambier and that would probably alleviate a lot of the backload of urgent work,” he said. “What that doesn’t address is the current situation we’ve got at Keith with not having full services there, which means everything gets dumped onto Bordertown and that puts increasing pressure on limited resources up there. “I could really see another justification if not for a career emergency team at Bordertown or Keith, at least a general duties truck to do the transfers and also back up volunteers in the urgent things.” Mr Shouksmith said the addition of any new staff in the region was unlikely, saying although the previous State Labor Government did not provide adequate funding for the ambulance service, the current government had “totally forgotten” about SAAS. “I have been here for 20 years and I have watched it slowly deteriorate in terms of resourcing and ability to meet demand,” he said. “The whole system at the moment is almost getting to the point where it’s broken”. Member for MacKillop Nick McBride said he had fielded a number of concerns from constituents – particularly in Naracoorte – about the lack of ambulance services and delays in response times. “My office has had a number of inquiries about the ambulance service from residents who are presenting at the Naracoorte Hospital who are having to be diverted to Mount Gambier due to the lack of doctors and having to wait in the emergency department because the ambulance is already in Mount Gambier,” he said. “We have written to Health Minister Stephen Wade to ask how they are working through this and I have a meeting with him on Friday where I will raise this and other issues.” Shadow Health Minister Chris Picton said the lack of resources and additional demand contribute to increased delays in response

times, primarily affecting individuals who have been categorised as having a potential life-threatening condition. “When you’ve got a region like the South East where there’s a significant population, it doesn’t take many incidents to be happening at the same time for all of those ambulance resources to get used up and therefore be delays for patients who need it,” he said. “Some of the time, those delays will be particularly acute if someone has a fall or another incident where they are categorised as a category three – which was meant to have a response within 30 minutes. “These are the people regularly waiting sometimes hours to get an ambulance… frankly, the paramedics just can’t get to everyone at the same time.” Mr Picton said Labor will invest in additional ambulance resources if elected to government in 2022, with the party scheduled to released its detailed document in coming months. “There does need to be additional paramedics put on,” he said. “What the government has committed to so far isn’t going to be enough to make sure we are properly caring for people.” A State Government spokesperson said the Limestone Coast was “well supported by five dedicated 24/7 paramedic and ambulance crews and 160 volunteers, but said the government were looking to increase the SAAS workforce in coming months. The spokesperson said the government recognised the demand for ambulance services in some regional locations and acknowledge the enormous contribution that SAAS crews in the Limestone Coast make. “SAAS operates on a dynamic deployment model, meaning ambulances are not ring-fenced to certain stations and that the closest ambulance is dispatched to those in need,” the spokesperson said. “Ambulance crews within the Limestone Coast work collaboratively to provide ambulance coverage – this modelling is kept under constant review by SAAS to ensure all areas are adequately resourced.”

Raquel Mustillo borderwatch.com.au

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Proudly Supporting our Paramedics. The life they Save may be Yours


VICTORIA

AEAV SUPPORT Last year AEAV supported our member Rob Paton, who had his Paramedic registration suspended by AHPRA following an incident at a hospital where Rob defended himself from an aggressive patient. AFTER 26 YEARS IN THE JOB AND with a history of unblemished performance and no disciplinary record, we challenged AHPRA’s decision to suspend Rob whilst the matter was investigated and took the matter to VCAT. We won that case in September of last year at VCAT and Rob was immediately reinstated as a paramedic. You can read more about that here. In the VCAT findings the Tribunal stated: “Mr Paton would over his long career have had to deal with heightened patients before. No evidence was led to suggest that he has any history whatsoever of using inappropriate force or restraint. The numerous testimonials placed before us suggest that the opposite is true – that is, that he has been an exemplary dedicated member of and credit to his profession over many years.” “The decision of the respondent to take immediate action under s 156 of the National Law is set aside.” Since then, the Board of AHPRA requested evidence from all parties involved and investigated the matter. Included in AEAV’s brief was a statement of support from the AEAV Secretary, Brett Adie, drawing on his 25 years of experience of occupational violence as a police officer and a paramedic. After considering all of the submissions the AHPRA Board decided to take no further action. The result being that Rob remains a registered paramedic and can continue to serve the Victorian public. In their decision letter AHPRA highlighted that there is no ongoing risk to the public and that the need to restrain the patient was an isolated incident. Occupational violence can take a huge toll on people in the job, and Paramedics experience this more than most. The AEAV believes that the responsibility for supporting our members does not just rest with the AEAV, but also with the employers, the courts, the community and legislative bodies that exist to ensure standards are maintained. Rob is thrilled with the outcome and grateful that the 17 month long drawn-out process is finally behind him: AMBULANCE ACTIVE

