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We are excited to share with you the 2023 entries for the CAA Awards for Excellence. This year we received 50 submissions from across Australian, New Zealand and Papua New Guinea ambulance services, a significant increase on 2022. This year the award categories included Excellence in Technology, Excellence in Clinical Practice, Excellence in Staff Development, Excellence in Patient Care, Excellence in Leadership, and Excellence in Mental Health and Wellbeing. And, recognising the best of the best as judged by our international judging panel, the over-arching Star Award winner will be selected from amongst all category winners.
On behalf of the CAA, I would like to thank everyone who took their time to enter the CAA Awards. It is an honour to see what you have shared with the panel, and to be able to showcase your achievements, innovation, and solutions.
As ever, thank you to the distinguished panel of international, independent judges who donate their time to judge all entries and help us choose finalists and winners from amongst very high calibre competition.
Even before the winners are announced, I would also like to take this opportunity to let you know that the 2024 CAA awards for Excellence will open in November later this year, and we invite all our member services to enter your programs and projects, showcasing the ambulance sector’s best work.
Congratulations to all entries for the high quality, and the best of luck to the finalists.
David Waters Chief Executive, Council of Ambulance Authorities
For over 15 years, the Council of Ambulance Authorities have proudly presented the Awards for Excellence.
The Awards recognise the hard work and innovative solutions of our member services from Australia, New Zealand, and Papua New Guinea across a range of areas and representing all the people, teams and job functions that go in to running and developing a truly world-class ambulance service.
The awards are designed to encourage our members services to learn and share from each other beyond the committees, forums and networking groups that are also a vital and formal part of sharing best practice and information.
The awards are judged by a panel of independent, industry-respected judges from around the world. They give of their time and expertise freely, and we are truly grateful for their assistance and insights.
Freddy Lippert MD
CEO, Copenhagen Emergency Medical Services
Associate Professor, University of Copenhagen, Denmark Co-founder, Global Resuscitation Alliance, and the European EMS Leadership
Freddy K. Lippert, MD, Associate Professor, FERC, is CEO of the Emergency Medical Services in Copenhagen, Denmark.
The EMS Copenhagen covers a population of 1.7 million, that is, one third of the Danish population.
The EMS Copenhagen includes the following: Emergency Medical Dispatch, ambulance services including physician manned mobile critical care units, psychiatric mobile unit, a medical hotline 24/7, responsibility and coordination of medical preparedness on behalf of all hospitals in the Capital Region.
Executive Officer, Association of Ambulance Chief Executives
Steve has nearly 40 years of ambulance service, initially working in London and more recently with the Association of Ambulance Chief Executives in the UK.
An extensive front line clinical career included secondments as both a HEMS and Motorcycle paramedic. Steve has been lucky enough to experience a variety of ambulance related roles and leads on organising the AACE’s Ambulance Leadership Forum (ALF) conference each year.
Academic Director, The Alfred Emergency and Trauma Centre
Professor of Emergency Medicine, Monash University
Professor Peter Cameron is Academic Director of Alfred Health Emergency, and Professor of Emergency, and Precinct Lead of the Alfred-Monash Research and Education Precinct.
He is Past President of the Australasian College for Emergency Medicine and the International Federation for Emergency Medicine. He has also just completed his term as the Clinical Lead for the Emergency Clinical Care Network for Victoria.
Peter has an extensive history of practical involvement in health services planning and analysis, and a considerable research portfolio with over 700 peer-reviewed publications.
Peter is passionate about testing the orthodoxy of establishing clinical pathways in emergency and trauma medicine and is an active contributor of education and training programs at both undergraduate and postgraduate levels.
Tony Ahern
Board Member, St John WA
Board member, WA Primary Health Alliance
Tony Ahern was Chief Executive Officer of St John Ambulance Western Australia Limited from 2006 to 2018, when he retired after 45 years’ service. Prior to his appointment as CEO, Tony was the Finance Director/Deputy CEO for 11 years and before that the organisation’s IT Manager.
Tony served as the Chairman of the CAA’s Strategic, Business Advisory Committee for almost a decade and was a CAA Board Member for the 12 years of his term as CEO of St John WA, including three years as Chairman of the CAA Board. He has extensive Board experience currently serving on the WA Primary Health Alliance and St John Ambulance WA Boards. In addition to his business degree Tony holds a Masters in Information Systems and completed the London Business School Senior Executive program.
Mr Ahern is a Knight of the Order of St John and a recipient of the Ambulance Service Medal.
Associate Professor
Belinda Flanagan (PhD) Head of School, School of Paramedicine, University of Tasmania
Belinda is the Head of School at the University of Tasmania, leading the first School of Paramedicine in an Australian university. She has worked as a Paramedic & Registered Nurse/Midwife for 25 years.
Belinda collaborates with ambulance services in guideline development, education, research, and clinical governance.
David Waters
Chief Executive, Council of Ambulance Authorities
David Waters is the Chief Executive of the Council of Ambulance Authorities (CAA).
He concurrently holds the positions of Chief Executive of Ambulance New Zealand and is President Elect of the Aeromedical Association of Australasia (ASA).
In addition to his extensive experience in the pre-hospital sector, David holds a Bachelor of Nursing, a Post Graduate Diploma in Business Administration. He is also a graduate of the Strategic Management Executive Program, Darden University Virginia, USA.
Dr Yih Yng Ng
Director, Digital and Smart Health Office, Singapore
Deputy Clinical Director, Ng Teng Fong Centre for Healthcare Innovation, Singapore.
Dr. Yih Yng Ng is the Director of the Digital and Smart Health Office and the Deputy Clinical Director for the Ng Teng Fong Centre for Healthcare Innovation and is actively involved in population health and digital health transformation efforts in Singapore.
He is a Senior Consultant, Department of Preventive and Population Medicine at the Tan Tock Seng Hospital and concurrently serves as the HomeTeam Chief Medical Officer, Ministry of Home Affairs, overseeing administrative healthcare services and policies across the HomeTeam Departments.
He is a professor with the Lee Kong Chian-Nanyang Technological University School of Medicine, Duke-NUS Prehospital Emergency Research Centre, and the Saw Swee Hock School of Public Health.
Linda Ross
Director of Education, Department of Paramedicine, Monash University
Linda is a registered paramedic with over 30 years’ experience in the discipline as a clinician and educator.
She also has an extensive research portfolio and chairs the Australasian College of Paramedicine Research Committee.
