8 minute read
Preface
It is not an understatement to say that the COVID-19 pandemic has changed life as we know it. For more than two years now Australia – and the world – has been dealing with a health crisis of such scale and consequences that the closest precedent was the devastating outbreak of Spanish Influenza following the Great War.
COVID-19 has challenged and stretched health systems across the world. Despite Australia’s relatively small population and situated within a continent of its own, state and national health systems have been subjected to significant stress and strain, affecting both systems and people. It is appropriate to acknowledge that many Victorians have died from the SARS-CoV-2 virus, leaving bereaved families and friends to carry-on in a world in which this pandemic is far from over. In any emergency, seeking help from professionals is instinctual. Emergency communications –comprising call-taking and dispatch – are critical steps in responding emergency services. For many emergencies, especially those involving serious illness or injury, time is critical and timely response from emergency services may improve patients’ chances of survival and can reduce the risk of further harm. Victorians expect that when they call triple zero (000), their call will be answered promptly. The move to centralised emergency call-taking and dispatch in the mid-1990s largely delivered upon this expectation across emergency services organisations. Presently, the Emergency Services Telecommunications Authority (ESTA) provides the critical link between Victorians and emergency services, delivering call-taking and dispatch for Ambulance Victoria (AV), the Country Fire Authority, Fire Rescue Victoria, Victoria Police, and the Victoria State Emergency Service. In so doing, ESTA manages millions of emergency and non-emergency calls and associated dispatches every year. Emergency ambulance call-taking presents a particular set of challenges, given the nature of the events involved. Many 000 calls concern people who are acutely ill or seriously injured and in need of urgent assistance – the provision of which may literally be a matter of life and death. When ringing 000, Telstra 000 agents are the first point of contact, ensuring that the call is transferred to emergency call-takers in the requested state or territory. Following transfer, ESTA call-takers obtain location and emergency details, enabling triage of the situation. This information is then passed to ESTA dispatchers who dispatch the required emergency services in line with the requirements of those organisations for whom ESTA provides services. It is important that I recognise, at this point, the vital and skilful work of Telstra agents and ESTA calltakers and dispatchers during the past few years that have presented so many challenges for us all. On the frontline of Victoria’s emergency management system, these people have worked tirelessly to help safeguard the community. Although this review details some missed opportunities and failings of the emergency communications system in Victoria – resulting in unacceptable call answer delays for many 000 calls during the COVID-19 pandemic – I find no fault in the people who have so capably served in this capacity through such difficulties as the pandemic has presented us all. This work is highly-skilled although physically and psychologically demanding on Telstra agents, ESTA call-takers, dispatchers, and their families.
The current benchmark for ESTA’s speed of call answer for emergency ambulance is that within a calendar month, ESTA answers 90 per cent of such calls within five seconds. I have a key role in monitoring, investigating, and assuring ESTA’s performance in accordance with the Emergency Management Act 2013. Despite its careful planning and best endeavours ESTA’s call answer speed performance for emergency ambulance via 000 has fallen below community and government expectations and performance benchmarks during the pandemic. This occurred in the face of enormous and unprecedented demand for AV services; demand that reverberated and challenged the health system broadly as a whole. This review identifies significant declines in ESTA’s emergency ambulance call answer times, commencing in December 2020, with ambulance call activity increasing beyond historical highs, and emergency calls queuing for completely unacceptable lengths of time – 10 minutes, 15 minutes, and longer.
I identified 40 potential adverse events during the period 1 December 2020 and 31 May 2022 (inclusive) associated with call answer delays, agency command and control decisions, and/or ambulance resourcing issues. Tragically, 33 of these patients did not survive their emergencies. Due to legislative constraints placed upon me by the Emergency Management Act 2013, by law I am not permitted to include in this review report information that may identify any person. This means that case studies about the potential adverse events are limited in detail. I do not make any findings about whether the associated performance issues may have contributed to the passing of these patients, or whether faster intervention may have prevented deaths. These important questions are for the jurisdiction of the Coroners Court of Victoria, with whom I have liaised closely and will be providing further information not contained in this report. I therefore apologise to the families and friends of those 33 people, if their expectations of this report are not met concerning the circumstances of their loved ones’ emergencies. I assure you that I will continue to consult with the State Coroner to ensure they are in possession of all relevant information so that they may acquit their critical function to investigate and make findings about these events, and to obtain for you the answers you deserve. This review is specifically focused on emergency ambulance call-answer performance in Victoria and should be read in conjunction with the recent ESTA Capability and Service Review led by Mr Graham Ashton AM APM.