Rob Paton

“When your 26-year career is suddenly brought to an end for defending yourself at work, it can feel pretty isolating and distressing. But the AEAV stepped in to support and helped me navigate the processes with Ambulance Victoria, VCAT and AHPRA. I feel vindicated by AHPRA’s recent decision. Thanks to the AEAV for being in my corner at this difficult time in my career.” AEAV Secretary Brett Adie said in response to the decision “Paramedic registration is a relatively new frontier for paramedics. This was an important case to show AHPRA that we are behind our members and that their decisions will be challenged when necessary. Our congratulations go to Rob, who can sleep easier now. I would also like to thank our legal team for the great work they did in supporting Rob.”

The consequences of this result can not be underestimated, not only for Rob, but all paramedics. Paramedics operate in uncontrolled and dynamic environments and can be subjected to intense scrutiny based on the observations of bystanders. High quality advocacy and emotional support are necessary to ensure that paramedics are not only afforded natural justice, but also an understanding and compassionate support network. The AEAV can support you if your career is threatened by Ambulance Victoria or AHPRA through legal representation and quality advocacy. Our experienced team is dedicated to ensuring you have the support you need, when you need it. For representation or membership enquiries contact the AEAV team on 9287 1713 or via email at aea.vic@unitedworkers.org.au

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VICTORIA

GOVERNMENT DEMANDS FOR ARBITRARY PERFORMANCE TARGETS ARE CONTRIBUTING TO AMBULANCE DELAYS, PARAMEDIC EXHAUSTION Last week, a Victorian woman died while reportedly waiting six hours for an ambulance. THE INCIDENT IS SAID TO HAVE BEEN linked to a “busy night” and ambulance ramping, which leaves paramedic crews unable to respond to other issues because they’re waiting at hospital emergency departments for their current patient to be allocated a bed. Ramping is a serious issue within paramedicine, and it’s entirely possible this issue contributed to the delay in responding to the Victorian woman. However, the delay may also be symptomatic of a larger issue: ambulance services being held to ransom by arbitrary performance targets set by governments, which often bear little relevance to actual health outcomes for patients. These productivity metrics result in an overworked and exhausted paramedic workforce, which sadly means we may

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see more similar deaths in future, unless something changes.

WHAT’S REALLY HAPPENING IN THE AMBULANCE SECTOR A “busy night” is now the norm for ambulance services. Demand for emergency ambulance services in Victoria has steadily increased. Between 2008 and 2015 it increased by almost 30%, and 2019-20 data showed life-threatening emergencies are becoming more common. Ambulance services have taken some measures to address this rising demand, such as the recruitment of extra paramedics, and programs that divert patients with less urgent conditions to primary care services such as GPs. However, the rising demand, combined with a frequent lack of available

ambulances, seems to outstrip the impact of these measures. This issue started long before the COVID-19 pandemic. Our paramedic workforce used to have a surge capacity, but we lost this when the ambulance service began using its surge potential to meet day-to-day demand. We can no longer count on ambulance services to respond to sudden increases in demand, as they’re often already operating at full capacity. For example, on Monday this week, Sydney’s ambulance network reached “status three”, its highest and most severe level of emergency response. It had to pull staff from elsewhere, including ambulance educators and senior graduate paramedics, to deal with the surge. AMBULANCE ACTIVE