2023 CAA
1 CE Letter
2 Award History and Judges
11 Excellence in Technology
Entrants
ACT Ambulance
Personalised Skills Dashboard
Ambulance Victoria
Electronic Audit Platform
Ambulance Victoria
Can-Am Oversnow Patient Retrieval Vehicle
Hato Hone St John
Major Incident Support Vehicle
NSW Ambulance
Statewide Deployment of Digital Signage
NSW Ambulance
Real-time Operational Analytics for Grade of Service in NSW
Ambulance Control Centres and Virtual Clinical Care Centre
SA Ambulance Service
GoodSAM Responder Integration Program (GRIP)
St John Ambulance Australia (NT)
H300 Toyota Commuter 4x4 Response Ambulance Project
St John WA
Electronic Drug Register (EDR) system & Integration with Electronic Patient Care Record (ePCR)
Ambulance Victoria
Surge Work-from-Home Operating Model
Finalists
Hato Hone St John
Ambulance Activity and Resource Model (AARM)
Hato Hone St John
National Operations & Emergency Centre (NOC)
Winner
Ambulance Victoria
2021 Clinical Response Model: An evidence-based approach to improve ambulance resource allocation and response performance during the COVID-19 pandemic
29 Excellence in Clinical Practice
Entrants
SA Ambulance Service
Intensive Care Paramedics
Extended Scope Pilot
Finalists
Hato Hone St John
Aotearoa New Zealand
Out-of-Hospital STEMI Report
St John WA
Recognising and responding to acute deterioration SJWA project: Introduction of early warning scores and clinical escalation pathways
Winner
St John WA
‘Leave behind Naloxone’ by St John WA Ambulance Officers/Paramedics
35 Excellence in Staff Development
Entrants
Ambulance Victoria
Points of View Clinical
Discussion and Learning Series
Ambulance Victoria
Enhanced Clinical Practice support
Ambulance Victoria
Family Violence
Continuing Education
NSW Ambulance
Post-Employment Tertiary Pathway
Hato Hone St John
Residential EMT Programme
SA Ambulance Service
Gender Transition and Affirmation Procedure
St John WA
Infection Prevention and Control Champion (IPCC) Program
Finalists
NSW Ambulance Statewide Mechanic Training Program
Wellington Free Ambulance Podcasting as a Clinical Tool
Winner
St John WA
Critical Care
Paramedic Internship
47 Excellence in Patient Care
Entrants
Hato Hone St John
Manaaki Mamao (Remote Care)
Queensland Ambulance Service
QAS and Mater at Home Direct Program
SA Ambulance Service
Ambulance Transport Assist COVID
SA Ambulance Service
Paramedic Telehealth Clinician
Mental Health Project
St John WA
Care Link program connects repeat callers to care in the community
Ambulance Victoria
Statutory Duty of Candour introduction to Ambulance Victoria
Finalists
Ambulance Victoria
Residential Aged Care Enhanced Response (RACER)
Hato Hone St John
Closing the gap - Integrating health care to improve patient outcomes
Winner Wellington
Free Ambulance
The Case for Prehospital Telestroke
59 Excellence in Leadership
Entrants
Ambulance Tasmania Inspire and Lead
Hato Hone St John
Optimising PPE through the COVID-19 response.
St John Ambulance Australia (NT)
Remote Area Access
Trained Paramedics
Wellington Free Ambulance Tactical Emergency Medical Support (TEMS) Trial
SA Ambulance Service
Early access to telehealth assessment, intervention and referral to alternative care pathways for mental health consumers accessing triple zero (000) in a crisis via a Paramedic Telehealth Clinician Mental Health could be introduced across all ambulances
Finalists
NSW Ambulance
Ground to Air Radio
Communications in Remote Areas
Hato Hone St John
Improving Equity
Winner
Queensland Ambulance Service
Development of the QAS Strategy 2022 - 2027
71 Excellence in Mental Health and Wellbeing
Entrants
NSW Ambulance Staff Psychology Service
NSW Ambulance Wellbeing Workshop
SA Ambulance Service
Peer Support
COVID-19 response
Finalists
Queensland
Ambulance Service
Ambulance Wish
Queensland
Ambulance Victoria
Mental Health and Wellbeing
Action Plan 2022 – 2025
Winner
Wellington
Free Ambualnce
Review of Shift Pattern and Fatigue at Wellington
Free Ambulance
77 Star Award Winner
Wellington
Free Ambualnce
Review of Shift Pattern and Fatigue at Wellington
Free Ambulance
Recognising innovation or capability in the fields of equipment, communications, and information systems. When making their submission to this category, each service is encouraged to reflect on how their organisation has used technology in the past twelve months to enhance patient outcomes, staff performance or response capacity.
Previous submissions have included using systems and technology to reduce emissions whilst improving operational efficiency, Real Time COVID-19 data linkage and Secondary Triage Work from Home management.
Sponsored by
The ACT Ambulance Service (ACTAS) is working towards increasing data-informed practice and enhancing our ability to ensure that our staff can maintain their clinical skills and ensure a high-level of confidence in their daily work activities. This work will see the ACTAS continue to strive for clinical excellence in the level of prehospital care provided to the ACT, as well as increasing staff satisfaction in the workplace.
In 2022 the ACTAS launched a trial of a Personalised Clinical Skills Dashboard. This initiative aims to utilise contemporaneous clinical data, tailored to the individual practitioner to inform practice and enable selfimprovement. This forms part of a wider initiative to use the clinical data harvested by the ACTAS to inform service provision and development.
Clinical data harvested from patient care records is manipulated into an easy to digest and personalised format to allow the individual to compare their performance of practiced skills against both personal goals and service-wide performance. Data is extracted from the VACiS Clinical Data Warehouse and presented to the user through easy to digest graphics via the Power BI application.
The goal will be for individual clinicians to track the frequency of performed interventions over an adjustable period and assess their skill performance with comparison to service-wide performance, where applicable. This initiative aims to identify areas of excellence and knowledge gaps on both the individual and service level to inform and improve practice and service delivery.
Team: Luise Grisdale, Desmond McGuirk (Customer Feedback Systems Australasia (CFS)), Joel Mendez (CFS), Tilly Beresford (CFS), Josh Roussos (CFS), Paul Smith, Srinivas Shesham, Renjith Kanavila, Jagadeesh Baskaran, Tony Ginis, Kristy Austin, Warwick Bone, Dave Jones
Monitoring and auditing of clinical care provides assurance that safe and high-quality care is being delivered by Ambulance Victoria (AV) and is the foundation for continuous improvement. AV identified the opportunity to standardise the organisation’s clinical auditing framework, systems, and tools to better analyse and improve patient care on an ongoing basis. This assists in monitoring areas of identified risk and trends while reflecting a safe, highly reliable system.
In November 2022, after successful pilots, AV introduced the innovative Electronic Audit Platform (EAP) to create a consistent organisational approach to auditing. It also provides AV with local and organisational information about the quality and effectiveness of patient care, helping identify risks and priorities for improvement.
