paramedics – Michmutters

Tag: paramedics

Categories
Australia

Fixing weekend discharge key to improving capacity at South Australia’s hospitals

A white hospital building with blue and green windows, with green trees in front of it

A senior doctor at Adelaide’s biggest hospital says the health system is under “siege” and pinpoints Mondays as the busiest day.

SA’s struggling health system was again in focus this week due to the death of a 47-year-old man while he waited for an ambulance in suburban Adelaide on Monday.

Problems around ramped ambulances, overcrowded emergency departments and full inpatient hospital beds, trouble doctors and nurses on any day of the week.

But each Monday a perfect storm of complications aligns, cranking up pressure on health staff and patients.

So, what makes Monday the busiest day in SA’s hospitals, and what can be done about it?

Headshot of Dr Peter Subramaniam at an Adelaide hospital
Dr Peter Subramaniam says having fewer doctors working and community services unavailable on weekends leads to lower discharge rates.(ABC News: Ethan Rix)

A weekend hangover

As medical lead of the surgery program at the Royal Adelaide Hospital and chair of the Australian Medical Association Council, Peter Subramaniam knows South Australia’s health system well.

He says it is under “siege”.

“The system is under pressure and there is a significant demand and our capacity to meet that demand is not working,” Dr Subramaniam said.

The qualified vascular surgeon pinpointed Mondays as the busiest days for hospitals.

“You can see from the data we have that ours are lower on the weekend compared to weekdays,” he discharge said.

“So that contributes to the log jam that occurs on a Monday.”

A masked nurse adjusts their blue plastic glove in an operation room.
Experts say more resources are needed every day of the week, including weekends.(Rawpixel: Chanikarn Thongsupa)

Dr Subramaniam said fewer doctors working to patients over the weekend had an impact discharge.

“Most acute care hospitals operate on reduced staffing,” he said.

But that’s not the only thing bringing down discharge numbers.

“We rely heavily on community services to be available and accessible over weekends and often that’s difficult to organize,” Dr Subramaniam said.

“You might need a rehab bed or a step-down bed or a community nursing service to be able to manage the patient once they’re discharged.

“Once we’ve discharged the patients, they need to go somewhere.”

Elizabeth Dabars stands outside a hospital in Adelaide
Elizabeth Dabars says a criteria-led discharge policy was never fully implemented.(ABC News: Michael Clements)

monday blues

Chief executive of the Australian Nursing and Midwifery Association’s SA branch Elizabeth Dabars said the “absence of senior clinicians” on the weekend was driving up ramping times.

Professor Dabars wants to see nurses, allied health professionals and junior doctors able to discharge more acute patients under something called criteria-led discharge (CLD).

“It’s a win for the people wanting to go home and it’s a win for the broader community who would have better access to hospital beds,” the qualified nurse said.

CLD has been hotly debated for decades and was a policy directive issued by SA Health in 2019.

A car drives past an emergency department building
The state’s emergency departments have been under extreme pressure.(ABCNews)

Professor Dabars said it was never fully implemented.

“That has not really seriously been put in place and that is a blocker to people being discharged,” she said.

“It doesn’t actually make sense for it not to be enabled.”

But the former president of the South Australian Salaried Medical Officers Association, Dr David Pope, said the number of patients that would fit the CLD criteria was small.

“Item [CLD] works quite well in some areas but I defy anyone to go around and find patients sitting around in the hospital for want of a doctor to come in on a Monday morning,” Dr Pope said.

“That just doesn’t happen.”

Headshot of Doctor David Pope
David Pope says elective surgery admissions make Mondays busier than other days.(ABC News: Ethan Rix)

He said a crowded start to the week was a side effect of elective surgery.

“That worse effect on a Monday is purely a function of when elective surgery patients arrive,” he said.

The doctor said the idea that senior clinicians were unwilling to provide care on weekends was damaging to an already stretched workforce.

“Doctors are in the hospitals 24/7, so if there’s a need for a doctor to be in the hospital they will be there if they exist,” he said.

What will change?

The state government said it was looking to make criteria-led discharge “a regular part of hospital operations.”

.

Categories
Australia

Country Fire Service boss Mark Jones raises concerns about plan to send volunteer firefighters out to medical emergencies

Cadell CFS volunteer

South Australia’s volunteer firefighters are already attending a growing number of medical emergencies and are not trained to deal with the trauma, according to the head of the Country Fire Service (CFS).

CFS chief officer Mark Jones has raised concerns about a state government probe into whether firefighters should attend more medical call-outs as the SA Ambulance Service (SAAS) remains under increasing pressure.