VICTORIA

RESPONSE TIMES AREN’T NECESSARILY THE BEST METRIC Ambulance ramping is a factor, but another is the impact of the key performance measure used by government to demonstrate the effectiveness of the sector: response times. This is the time it takes for ambulances to arrive once called. For example, in Victoria it’s expected 85% of ambulances should arrive within 15 minutes when the patient is classified as “priority 1”, experiencing life-threatening symptoms that need immediate intervention. Metrics such as this are used throughout Australian ambulance services despite a lack of evidence that links them to beneficial health-care outcomes for many patients. There are some instances in which fast response times for ambulances are linked to better outcomes, such as cardiac arrest. However, a review of case records in Perth, Western Australia showed only 5.8% of patients initially classified as requiring a priority 1 response were later found to actually be time-critical. In other words, patients were incorrectly classified as priority 1 in around 94% of cases. For many cases, the speed with which an ambulance arrives isn’t directly linked to beneficial patient health-care outcomes. One example is the dramatic growth in ambulance use for patients with mental health conditions. While a paramedic can offer initial supportive care, such AMBULANCE ACTIVE

cases often require input from a range of specialist mental and social health-care services. Yet ambulance services are compelled by government to meet response targets even when the patient doesn’t require rapid care. This means tying up emergency resources to attend to legitimate but nonetheless non-emergency cases. Thus, when life threatening emergencies do occur, ambulances may not be available. What’s more, as demand for ambulances increases beyond budgets for increased staffing, it’s the paramedics themselves who are being squeezed to make up the shortfall in response times. According to one paramedic union, paramedics are regularly asked to skip meal breaks and do compulsory overtime. Many paramedics have no opportunity to rest and recover. Studies consistently find high rates of fatigue and burnout among Australian paramedics. This is potentially driving increased turnover, higher numbers of people intending to leave the profession and an inability to fill staffing vacancies. The industry is beholden to performance targets that can harm staff while doing little to benefit patients’ health. Governments can tell the public the ambulance service is meeting its response time targets, but behind the scenes it’s the paramedics who are being overworked and burnt out to tick these boxes.

WHAT HAS TO CHANGE? Firstly, we need to review how appropriate the metric of response times is and look for better ways to gauge the effectiveness of ambulance services. Targets should be based on evidence and reflect benefits to patient health, not arbitrary metrics designed to be easy to understand and report. Where response times are shown to be beneficial, they may be the most appropriate measure. But for the vast majority of cases, they could be scrapped and replaced with a more appropriate measure. Secondly, any metric used to measure the effectiveness of the ambulance service must be weighed against a measure of staff health and welfare. When productivity measures are the rule, management has an incentive to ignore their impact on staff welfare, which is possibly what we’re seeing the impacts of now. There’s a risk paramedics are operating in a highly unsafe workplace. We need to ensure paramedic and patient welfare is equally important as productivity. We shouldn’t have to sacrifice the health of our paramedic workforce or the lives of our communities to meet arbitrary and harmful government performance targets.

Simon Sawyer

Lecturer in Paramedicine, Australian Catholic University

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VICTORIA

AMBULANCE VICTORIA STAFF KEPT IN THE DARK ON THEIR WORK VALUE BACKGROUND For many years Ambulance Victoria has used the Mercer CED Job Analysis System to assess the work value of their administrative employees covered by the Ambulance Victoria Enterprise Agreement. The system had been used broadly across the Victorian Public Sector (VPS) and other jurisdictions around Australia. Much of the VPS dumped the Mercer CED system many years ago because it was considered biased towards employers and provided no transparency for employees. The Mercer CED involves a complex system of allocating points based on expertise, judgement and accountability required in the roles. These points are then matched to pay bands. The problem is that the methodology is confidential, and employees and their representatives are not afforded the opportunity to review the outcomes. So effectively the employer can make their own call on the work value of the employees without employees having the ability to challenge the assessment.