The platform is secure and easy to use, providing governance, tools, and reports to support those responsible for auditing and reporting across AV.
The project consisted of three concurrent phases:
• Design and development of a secure electronic audit platform, meeting AV’s Information Communication and Technology (ICT) specifications.
• Compilation of a library of patient care audit tools, and accompanying reports aligned to the National Safety and Quality Health Service Standards (NSQHSS) evidentiary requirements, and AV’s Clinical Practice Guidelines (CPGs), standards, and reporting requirements.
• Development and delivery of a robust Patient Care Audit Framework, procedure, and scope in line with AV’s Best Care commitment and clinical governance framework. This ensures accountability to patients and the community for assuring the delivery of safe, effective, integrated, and continuously improving care across AV, from frontline clinicians to managers and governance committees.
The benefits already experienced include improved consistency, time efficiency and accessibility in patient care reporting at both local and organisational levels. Even more significantly, observational point of care audits for quality improvement are now routinely conducted.
Team: Rob Heaslip, Narelle Capp, Richard Aspinall, Simon Etherington (Mader International), Falls Creek Alpine Paramedic Team, Ambulance Victoria's Health and Safety Team and VECG representatives
Ambulance Victoria (AV) is committed to reliable patient care service and transport for alpine environments. Its Can-Am Oversnow Ambulance has been heralded as the first of its kind in Australia. During Victoria’s winter snow season (June – October), AV provides on-mountain paramedic response to the community within the Falls Creek, Mt Hotham and Mt Buller ski resorts and precincts.
In winter 2022, AV welcomed the purpose-built dual cab Can-Am Oversnow Ambulance ('Can-Am') vehicle to its fleet. Specifically designed for snow conditions, the Can-Am offers superior support with patient recovery and stretcher carrying capability. It is used alongside two existing ski-doos at Falls Creek, which are still required for appropriate responses to the ski fields and adjoining areas unsuitable for Can-Am access.
AV has found that the Can-Am's capabilities are best suited for responses to incidents in the alpine village areas and immediate surrounds. It is:
• An enclosed transport option with protection from the extreme weather for paramedics, patients, and equipment.
• Equipped with manual handling equipment, such as a stair chair to assist with areas of difficult egress.
• The only alpine-based vehicle in AV’s fleet with the capacity to carry four passengers and a patient, a unique attribute for these types of vehicles.
The introduction of this multi-functional vehicle supports paramedics to provide clinical care in diverse environments such as the Victorian snow fields. Without an all-terrain vehicle, designed specifically for retrieving and transporting patients in alpine environments, paramedics had been undertaking ad-hoc and risky manual handing manoeuvres. There was an opportunity to improve patient care in line with AV’s Best Care standard.
In 2021 Hato Hone St John revitalised its approach to support vehicles, creating a standardised approach to support major incidents. Our primary incident caches had several iterations over the years, with the last central review in 2009-11. With this in mind, a multipurpose Incident Support Vehicle (ISV) was designed and implemented as an "all hazards approach" platform to be versatile and deployable for a local bus crash or to an austere disaster environment in a national emergency caused by a seismic event.
Our Major Incident Support Teams (MIST) are a subset of our emergency capability within ambulance operations which provide incident support and are crewed by volunteers nationwide. In 2021, the organisation refreshed the MIST capability and focused on upgrading its current capability. The ISV is the cornerstone to supporting deployment and will make up the most significant quantity of fleet within MIST.
A working group was established based on the initial concept of an ISV, and a preliminary analysis was carried out. The project’s scope was defined as a platform that could carry a 50-person cache suitable for an all-hazards response which would serve our needs for the next ten years, but be adaptable to changing needs. The project had three stages: design/analysis, cost analysis, and platform criteria. Using a phased approach, mock-ups were constructed to ensure that the intended equipment fitted the designed build. This was then followed by the implementation of the prototype build. At all times, end-user feedback was considered to make the production platform a success. 28 Incident Support Vehicles based on a Mercedes Benz Sprinter 5.5 tonne double cab chassis were ordered, with nine are now in service. The ISVs have proved their worth recently during Cyclone Gabrielle, with the design showing adaptability to austere environments and being flexible enough to accommodate changing objectives.
Team: Gareth Becker, Lindsay Mackay, Diana Zimmermann, Caley Geary, Angela Iliopoulos, Flynn Snell, Paul Crole, Jenny Davis, Catherine Spiden, Tom Bawden, Larissa Walsh, Patrice Bottcher, Hayden Peucker, Nicole Magnuson
In preparation to respond to pandemic-related impacts on emergency medical services (EMSs) in Victoria, Australia, Ambulance Victoria (AV) designed both a surge response and a work-from-home (WFH) operating model within their Secondary Triage Services. This WFH operating model provided significant capability to manage the overwhelming demand of Triple Zero (000) calls during the height of the pandemic, whilst simultaneously managing the increased risk of higher staff furlough.
The Surge WFH operating model led by AV Secondary Triage Services aimed to establish the world’s first WFH operating model, whereby EMS Triage Practitioners were able to access Triple Zero (000) callers and the Computer Aided Dispatch (CAD) application that is used to identify available ambulance unit(s) to respond to emergency events outside of the work-based setting. The design and development of the Surge WFH operating model involved vital technical and procedural enhancements, and since inception in October 2020, has shown to be effective in minimising staff furloughing and delivering greater surge capacity during peakperiods of demand.
This surge response and WFH operating model can now be used as a blueprint for EMS around the globe to develop and implement an operating model, that is resilient to the pressures of increasing Triple Zero (000) demand during unprecedented times.
The overarching aim of this project was to establish an operating model that allowed Triage Practitioners in AV’s Secondary Triage Services to continue to work during times of furlough as well as be able to immediately surge up in response to high workload demand. In doing so, the project aimed to:
• Build a safe and resilient operating model that would minimise the risk of staff exposure to COVID-19, and thereby reduce the impacts of staff furloughing during the pandemic.
• Establish an operating model that could increase surge capacity immediately during peak periods of demand, to ensure Triple Zero (000) callers had timely access to the care they need, when they needed it.
Tripleplay is an innovative digital technology solution which significantly enhances the communications capability of NSW Ambulance to reach its 7,500 strong workforce with vital content through internet protocol television, digital signage and enterprise video. Tripleplay is fully integrated and easy to manage via its browser-based content management console. This allows users to easily access, update and control different content types and dynamically display a variety of content on screens across more than 240 NSW Ambulance sites. The platform was implemented under a pilot initiative that was kicked-off at Northern Control Centre in March 2021.
