MEDICUS May 2022

FIX RAMPING WITHOUT DELAY W hen it emerged in late April that a woman had died at Busselton Health Campus, having waited in the emergency department for several hours, reportedly under the care of St John WA paramedics, ABC 720’s Nadia Mitsopoulos spoke to Dr Mark Duncan-Smith for context. The case is now the subject of an investigation, and the AMA (WA) President was only able to make general comments, but reflected on the effects of chronic ambulance ramping. "The AMA (WA) supports a thorough and complete transparent investigation to see if there are system errors or problems that could be improved to ensure that this never happens again… Basically, ramping leads to delay in treatment and delayed treatment leads to potential poor outcomes and death. There’s an Australasian College of Emergency Medicine study that shows that if a patient presents to a crowded emergency department, they are 10 per cent more likely to die in the next seven days than if the emergency department was uncrowded. So, these deaths are occurring, adverse outcomes are occurring and it’s up to this Government to sort this out. They’ve been in power since 2017, for five years. They were going to reduce the operational budget of health at last year’s budget by $140 million over the next two years. And they didn’t start to increase or reopen, I should say, reopen closed beds until late last year – it’s just a little bit too little, too late. Whose care? Dr Duncan-Smith was asked whether it was common for patients to remain under the care of paramedics while being in the hospital itself. "This is hours of ramping that actually don’t, I'm pretty sure, get reported, but the patient is still technically not in the emergency department," Dr Duncan-Smith said. St John WA states: Hospitals aim to receive all patients within 30 minutes of our arrival at the ED. If it takes longer than 30 minutes, this is referred to as ramping. We therefore record the time (in hours) that ambulances are parked outside a hospital, waiting to handover the care of the patient. "They’re physically in the building, but they’re not on the books of the emergency department, so they haven’t seen the doctors in the emergency department. They’re still under the care of the paramedics. So functionally they might not physically be in an ambulance, but they’re effectively still ramped. "Ultimately, ramping and crowded emergency departments are due to a lack of hospital beds. Our hospitals are pretty much nearly 100 per cent occupied because we don’t have enough beds. "We have the lowest number of hospital beds per head of population of any state or territory in Australia. Now, with the beds that have been reopened over the last six months and in the next six months, they’re reopening closed beds, that’ll probably get us off the bottom, but not by much. Now, in a State that had a $6 billion budget last year, and is purported to be getting a $10 billion budget this year (a $5.7 billion surplus was announced on 12 May), I’d like to see the McGowan Government not just say the words ‘With great power comes great responsibility’ but actually take responsibility for this and sort it out properly. ■ ABC Online, 21 April 2022 abc.net.au/news/2022-04-21/investigation-into-busselton- hospital-death-could-take-six-weeks/101005060 M AY 2 0 2 2 M E D I C U S 39 A M A I N T H E M E D I A