CURRENT STATUS Ambulance Victoria is in the process of moving away from the Mercer CED methodology for higher rated management and admin staff but have left most lower ranked roles at the mercy of this system. This leaves over 200 AV employees in the dark on whether they are paid appropriately for the jobs they do. Roles have changed considerably in some cases, yet AV’s secret assessment of the work value has not changed. Recent restructures within AV admin teams have brought to the fore the issues related to the Mercer CED methodology. At AEAV’s request a re-assessment of work value points was conducted. AV conducted the review internally with no external review or oversight. AEAV is currently in negotiations with AV to have the assessment independently reviewed. In discussions, AV representatives have stated that the assessment is independent if conducted by another corporate division of AV. The AEAV

contends that this does not “pass the pub test” for independent assessment. The table below was provided to staff as justification for the work value points. With no visibility of the scale used, employees have no way of knowing whether C+ or D- is the most appropriate classification for Knowledge & Experience.

BEST PRACTICE Given that AV is not the only organisation to use the Mercer CED methodology for calculation of work value, it would be reasonable to look to other organisations for guidance as to best practice when using this system. The Northern Territory government in 2008 published an Information Booklet on the Job Evaluation System (JES). The guidance is designed for NT public sector agencies. The guidance relates to the same Mercer CED system and how it should be implemented. According to the NT government, integral to the effective application of the system is the preparation of Job Analysis Questionnaires (JAQ) and the formation of the panel that assesses the roles. This is where holes start to appear in the way AV uses the Mercer CED methodology. The NT government requires that the panel consist of one representative from the agency and two from external agencies. AV has used two of its own staff and nil from outside. The NT government also requires that the JAQ’s be completed by impacted staff and supervisors. It is AEAV’s understanding that AV does not do JAQ’s and have recently only consulted supervisors. The NT guidance highlights the risk of a conflict of interest for direct line managers and stresses that they should not be involved in the evaluation. In AV’s most recent case, involving the Financial Transactional Services team, the only person from the department who contributed to the evaluation was the line managers. The AEAV is challenging the independence of the work value review on the basis that JAQ’s were not completed, impacted staff were not consulted and there was no independent input.

EXPERTISE

JUDGEMENT

By way of comparison, the VPS Enterprise Agreement 2020 provides detailed job descriptors which are clearly defined. Any employee can refer to the Agreement and use the detailed table to self-analyse the most appropriate grade for the work they do. Unfortunately, this is not the case for these AV employees. Historically, many awards and agreements that used the Mercer CED Job Evaluation System incorporated protections for workers to mitigate the risks associated with the opaqueness of the system. Whether the protections were union involvement in the job evaluation committee, preparation of JAQ’s or utilising external agencies that afforded some degree of independence, the inference was clear, that the process should not solely be the domain of the employer. Unfortunately for Ambulance Victoria employees these protections are not available. Effectively AV is asking these employees to put their faith in an employer that failed to deal with years of cultural decay, resulting in an independent review by the Victorian Equal Opportunity & Human Rights Commission. An organisation that has failed its employees to this degree needs to earn back that trust by being transparent.

WHERE TO FROM HERE … In the short term, AEAV has challenged the process but has seen little movement from AV despite acknowledgement by AV that the current system is not transparent and does not afford these employees the same protections as their colleagues. Negotiations continue with AV to have external or independent oversight, with AEAV assessing our options to challenge the process. In the long term, AEAV will fight in Enterprise Bargaining for a fairer system that is transparent and provides options for review. For representation or membership enquiries contact the AEAV team on 9287 1713 or via email at aea.vic@unitedworkers.org.au ACCOUNTABILITY

TOTAL WORK VALUE POINTS

Knowledge & Experience

Breadth

Interpersonal Skills

Points

Job Environment

Reasoning

Points

Independence & Infulence

Impact (Type: Service)