The platform can be used to present operational dashboards, featuring informational and local content across a diverse number of screens depending on their location, purpose and level of sensitivity. The local staff at Northern Control Centre adopted the newly installed capability, created a content team from the ‘ground-up’ and ensured frontline staff did not feel disempowered in the process. The early pilot at Northern Control Centre enabled this significant statewide rollout and its positive outcomes ensured adoption across a broader spectrum.
Following installation of Tripleplay across all Superstations, Western Control Centre and Southern Control Centre, the rollout of Tripleplay across Metropolitan sites and the new State Operations Centre in Sydney Olympic Park is underway as is the establishment of an ownership and management model allowing different business areas and local teams to continually update their content.
This dynamic capability enhancement to information sharing across NSW Ambulance has been delivered within the realm of existing content policies and guidelines leading to the adoption of controls and authorities for publishing content and minding the intrinsic needs and audience applying to each site.
Early learnings were gained from effectively increased levels of engagement and response to content driven initiatives. It has supported the potential opportunity and favourable response by placing control centre content on to ambulance station screens. This followed encouraging feedback regarding the local content they are sent from Rescue/Special Operations Team. This rescue content is displayed at Northern Control Centre and has invigorated relationships and information sharing across the two local groups.
The experience also provided insights on the treatment of corporate and local content to avoid being dismissed, and the development of new screen layouts to cater for emergency/critical events such as bushfires and flooding, and other major social events in ways which each control centre can make relevant to their region.
NSW Ambulance
Team: Arun Pal, Stephanie Wood
The business need was to implement a real-time operational intelligence solution to help operational decision making and aid in outlier analysis across the vast and diverse NSW Ambulance service.
The executives were eager to build real-time dashboards which would help operational managers to monitor Key Performance Indices (KPIs) for the NSW Ambulance Control Centres and the Virtual Clinical Care Centre (VCCC). This was done through engagement of stakeholders in control centres, understanding the business needs and processes, onboarding relevant real-time data from the computer aided dispatch systems, and iterative development and release cycles with our solution development partners. The choice of platform - Splunk - was made on its ability to ingest high volumes of transactions and system logs, run high-performance complex queries on a large dataset in real time, and speed to develop dashboards.
The team achieved the goals set out and delivered the capability through multiple dashboards targeted at different user groups focussing on their relevant KPIs and making apparent any degradation of service levels to advise necessary actions throughout the day. The dashboards were adopted into operations and continue to play a critical role in executive decision support. A product management methodology was also put in place for continuous improvement of the solution, to expand the KPIs being reported, and explore novel use cases with existing and new datasets.
Team: Kestrel Blackmore
SA Ambulance Service (SAAS) has joined the global GoodSAM program, which saves lives through people’s natural instinct to help others in a crisis, so as to improve cardiac arrest survival rates. GoodSAM is an alert system that uses a phone app to notify registered responders – like off-duty health professionals and first-aiders – if a cardiac arrest occurs near them. These responders can provide CPR while an ambulance is on the way.
SAAS have also adopted the GoodSAM Automated External Defibrillators (AED) Registry replacing several inhouse registries. This provides details of nearby defibrillators which further improve the chances of surviving a cardiac arrest. The GoodSAM Responder Integration Project (GRIP) team integrated the South Australian Computer Aided Dispatch (SACAD) system with GoodSAM to ensure Emergency Operation Centre (EOC) call takers and dispatchers did not have to change any existing work practices – the system “just worked.”
To date, 3.2% of cardiac arrest events, notified via Triple Zero (000) to SAAS, have had a GoodSAM responder on scene – several before an ambulance arrived. There are ~500 SAAS staff and volunteers registered with this being opened up to all registered health professionals in late March 2023.
St John NT paramedics are often called to respond to cases in remote locations with unsealed roads which prove difficult to access in a metro ambulance vehicle. Whilst a regular 4WD is capable of accessing these remote locations, it is not suited to the needs of paramedics, as the vehicle is not equipped with the means to store and transport all of the equipment needed. Looking at measures to improve its service and provide the best care possible in remote locations, St John NT identified the need to bridge the gap between the two vehicles and create an alternative that was equipped for the needs of paramedics and had the 4WD capabilities to access remote offroad locations.
The H300 Toyota Commuter 4x4 Response Ambulance project was developed to design and build a new 4x4 response vehicle with the capability to access remote NT locations while carrying the latest emergency medical equipment. The vehicle design aimed to achieve a hybrid between the ergonomic capabilities of a metro ambulance and the off-road capabilities of a Land Cruiser, with the Toyota HiAce 4WD chosen as the best suited model to meet this challenge.
The project was developed by St John NT’s Northern Region Operational team and Vehicle Services Department with the intention of producing multiple vehicles that could then be distributed to St John NT centres across the Territory.
The technology utilised in the development of the HiAce 4WD will enable St John NT to provide services to remote communities in a more efficient manner. Having the option to customise these vehicles will create greater flexibility than was previously available. The HiAce 4WD vehicle will allow paramedics to reach cases in remote areas with greater ease and potentially reduce response times.
The development of these vehicles demonstrates St John NT’s capacity in tailoring service delivery to meet the operating environment and potentially assisting other ambulance services and health organisations needing to meet similar challenges.
St John WA
Team: Rebecca Minchin, Rudi Brits, Deb Barbas, Curtis Naylor, Reilly Ettridge, John Dwyer, Avinav Duggal
St John WA (SJWA) has introduced a centralised and integrated electronic drug register (EDR) system across Western Australia to track and record aspects of storage, handling, administration and dispensing of all Schedule 8, specified Schedule 4, and Schedule 5(a) drugs. Following an independent WA healthcare review of medication practices, which was prompted by a major inquiry in Victoria into drug misuse and corrupt conduct among paramedics, SJWA investigated a recommendation to move to an EDR in February 2021. Formal commencement of the project began in January 2022 as the selected vendor system ‘StockInsite’ required regulatory approval from the WA Department of Health (DOH) Chief Pharmacist to proceed with development and implementation of an EDR.
An electronic register provides a state-wide closed loop system for tracking of all high-risk medication transactions associated with SJWA poisons permits, such as fentanyl, to strengthen compliance with the Medicines and Poisons Act 2014 and the Medicines and Poisons Regulations 2016. An EDR system replaces current paper-based register methods designed for in-hospital settings.
The system provides robust chain of custody from the distribution warehouse to every SJWA service location, as well as recording patient administration events, returns and disposal/destruction of medications. It will be used across 235 metropolitan and regional ambulance locations with 315 medications storage facilities, 769 medications pouches and about 3900 personnel. The system will monitor and track medications and provide overarching visibility of all frontline areas delivering pre-hospital care across the state, while directly relaying with the regulatory body for greater transparency.