Premier Peter Malinauskas on Thursday launched a taskforce to look into the concept, after a 47-year-old father-of-two died in Plympton while waiting 40 minutes for an ambulance to arrive.

Mr Jones is not on the panel, however, Metropolitan Fire Service (MFS) chief Michael Morgan and South Australia Ambulance Service (SAAS) boss Robert Elliott will be part of the taskforce, along with Health Minister Chris Picton and union representatives.

“I lead a government that is open to ideas about what we can do to relieve pressure [in] any way we can,” Mr Malinauskas said.

“One such measure that is being proposed is drawing on the resources of the MFS to potentially respond in ways that are safe — all options are on the table.”

He said the taskforce had been established “in haste”, but other measures the government wanted to introduce — such as employing more paramedics — would take time.

Mr Malinauskas said on Friday morning that the idea was “worthy of investigation” and would be looked at “thoughtfully and safely”.

“You don’t want to fix one problem and create another, particularly with respect to the work the MFS already do,” he told ABC Radio Adelaide.

CFS attend 1,000 medical emergencies

Mr Jones said his firefighters were already doing that, attending about 1,000 medical incidents in the past year and 14 this week.

“They attend these with no specialist medical training and no additional mental health support,” he said.

“Additionally, these incidents often happen in small communities, where the volunteers are turning up to an incident where they know the casualty.”

A man wearing a Country Fire Service uniform addresses the media in front of a CFS and Government of South Australia banner.
CFS chief officer Mark Jones has raised concerns.(ABCNews)

He said the volunteers responding to medical situations were doing it “outside the scope of their standard duties, in their own time, without pay and without the same support as paramedics.”

“Our volunteers are routinely called upon to attend traumatic events beyond the scope of their firefighting duties and these jobs fall outside of most people’s expectations when they join the service,” he said.

“I have seen the number of SAAS-assist jobs that our volunteers are expected to attend grow significantly.

“This is something that has occurred without any formal agreement or additional support for our volunteers doing an already tough job.”

Mr Jones said volunteers were trained in first aid but there was a “large difference” between providing CPR and addressing the underlying clinical health issues of a patient.

Mr Malinauskas acknowledged that the CFS “have always played an extraordinarily broad role in their communities”.

“The way the CFS responds to call-outs in regional areas very much depends on the other services that are already in place in those other areas,” he told ABC Radio Adelaide on Friday morning.

“And to be clear our CFS officers attend a lot more than fires.

“In some places where we don’t have a SES, the CFS is responding to car accidents, to fires, and other emergencies on a frequent basis.

“So they already do this work and their caseload continues to grow, and that’s why we’ve got to keep an eye on the volunteer base.”

In a statement, an SAAS spokeswoman said the service already worked closely with fire services and police to support South Australians during a medical emergency.

“We are excited about the opportunity to work further with the SA Metropolitan Fire Service on a co-response model for the community here in [South Australia]and hope to grow the program over time,” she said.

“Any initiative that supports early CPR and early defibrillation is potentially life-saving.”

.

Categories
Australia

Country Fire Service boss Mark Johns raises concerns about plan to send volunteer firefighters out to medical emergencies

Cadell CFS volunteer

South Australia’s volunteer firefighters are already attending a growing number of medical emergencies and are not trained to deal with the trauma, according to the head of the Country Fire Service (CFS).

CFS chief officer Mark Johns has raised concerns about a state government probe into whether firefighters should attend more medical call-outs as the SA Ambulance Service (SAAS) remains under increasing pressure.

Premier Peter Malinauskas today launched a taskforce to look into the concept, after a 47-year-old father-of-two died in Plympton while waiting 40 minutes for an ambulance to arrive.

Mr Johns is not on the panel, however, Metropolitan Fire Service (MFS) chief Michael Morgan and South Australia Ambulance Service (SAAS) boss Robert Elliott will be part of the taskforce, along with Health Minister Chris Picton and union representatives.

“I lead a government that is open to ideas about what we can do to relieve pressure [in] any way we can,” Mr Malinauskas said.

“One such measure that is being proposed is drawing on the resources of the MFS to potentially respond in ways that are safe — all options are on the table.”

He said the taskforce had been established “in haste”, but other measures the government wanted to introduce — such as employing more paramedics — would take time.

CFS attend 1,000 medical emergencies

Mr Johns said his firefighters were already doing that, attending about 1,000 medical incidents in the past year and 14 this week.

“They attend these with no specialist medical training and no additional mental health support,” he said.

“Additionally, these incidents often happen in small communities, where the volunteers are turning up to an incident where they know the casualty.”

A man wearing a Country Fire Service uniform addresses the media in front of a CFS and Government of South Australia banner.
CFS chief officer Mark Jones has raised concerns.(ABCNews)

He said the volunteers responding to medical situations were doing it “outside the scope of their standard duties, in their own time, without pay and without the same support as paramedics.”

