If you need an ambulance in Tasmania, this ramping 'ban' will likely affect you. Here's how it works from today
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When emergency department staff at Tasmania's major hospitals start their shifts today things might look and feel a little different. They'll likely encounter the usual complexities — full beds, tired staff and a never-ending stream of patients. But there'll be an added pressure — a 60-minute "transfer of care" protocol. In practical terms, it means paramedics should be able to hand over care of their patient to the hospital within an hour of the patient arriving there, leaving them free to get back on the road. The "ramping ban", as it was once dubbed by the Liberal government, is an attempt to curb the excessive amount of time paramedics spend ramped at the state's public hospitals — and it's won the support of paramedics like Cam Johnson, who say the current situation is "demoralising" and "stressful". Paramedics say the protocol is a step in the right direction.(
ABC News: Luke Bowden
) "It's possibly the worst I've seen it in my career," the southern-based paramedic said. "My last two night shifts I've spent six hours out of the 14-hour shift at the hospital. "That's almost half the shift, ramped, looking after patients inside the hospital." North-coast paramedic James Watkins agrees something needs to be done. "It feels like paramedics are just the surge workforce for the THS [Tasmanian Health Service]," Mr Watkins said. "And while we're on the ramp, we know that calls in the community are coming in and going un-resourced." But while paramedics feel the protocol is a "step in the right direction", hospital workers say they are worried about how they'll meet the new targets without compromising patient care. "Sometimes there are 40 people in the waiting room and nowhere for people to sit and then you have people down the corridors, outside other patient cubicles, on ambulance stretchers and other ED trollies with no one-on-one care," a Launceston General Hospital (LGH) nurse told the ABC. "Before this protocol, you'd have a paramedic with that patient, but now they're going to leave, and those patients probably won't have a nurse, or the nurse ratio will be like one to 10. "People will die." One Royal Hobart Hospital (RHH) worker said that "prior to [the protocol] being watered down, it was essentially a dump-and-run policy". "'We're going to dump our patient and run, sorry', this is what the policy says," the worker told the ABC. The 'watering down' the worker is referring to is the removal of the word "mandatory". It was dropped after the nurses' union challenged the "ban" in the Industrial Commission. It means hospitals cannot be forced to take on patients. But as far as paramedics are concerned, little has changed. "I don't think the changing of the wording in the policy changes the intent of the policy or the way it'll be enacted," paramedic Mr Watkins said. "I think the result is that it will still effectively be the mandatory offload or requirement that happens. I certainly hope that that is the case anyway." It is an attitude shared by the Health and Community Services Union (HACSU), which worked with the government to develop the policy. HACSU believes that if the clock hits the hour, there must be an "immediate transfer", and it is up to the hospital to figure it out. The 'ramping ban' was initially meant to be mandatory, but that has now been revised.(ABC News: Luke Bowden) "The hospitals have had plenty of time to prepare for this situation," said HACSU state secretary Robbie Moore. "The reality is that it's over 12 months ago that the government agreed to this protocol." But some worry this split risks creating more "tension" between paramedics and hospital staff. "There's still an expectation … that they will be able to offload their patients within one hour and that is not always achievable," the RHH worker said. "The nurses do their best to take their patients off the ramp, but our EDs are oversubscribed." The protocol will see a new escalation system in place that begins as soon as the ambulance arrives at the emergency department. Thirty minutes will be considered a transfer of care delay and paramedics are expected to notify the appropriate ED staff member that half the maximum timeframe has elapsed. If it's indicated that the hospital can't accept the patient within an hour, Ambulance Tasmania's Operations Supervisor will get involved. "What this protocol does is bring managers and supervisors into the process," explained Mr Moore. "They're the ones that should be dealing with this and by bringing in higher level management of the hospitals and Ambulance Tasmania, we can ensure that transfer of care happens as quickly as possible." While the 60-minute protocol has created a lot of chatter, the Rockliff government went further during the election, announcing it would "ban ramping" by shrinking that target to 45 minutes in 2025 and 30 minutes in 2026. However, many feel that even implementing the 60-minute protocol will require more staff. "We should have been hiring as soon as they thought of this and we should've increased our FTE [full-time equivalent] to cover for these paramedics," a second LGH nurse said. "We're going to be losing probably four paramedics at least a day constantly in our department looking after patients so why are we not hiring nurses to cover them? "We're losing staff [in the paramedics] and gaining patients." That nurse told the ABC she had started looking for jobs outside of the industry. Staffing issues and bed block remain unaddressed, urges ANMF Tasmania State Secretary Emily Shepherd.(ABC News: Maren Preuss) The state government has indicated it would provide extra resources to help emergency departments meet the reduced time frames, ensuring "hospitals are resourced adequately". "We'll continue consulting with our nurses and our doctors and health professionals to ensure that this works and indeed is implemented effectively," Premier Jeremy Rockliff said. "We've got continued resources coming through, such as the Royal Hobart Hospital with more nurses and doctors to be employed once we transition, in a very measured way, to the 30-minute protocol." However, the Australian Nursing and Midwifery Federation (ANMF) argues one of the main causes of ramping — the lack of available beds, known as bed block — is not being addressed. Loading... "Patients that are ramped for too long is a direct result of ineffective access and flow across our hospitals," branch secretary Emily Shepherd said. "If we can improve access and flow throughout our hospitals we will in turn improve or reduce the wait times of patients on the ramp." But as workers face the reality of this 60-minute protocol today, the EDs have been given no extra assistance, and many feel they're already doing the best they can. "Nurses are aware that patients will get better care and get their treatment started if we can get them off the ramp or get them into a bed in the ED," the RHH worker said. "We would love to get them off the ramp, we want them, it's just we don't have the space or staff to do it." The one thing everyone can agree on is that they want the issue solved. "It's not a simple solution. This policy … goes in the right direction," paramedic Mr Watkins said. "But we need more funding for health in primary healthcare, and for the wards and for the emergency departments and indeed for more ambulances." LoadingLoading... Posted 21 Apr 202421 Apr 2024Sun 21 Apr 2024 at 9:58pm, updated 22 Apr 202422 Apr 2024Mon 22 Apr 2024 at 12:52amFears of growing division between hospital staff and paramedics
How the protocol will work
Bed block still unaddressed