At the point of care, record of medication administration in the existing Electronic Patient Care Record (ePCR) has been integrated with this new EDR so records and stock levels are adjusted and recorded instantly. Frontline ambulance officers, who are often time poor, have directly benefitted from improved workflow, efficiency, accuracy in maintaining records, compliance, medication safety and improved cycle times. These collective benefits will enhance patient safety and deliver operational capacity back for timelier community response.
Innovative design and integration work by SJWA developers underpins the success of this EDR system. Incorporating ePCR - which has internal validation processes, seamless external database integrations, and embedded risk controlsenables a higher degree of accuracy in documenting administration practices in patient care, transparent handling transactions, responsible chain of custody and practitioner protections.
Team: Dave Richards, Robbie Blankenstein, Zoltan Varadi, Max Yang, Dale Truman
Increased demand for emergency ambulance services (EAS) in Aotearoa New Zealand led to demand exceeding available resource. As a result, patients were waiting longer, ambulance utilisation had reached unsafe levels for staff and contractual targets were not being met. This had been compounded by reduced volunteer contribution. As NZ moves to living with COVID-19 in the community, it is essential that the ambulance service has the resilience and capacity to be able to respond. International experience is showing that there are ambulance demand surges associated with community outbreaks of COVID-19 and a backlog of acute presentations to emergency services where the pandemic has interrupted diagnosis and treatment for diseases.
To address these issues Hato Hone St John worked with our funders to identify and articulate the resource requirements to meet response time targets. We took them on the journey and involved them in deciding the inputs/assumptions, showing the results of decisions on model iterations with simulations.
The Ambulance Activity and Resourcing Model (AARM) was created to determine the level of resource investment required for the next four years to adequately service the forecasted demand and achieve government set response targets. The AARM defines a set of demand and resource inputs/assumptions and uses CSAM Optima predict simulation to determine resource requirements.
This new approach of including the funders in the AARM process was ultimately successful with full funding for one of the modelled options. Not only that, the new contract defines the AARM as the process of using agreed assumptions and simulation to determine future resource requirements.
Our research shows that shows that as utilisation increases, staff get fewer breaks, resulting in more sick leave and more fatigue. Ultimately, when we look after our staff they provide better care, and patient satisfaction improves. It is also easier to attract and retain employees.
The National Operations and Emergency Centre (NOEC) was built to operate 24/7 as an adjunct to Ambulance Communications and enact the tactical performance and operational escalation functions of Ambulance Operations. The intended purpose of the NOEC was to enable operational efficiencies, improved spans of control through removing tasks from operational managers and manage operational escalation.
One of the first technical enhancements built for the NOEC was the real time Resource Escalation Action Plan (REAP) called the Surge Plan. Live data enables the NOEC team to enact a Surge Plan, whereby each district is given a score based on variables pending incidents, vehicle utilisation, Emergency Department (ED) wait times and response times. This determines whether the ambulance service is at business as usual, or experiencing moderate, major or extreme pressure. For each level above BAU there are pre-determined levers (listed in the Surge Plan) to consider pulling to reduce system pressure.
The NOEC has a wide variety of functions including implementing ‘Surge’ actions, the point of contact for all sick/absenteeism calls, operational escalation, COVID-19 exposure reporting, HSW incident reporting, frontline logistics issues and dispatching Major Incident Support Teams. To streamline the information collection process within NOEC for the various functions and to automate subsequent steps, a NOEC Information Management System (NIMS) was built using Microsoft Power Apps. Not only does the NOEC enable us to proactively monitor and enhance our emergency ambulance response nationally, the technology developed has ensured a streamlined and efficient process. The NOEC has also been a key element in our recent response to the Auckland Flooding and Cyclone Gabrielle.
Team: Nicole Magnuson, Dr Ziad Nehme, Dr Shelley Cox, Tash Alexander, Emily Mahony, Emily Nehme, Kavitha Sathish-Kumar
In Victoria, easing of COVID-19 restrictions in 2021 led to surges in ambulance demand and compounding hospital delays, impacting Ambulance Victoria’s (AV’s) ability to provide a timely response to time-critical patients. This is a universal challenge faced by all ambulance services across Australia and New Zealand.
Optimising response performance under these evolving challenges requires a renewed emphasis on the appropriate prioritisation and dispatch of emergency ambulances. To address this challenge, AV conducted a review of its Clinical Response Model (CRM), or dispatch grid, using an established and internationally adopted framework. This comprehensive review focussed on identifying call types with a high volume of low acuity patients which could be diverted to Secondary Triage, where a nurse or paramedic further determined the need for emergency ambulance dispatch.
The intervention, implemented in September 2021 (at the height of the COVID-19 pandemic), was designed to:
1) Reduce the number of calls for which an emergency ambulance was dispatched.
2) Increase the number of calls managed through alternative service providers.
3) Improve response time performance to time-critical patients.
4) Better align the operational response with patient acuity.
The intervention represents a clinically safe, replicable, and cost-effective method for optimising dispatch prioritisation decisions. In Victoria, these CRM changes are now embedded into normal business with routine post-implementation safety monitoring. The initiative is an easily transferrable model of dispatch reform that can be implemented into ambulance services internationally, supporting the ongoing response to the pandemic.
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Recognising innovation or capability in the fields of skills mix, pharmacology, and clinical intervention as they relate to patient treatments and outcomes. When making their submission to this category, each service is encouraged to reflect on how their organisation has excelled in clinical practice with breakthrough moments that saw cutting edge techniques implemented to revolutionise the world of paramedicine.
Previous submissions include Spotlight on Aeromedical, Clinical Practise Manual and app, and Virtual Care Service.
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In June 2022, SA Ambulance Service (SAAS) commenced an Intensive Care Paramedic (ICP) Extended Scope Pilot. The aim was to pilot new skills to build a greater organisational understanding of how further developing ICP scope of clinical practice (SoCP) can produce improved patient outcomes.
11 experienced ICPs were selected to undertake a 2-week workshop where skills such as ultrasound, video laryngoscopy, arterial line monitoring, the use of sublingual ketamine (wafermine) and metaraminol were taught in a simulation heavy experience. There was also a significant focus on non-technical skills and how critical these are to teamwork and achieving great outcomes in challenging situations.
Data was collected every time interventions were used to build a repository of information to maintain oversight and to better inform decisions regarding the future of ICP SoCP. An airway registry was also piloted; this inspired a state-wide airway registry commencing on 1 January 2023.
These ICPs went on to become mentors for our latest group of ICP interns. These interns benefitted from the investment made in these clinicians which will in turn positively influence organisational culture and clinical leadership. SAAS view the pilot as a success and have already begun implementing some of the piloted innovations.