C+

2

c-

58

B+

2+

33

B+

1

i+

33

124

C+

2

c-

58

B+

2+

33

B+

1

i+

33

124

C+

2

c-

58

B+

2+

33

B+

1

i+

33

124

C+

2

c-

58

B+

2+

33

B+

1

i+

33

124

C+

2

c-

58

B+

2+

33

B+

1

c-

38

129

AMBULANCE ACTIVE

Involvement Points

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WESTERN AUSTRALIA

AMBULANCE RAMPING LEAVES RFDS PATIENTS STUCK IN SHED FOR HOURS Western Australia’s Royal Flying Doctor Service is being forced to wait with patients in a shed for hours due to emergency department backlogs at Perth’s major hospitals. IN THE PAST WEEK ALONE, A PATIENT suffering a medical episode had to wait six hours to be transferred to a hospital while a pregnant woman who had been flown in from Kununurra almost gave birth on a stretcher. The Royal Flying Doctor Service is the lifeblood of remote communities across the state, where health services are limited and can sometimes be hours away, meaning serious illness or injury can be fatal. The service operates out of five bases across 2.5 million square kilometres of West Australian outback and provided help to more than 9000 patients in the 2019/20 financial year alone. Newman local Anita Grace, who suffers from cancer, was flown to Perth last week with a blocked bowel and had to wait for 3½ hours for a free ambulance to take her to St John of God in Subiaco. The East Pilbara shire councillor said there were up to seven patients waiting for a transfer by the time she arrived at the Royal Flying Doctor Service centre in Jandakot, including a heavily pregnant woman having contractions. One patient flown in from the Kimberley was connected to a ventilator while another’s heart was being monitored for signs of cardiac problems. Ms Grace, who was on a drip and morphine at the time, said service coordinators had to leave their desks to treat the patients due to what they described as the worst ambulance ramping in 25 years. “This is our access to medical treatment and for that to be jeopardised it’s frightening,” she said. “This is the hidden part of this ramping crisis.” Ms Grace was told by personnel the situation was out of their hands as there were no ambulances available to take them to hospital since they were waiting to offload patients. St John Ambulance figures show in the past week crews spent about 280 hours ramped outside Sir Charles Gairdner

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Perth ambulance ramping is impacting the service’s ability to transfer regional patients. Credit: Paul Kane

Hospital and 270 at Royal Perth Hospital, about 50 more hours than the entire month of April. Ramping times broke a fresh record in June after ambulances spent 5290 hours waiting at emergency departments, about five times the number Health Minister Roger Cook described as a crisis during his time in opposition. To date, Mr Cook has refused to use the same term to describe the current situation. Ms Grace said the care she received from Royal Flying Doctor Service was “first‑class” but the staff looked under pressured and burned out. “They need ambulances allocated to the Royal Flying Doctor Service,” she said. “These are patients that have nowhere else to go.” A Royal Flying Doctor Service spokeswoman conceded the state’s health system was under pressure but the service’s base at Jandakot was equipped to provide high clinical care, including for critically ill patients needing intensive care. “As always, the Royal Flying Doctor Service’s priority is to provide the best possible patient care in every situation,” she said. “During the past 12 months, the RFDS has consistently experienced a uniform 10 per cent increase in average patient demand.”

She said the service was considering contributing to the parliamentary inquiry into the state government’s contract with St John Ambulance announced by Public Administration Committee head Pierre Yang last month. The inquiry’s terms of reference include looking at alternative models for the contract, which could include a state-run service or finding a new contractor. A spokeswoman for St John said the ability to get crews on the road had been impacted by record rates of ramping and extreme demand. “The patient experiences described do not meet community expectations and certainly the system must work together to do better,” she said. “Our people are doing their absolute best in challenging circumstances and we’re working with our partners in the health system such as the RFDS to continue serving our community.” She said St John had an ambulance permanently stationed at Jandkot to support the Royal Flying Doctor Service and a paramedic working from the service’s call centre to co-ordinate patient transport. Mr Cook’s office was contacted for comment.

Marta Pascual Juanola www.watoday.com.au

AMBULANCE ACTIVE



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