Mr Ashton’s review focused more broadly on ESTA as an organisation and made many recommendations that my review supports and for several, reiterates. In formulating my findings, I have had the advantage of doing so in retrospect, this is something the ESTA did not have luxury of, as it planned for and responded to the pandemic; an event that due to its rarity, ESTA could not have experienced before. I ask that you keep this in mind when reading this report. The key reason that emergency callers to 000 have experienced ESTA ambulance call answer delays is related to resourcing. Since December 2020 – and more specifically since October 2021, when its call answer speed performance dropped below 70 per cent of 000 calls answered in five seconds, ESTA simply did not have sufficient ambulance call-takers to meet incredible demand.
ESTA missed opportunities to recruit and deploy additional emergency ambulance call-takers during the pandemic, particularly in 2020. This was for several reasons, one of which is related to the existing funding model to which ESTA is subject. Another reason for shortfalls in call-takers related to the need to furlough employees affected by COVID-19 itself; a situation that affected all emergency services organisations and the broader health sector at various times during the pandemic. Despite liaison with counterparts interstate and overseas, and extensive planning, ESTA’s governance, existing links within the Victorian emergency management sector, and funding model revealed shortcomings in its ability to rapidly scale-up its response. The nature of the COVID-19 pandemic itself and the lack of information about this novel Coronavirus also contributed to increased demand upon ESTA and AV. Tragically, COVID-19 is a fatal disease and a factor in the deaths of almost 4000 Victorians by June 2022. For much of the duration of the pandemic, and especially when the population was unvaccinated, we have been told of its contagious and deadly characteristics. Little wonder, perhaps, that the first response of many facing a loved one displaying symptoms was to see this as an emergency and to ring 000 for an ambulance. Sometimes this was warranted, at other times, not.
This was not assisted by a lack of community education and information about when to ring for an ambulance in the early-stages of the pandemic, and further complicated by the difficulties many Victorians experienced in seeking healthcare during lockdowns. The significant system impacts that flow from unwarranted calls to the emergency services highlight the need for much closer cooperation between agencies around public messaging and much better communication with the Victorian community about when it is appropriate to ring 000.
The numbers of COVID-19 positive infections in the community correlated directly with the large increases in emergency ambulance call demand in Victoria. Conversely, actions to stem virus spread, such as lockdowns contributed to temporary declines in demand for some other emergencies such as motor vehicle accidents. However, the ongoing demand for ambulance dispatch due to emergency events such as cardiac arrest, premature childbirth, and other demands for urgent medical intervention did not disappear. It is heartening that emergency ambulance call answer performance has improved since this review began. There are fewer 000 calls waiting for an ESTA ambulance call-taker to answer, waiting times are less extreme, and ESTA reported emergency ambulance call answer performance of 86.2 per cent in June 2022. Although still below benchmark, this is a significant improvement on ESTA’s lowest monthly performance of 39 per cent of such calls being answered at or within five seconds in January 2022. This improvement has no doubt been due to some urgent interventions by government and the committed efforts of ESTA.
This review is detailed and sometimes technical in nature; it includes 42 findings and eight recommendations that, if implemented together with those made in the ESTA Capability and Service Review, will improve the resilience of emergency call-taking and dispatch in Victoria, and assist in reducing risks associated with the call answer delays that have concerned so many Victorians. I am very grateful for the assistance provided by many people and organisations, including those at the senior levels of managing the response to the COVID-19 pandemic, without whose time and expertise this review would not have been possible. The consequences and effects on governments, health systems, the emergency management sector, and the lives of people around the world were largely unknown when the COVID-19 pandemic commenced. As I earlier intimated, this global health crisis is not over and while many consequences have made themselves crystal clear in the intervening years, some are still emerging. In fulfilling my legislated role to foster continuous improvement of Victoria’s emergency management arrangements, it is vital that the emergency management sector – considering all stages of planning, response, and recovery – continues to learn and evolve in order to continue to meet the current challenges and those yet to come. In the context of the world becoming a ‘global village’ and in which the risks and consequences of climate change are becoming more apparent, it is critical that we consider and prepare for the possibility that this may not be the only major public health emergency in our lifetimes.
Tony Pearce