The New Zealand Out-of-Hospital ST-segment Elevation Myocardial Infarction (STEMI) Pathway aims to expedite reperfusion therapy for patients attended by emergency medical services experiencing STEMI. The Aotearoa New Zealand Out-of-Hospital STEMI Pathway underwent an incremental national rollout throughout 2019 and 2020. Following the roll-out of the pathway, it was unknown how well this was implemented and if it was implemented equitably. Therefore, we aimed to evaluate the performance of the STEMI Pathway, establishing benchmarking measures and identifying areas for both clinical and operational improvements. Our evaluation was first published in 2022 as the inaugural Aotearoa New Zealand Out-of-Hospital STEMI Report (Te p–urongo STEMI –a-motu) with a subsequent update in 2023. These reports set the foundation for outof-hospital STEMI performance benchmarking in New Zealand and is the only comprehensive, annual national study of pre-hospital management of STEMI
To date, primary PCI is the preferred reperfusion strategy for patients experiencing STEMI. Nationwide, 74% of out-of-hospital STEMI cases followed the primary PCI reperfusion strategy while 13% underwent fibrinolysis. The remaining 13% did not met the criteria of either strategy.
The report shows that our pathways of care are working well, with 93% of STEMI patients undergoing primary PCI arriving at the PCI capable centre within 90 minutes of ambulance arrival. Similarly, this year’s median time from STEMI diagnosis to administration of fibrinolysis saw an over 12% improvement over last year’s measurement.
In addition to the benchmarking of key descriptive performance indicators among the two reperfusion strategies, the report also identified important trends indicating reduced access to reperfusion strategies among M–aori and socioeconomically deprived rural communities. A deep dive into this group identified a plethora of clinical and operational factors affecting access to reperfusion. While numbers among this cohort remain small at this stage, some trends are beginning to emerge, prompting the development of a nonreperfusion database for ongoing prospective analysis.
Team: Jason Belcher, Rudi Brits, Moin Uddin, Deane Coxall, Lauren Davids, Earl Beech, Marco Madiantoro
In early 2022, St John WA (SJWA) introduced an observation-based Early Warning Score (EWS) and associated clinical escalation pathway into frontline ambulance practice for all clinicians. While the Recognising and Responding to Acute Deterioration (RRAD) project introduced a system that helped bring SJWA into alignment with National Safety and Quality Health Service (NSQHS) Standard 8 (Recognising and Responding to Acute Deterioration), it more importantly was designed to increase patient safety through better identification of patients who have unrecognised critical illness or have high potential to deteriorate. There were identified gaps in recognition of these patients but also with processes to escalate concerns of patients who were unwell or deteriorating – particularly in an Extended Transfer of Care (ramping) environment. This project has introduced a systematic process to help find patients of concern and to escalate concerns, which ultimately saves lives.
The RRAD project is currently in Phase 2, as the clinical guideline for scoring and escalation of concern in adult patients is operational and already delivering positive results, however some supporting technology is being piloted and in development. SJWA believes implementation of technology to automate calculation of a score and increase real-time oversight of patients will increase uptake of SJWA’s RRAD system with all patients to improve patient safety.
Since implementation, SJWA have seen a positive impact on patient safety, with a reduction in reported incidents related to unrecognised deterioration or non-recognition of a high acuity patient. There has also been positive feedback from frontline clinicians who appreciate an objective measure to communicate concerns when escalating care. Hospital staff have indicated the system, which uses commonly understood language, has led to better communication and understanding when concerns are escalated, and SJWA Hospital Liaison Managers (HLMs) have also expressed views that the system has allowed more effective communication and escalation of patients of concern.
This project has potential to be replicated nationally using early warning systems as relevant to each ambulance service and their health system’s jurisdictional context.
Team: Rudi Brits, Curtis Naylor, Lauren Davis
St John Western Australia (SJWA)’s joint initiative with the WA Naloxone Program and WA Mental Health Commission (MHC) to reduce overdose (OD) deaths in the community is a nation-leading clinical model for patient-centred care as it provides a greater safety net to a vulnerable cohort of patients who refuse transportation to hospital due to opioid overdose. SJWA’s remodelled Take Home Naloxone (THN) program, known as ‘Leave Behind Naloxone’, allows ambulance clinicians to dispense lifesaving THN to patients and/ or their social network on scene when patients refuse transport, to be used if patients experience relapse due to residual opioid toxicity.
Opioids are a significant contributor to death and disability in Australia, with as many as three people per day dying from an opioid OD in 2018. Naloxone has been used by hospitals and ambulance services for decades to rapidly and safely reverse opioid OD.
MHC delivers the state-wide WA Naloxone Program using Commonwealth THN funding including purchase of THN for the SJWA ‘Leave Behind Naloxone’ project. SJWA’s aim is to decrease the incidence of overdoserelated harms and mortality, and to combat the serious issue of opioid misuse in WA communities.
In working with the MHC, SJWA has adapted its State Operations Centre (SOC) call taking processes, frontline clinical guidance, internal system protocols, which led to SJWA petitioning of the Poisons Regulator to allow ambulance clinicians to dispense THN in a first for Australia and possibly the southern hemisphere.
The joint initiative has resulted in a significant increase in the number of cases being administered THN by bystanders prior to emergency ambulance attendance, as well as a reduction in transportation to Emergency Departments (EDs) at peak times, which has aided a return in SJWA’s community response hours. Additionally, incidences requiring WA Police Force (WAPOL) support at OD-related cases has decreased, which has further supported emergency service response capabilities.
The ‘Leave Behind Naloxone (THN)’ project is well received by patients and their peers, and it has contributed to positive relationships between SJWA and people at risk of OD. In taking a patient-centred harm reduction approach to opioid overdose, SJWA is building on community resilience.
Recognising education improvement or innovation in the fields of: Programme design, delivery, assessment, and accreditation; professional development, skills maintenance, and practice standards, including community education; and research and/or innovation supporting evidence-based practice. When making their submission to this category, each service is challenged to explore areas where improvements have been made in staff development, and how these resonating changes have improved the evolution of paramedicine.
Previous submissions include Graduate Ambulance Paramedic Improvement, Shocktober and COVID-19 Surge Workforce.
Ambulance Victoria
Team: Matthew Humar, Dr David Anderson, Bart Cresswell, Toby St Claire, Andrew Keenan
Ambulance Victoria’s (AV’s) Quality and Patient Experience (QPE) Division is committed to looking after patients, staff, and volunteers through learning from and sharing patient care stories and experiences. AV’s ‘Points of View’ Clinical Discussion and Learning Series helps build a culture of continuous learning and safety for staff and volunteers to speak up and participate in open and transparent conversations around patient safety. Traditionally, communications around clinical review learnings had occurred through written documents, email updates, and content on Workplace (AV’s internal social media platform), supported by education delivered by senior operational leaders and managers. AV identified an opportunity to be more proactive and interactive.