“Our volunteers are routinely called upon to attend traumatic events beyond the scope of their firefighting duties and these jobs fall outside of most people’s expectations when they join the service,” he said.

“I have seen the number of SAAS-assist jobs that our volunteers are expected to attend grow significantly.

“This is something that has occurred without any formal agreement or additional support for our volunteers doing an already tough job.”

Mr Jones said volunteers were trained in first aid but there was a “large difference” between providing CPR and addressing the underlying clinical health issues of a patient.

In a statement, an SAAS spokeswoman said the service already worked closely with fire services and police to support South Australians during a medical emergency.

“We are excited about the opportunity to work further with the SA Metropolitan Fire Service on a co-response model for the community here in [South Australia]and hope to grow the program over time,” she said.

“Any initiative that supports early CPR and early defibrillation is potentially life-saving.”

.

Categories
Australia

Family of Canberra woman Bronte Haskins called on ACT coroner to find several people failed her in the lead up to her suicide

A woman holds a framed picture of her daughter.

The family of Canberra woman Brontë Haskins has asked the ACT coroner to make adverse findings about several people involved in her case before and after her suicide in 2020.

Ms Haskins, 23, died in hospital after several days on life support.

Her death came while she was on bail after a stint in jail for drug driving.

Ms Haskins had suffered both substance abuse and mental illness, something her mother said was not taken seriously enough by authorities.

In the lead-up to her death she had been staying at her mother’s home, while she was on bail.

A coronial inquest into Ms Haskins’s suicide heard her mother called police and mental health services when she became delusional, believing the unit where she was staying was a gas chamber.

Several issues have been raised in the case before the ACT Coroner’s Court, including the family’s claim that a mental-health nurse failed to give the case the priority it required and failed to follow up a call from Ms Haskins’s mother, Janine.

Lawyer Sam Tierney who represented Ms Haskins’s family referred to the staged triage system — where category A is the most serious, and category G requires more information — when criticizing the way the case was handled by mental-health nurse Karina Boyd.

A young woman relaxes in a hammock as she cuddles a large smiling dog.
The inquest heard Brontë Haskins’s case was not triaged correctly.(Supplied)

“Had Ms Boyd not incorrectly triaged Brontë as category G, Brontë would have more likely than not been assessed face to face by a trained mental-health clinician within 72 hours and certainly prior to her death,” Mr Tierney said.

Counsel assisting the coroner Andrew Muller also took aim at the way the case was triaged.

“Brontë should have been assessed as a category C or D, resulting in some urgent follow-up,” Mr Muller said.

“What is material is that, on any view of the available information, Brontë was incorrectly assessed for triage purposes.”

Mr Muller has recommended an overhaul of the triage system.

But in its submissions, the ACT defended Ms Boyd’s decision, saying she had not been able to speak to Ms Haskins and her only contact was with her mother.

“She had been told that the AFP had been called and she assumed that the police would contact her if they thought Brontë needed a risk assessment or mental-health service,” the territory submissions said.

Court hears CCTV footage of minutes before attempt to take life missing

A young woman smiles at the camera while cuddling a big black dog.
Ms Haskins’s family have called for greater transparency in passing on confidential details after the death of a mental health service user to the Coroner’s Court.(Supplied)

Another key issue was the fact police returned a CCTV recorder to Brett French, an associate of Ms Haskins, at whose home she had tried to take her life.

The court heard about 45 minutes of footage which may have shed light on the events leading up to her death was deleted

Court documents showed Mr French had admitted showing some of the CCTV to another man.

Mr Tierney told the court the family wanted an adverse finding against Mr French for his “callous” treatment of Ms Haskins on the day of her death.

Mr Tierney also identified the behavior of police investigating the death as an issue.

“A proper investigation and analysis of the CCTV recorder may have disclosed further and important information to the coroner to assist in the process of considering Brontë’s death,” he said.

He has called for a recommendation that will send a message to the AFP about the handling of coronial exhibits.

The inquiry has also looked into the management of Ms Haskins’s case and whether further detention could have prevented her death.

Mr Muller said there was evidence of better communications about her could have helped.

“Had Brontë been stopped the outcome may, of course, have been different,” Mr Muller said.

“But there was no proper reason she could be stopped.”

Other recommendations being sought by Ms Haskins’s family include greater transparency in passing on to the Coroner’s Court confidential details after the death of a mental health service user, recording of calls to the mental health line, audits of the triage system, and better information to be passed to AFP officers called to incidents.

Coroner James Stewart said he would take some time to hand down his findings.

.