The Patient Review Team (part of the QPE Division) recognised it could engage more deeply and transparently with staff and volunteers through relatable, helpful, and accurate topics on patient care, and by providing opportunities to ask questions, access resources, and encourage and support extended insights.
To achieve this, the project team proposed a new approach to clinical learnings – the ‘Points of View’ Clinical Discussion and Learning Series, which would:
• support existing communications and education.
• qualify as professional development.
• occur regularly (at least quarterly).
• be accessible through an engaging multi-media platform.
• focus on topics/themes informed by AV’s patient safety data, as well as best practice benchmarks, latest research, and staff and volunteer requests.
• engage AV staff and volunteers in the learnings associated with quality reviews.
• give a voice to operational staff and volunteers involved in clinical cases with adverse events and meaningful organisational learnings.
• enable staff and volunteers to directly share personal and professional learnings in a facilitated, supported, and educational space.
• empower operational staff and volunteers to role model peer review techniques, authentic vulnerability, and humility in leadership, fostering a culture of patient safety by levelling hierarchical relationships between operational, quality review and senior operational leadership staff and volunteers.
• welcome matter experts from outside AV to share best practice and the latest research.
The series enables peer-review, panel-style, collaborative discussions of case learnings. Staff and volunteers can directly contribute to and lead the conversation, share thoughts, questions, and feedback before, during and after events, and access recorded sessions they were unable to attend live.
Significantly, staff and volunteers can now directly contribute to organisational clinical development goals.
Throughout 2021 and 2022, the Medical Directorate introduced two new modes of sharing changes in clinical practice:
Ambulance Victoria (AV) has introduced new ways to inform and engage operational staff and volunteers in changes to Clinical Practice Guidelines (CPG). Over the past two years, AV has produced and shared podcasts and video recordings to enable and support paramedics to stay abreast of evolutions in guidelines, in a way that complements existing communications (such as email updates) while providing them with the information they need to provide Best Care to AV’s patients in a more succinct, dynamic and engaging way.
In recognition of the variety of ways people learn (not just through written communications or formal education), and best practice in information sharing, AV’s Medical Directorate team, which is responsible for keeping staff and volunteers updated about CPG changes, identified new approaches to share with paramedics the information they need to perform their role.
• Walkthrough videos to mark each CPG update: short, simple, plain language ‘explainer’ videos that walk paramedics through the intended use of a CPG.
• Podcasts providing more in-depth discussions about clinical changes, featuring interviews with relevant experts.
Podcasts are popular in medical and clinical fields, as they open up a way for people to learn in a non-written way, and at times when they can deeply engage, such as when exercising or driving. Walkthrough (or ‘explainer’) videos are a new idea in healthcare education, and are a great way to convert complex clinical information into bite-sized content, enabling them to be delivered succinctly and, importantly, in a timely manner.
These resources enable AV staff and volunteers to learn in their own way, in their own time, and from any location. For example, AV staff and volunteers are able to listen to the podcasts while travelling to and from their shift. This has been particularly beneficial given the variety and number of changes and information that paramedics continue to be required to absorb during the ongoing COVID-19 paramedic.
Ambulance Victoria (AV) has transformed professional development for paramedics with the introduction of multi-modal learning. As part of this new approach, in 2022, a Continuing Education package included improved tailored education to uplift responses to family violence, child safety and victim survivors. AV responds to thousands of cases of family violence and child safety every year. Paramedics are often the first professionals to speak with a victim survivor about their experience.
The FVCE online and face-to-face modules focus on:
• Providing patient-centred care for those at risk and experiencing family violence.
• Strengthening staff and volunteer knowledge and capabilities in identifying and responding to different types and presentations of family violence.
• Using a standardised assessment tool and evidence-based risk factors to assess risk and appropriate care pathways.
• Greater understanding of liaising with other services such as Victoria Police and hospitals to provide the best care pathway.
• Understanding safety risks and trauma-informed approaches, so paramedics feel confident in the care they provide, and minimise the potential for a traumatic experience and moral injury.
The training package is part of the AV Continuing Education program undertaken by all AV current paramedics and first responders. This innovative training package blends online learning content reinforced by scenario-based face-to-face learning.
The online learning modules offer comprehensive family violence content tailored for the operational pre-hospital care environment. The face-to-face content is scenario-based learning, with case studies/scenarios drawing on common presentations to AV of family violence. The scenario-based learning approach unpacks complex family violence presentations requiring learners to use family violence screening questions and assess risk and treatment approaches.
Team: Mike Richer
Health services have faced challenges in maintaining their clinical workforce in the face of challenges such as the COVID-19 pandemic. In addition, government responses to health service challenges can result in workforce enhancement requiring fulfilment within defined timelines. The ability to facilitate a short-term surge in the clinical workforce, while maintaining a high standard of foundation education and not adversely impacting standard supply pathways, requires an innovative approach. The NSW Ambulance Post-Employment Tertiary Pathway is an innovative solution to workforce surge challenges addressing these elements.
NSW Ambulance, in collaboration with University of Tasmania and Charles Sturt University developed a professional paramedicine employment pathway to compliment the Graduate Paramedic and Credentialling or Qualified Paramedic employment pathways. This program has an emphasis on progression and development of the clinician in the clinical and operational environment utilising an employment pathway.
After consultation and analysis with tertiary partners, there were two post-employment tertiary pathways established and a further sub pathway to increase the accessibility to the program and career pathway in paramedicine. The two core pathways are standard arm and nursing arm. It was recognised that there is an experiential difference between a registered nurse and other occupations with respect to a transition to paramedicine and therefore, an identified need to ensure we met the learning needs of both these pathways.
This program has been achieved by detailed planning, mapping and collaboration and is a true reflection on how public sector and tertiary education sectors can partner to deliver a world class program that provides an opportunity for career development and professional levels of care to the community of NSW.
Historically the supply of paid ambulance personnel has been greater than demand within Hato Hone St John, enabled by a stable supply of suitably qualified volunteers and an excess of Paramedic graduates from universities. As part of a project to double crew all emergency ambulances, from 2016 – 2021 Hato Hone St John increased the number of paid ambulance personnel from 1,161 to 1,678 which both consumed the available volunteer workforce, and created a workforce deficit of approximately 10.4% (or 11.4% when only considering the second crew component of Emergency Medical Technician (EMT) and Emergency Medical Assistant (EMA) positions).
At the emergence of COVID-19, Hato Hone St John anticipated a significant impact on our workforce, preparing for large scale loss of staff through direct effect of the virus. While these concerns were not fully realised, the wider impacts of COVID-19 were. These included a higher workload and associated increase of staff fatigue. When the requirements of Paramedic Registration and workforce attrition were coupled with the gaps created in our workforce by unfilled newly funded roles, the need for improved workforce pipeline was solidified. We elected to look within the organisation and create a vocational pathway to complement the existing academic pathways from tertiary providers.
By introducing a full-time Residential Emergency Medical Technician (EMT) programme, during the COVID-19 pandemic, Hato Hone St John was able to increase the availability of suitably qualified ambulance personnel. These cohorts targeted the recruitment of existing volunteer personnel and members of the public who were interested in working on frontline emergency ambulances. The Residential EMT Programme was launched in September 2021 with an initial 69 new recruits over four cohorts. This was followed in March 2022 with a further 124 new recruits over four cohorts. As of February 2023, a total of 163 new EMTs had graduated the Residential EMT Programme, reducing the second crew vacancy across Hato Hone St John to 3.2%.
Currently, 9.9% of all the paid frontline ambulance roles at Hato Hone St John (across all practice levels) have originated from the Residential EMT Programme, which is an outstanding achievement for those involved in bringing this project to fruition. Not only did the Residential EMT Programme exceed expectations for the numbers of successful graduates, but it has become an integral part of our range of initiatives to ‘turn-the-tide’ of wider workforce challenges.
The SAAS Gender Transition and Affirmation Procedure was released in August 2022. This procedure outlines the roles and responsibilities of executives, managers, and staff when a staff member wishes to undertake gender affirmation in the workplace. The procedure has also been designed to be flexible, in order to meet the needs of the individual, as no gender affirmation process is the same.
A number of supporting resources were also developed to provide more in-depth direction on certain topics. These include:
• A Plan template. This is intended to assist a staff member and their manager to discuss the affirmation process in a structured way. This ensures that all parties have a shared understanding of what will happen, when it will happen, and what supports are required.
• A guide to changing name and gender at SAAS. This guide provides the staff member with information to assist them to update their details where required, for example, on their uniform, in their email address and across rostering and HR systems.
• A guide for how to announce a staff member’s transition. Should the affirming staff member seek for their manager to announce changes to the rest of the team/workplace, this guide provides tips and a template for how this may be done.
• A checklist for managers. This is an overarching list of key steps that a leader can take to ensure that they are appropriately supporting their affirming staff member. The launch of the procedure also coincided with awareness building training for leaders. This was delivered by an expert facilitator with lived experience as a trans person. The purpose of this training was to provide leaders with an understanding of different gender identities, language and terminology, and allow them to ask questions in a safe, supportive environment. This training was delivered live but is also available as an eLearning module for any staff member who would like to improve their gender diversity awareness.
Specialising in Infection Prevention and Control (IPC) has traditionally been the remit of nursing and hospitalbased settings; however, COVID-19 highlighted the need to expand IPC knowledge and expertise into other nonhospital organisations, especially ambulance services. Healthcare-associated infection (HAI) affects nearly one in 10 patients and puts healthcare workers at risk, so breaking the chain of infection in the face of such a highly contagious and deadly novel virus as COVID-19 became critical to St John Western Australia’s (SJWA) 8000-strong workforce.
Over the course of the pandemic, SJWA recognised the need to build IPC capacity and capability in the frontline workforce to support the organisation’s IPC Specialist who was continually engaged in various department/staff requests for assistance. In WA alone there have been more than 100 clinical updates since the pandemic began, not including the numerous national documents and guidelines, as each hospital has its own procedure which frequently changed, as well as non-health organisations such as residential aged care facilities, ports, airports and quarantine hotels. The early guidelines were often hospital-centric and needed reworking for emergency services, while SJWA was also hampered by unsuitable personal protective equipment and sanitisers due to supply shortages.
As staff shortages and competition also proved a problem, Clinical Services created the IPC Champion program to establish mentorship and training in developing frontline IPC champions/advocates. Due to the success of the IPCC program, which ran from November 2021 to December 2022, it has now been supported to continue over the next five years.
The IPCC program consists of a four-month secondment in Clinical Services to work alongside the IPC Specialist to increase the champion’s IPC knowledge and skills, which are then transferrable to their clinical area and other business units. Individuals working in this role become an advocate for IPC and receive a fully paid scholarship for the completion of the Foundations of Infection Prevention and Control course facilitated by the Australasian College of Infection Prevention and Control. The role, along with SJWA’s IPC Specialist, provides one-to-one mentoring and support to improve patient and staff safety outcomes through IPC quality initiatives. The program has supported the development of three champions (all frontline paramedics), as well as one Clinical Quality Manager and one Clinical Program Coordinator to complete the FIPC course to assist with embedding best IPC practice into the Clinical Services department and across all education programs.
Team: Ols Duerr-Reuther
NSW Ambulance has developed the Statewide Mechanic Training Program as an initiative in excellent staff development. The training program improves service, maintenance and repair training for the specialised staff entrusted with keeping the organisations 1721 ambulance vehicles and related equipment in top working order and allows these workers the opportunity to develop professionally.
The training program was developed in response to a NSW Health People Matters Employee Survey result which showed concern among mechanics that training, and vehicle maintenance was not consistent across the state. The NSW Ambulance Statewide Mechanic Training Program provides comprehensive training to every employed mechanic within a defined time to enable consistency of fleet vehicle knowledge and skills at a single point in time. Previously, the training only occurred at commencement of employment or ad hoc to communicate a change in vehicle manufacturer’s servicing requirements.
This program enhances the skills and knowledge of our mechanic workforce which is charged with the enormous task of keeping a fleet of more than 1700 vehicles operational and on the road, covering an area of more than 800,000sq kilometres.
The new training also enables mechanics based throughout metropolitan and regional NSW to meet each other in person, share information and create a value-adding team network that is providing ongoing peer support and knowledge sharing.
Feedback prior to the delivery of the training was that there needed to be better communication with mechanics on vehicle and equipment repairs and services, along with an overview of the build layouts for any new vehicle models. The training established a clear and consistent baseline of requirements and processes for all staff involving the servicing and repair of the Mercedes Sprinter ambulance and the Stryker and Ferno stretchers.
The training also provided an overview of the new Toyota 200 Series LandCruiser 4WD ambulance commensurate with the rollout of this new vehicle. The program was delivered over four days and facilitated to groups of no more than 12 to ensure strong team dynamics and input and understanding and hands-on experience throughout the session. Each participant completed a feedback survey at the end of the training, with 99 per cent of the total session-related training outcomes being viewed favourable by the training participants.
Team: Dr Andy Swain, Dr Dave O'Byrne, Matthew Stuart
The Wellington Free Ambulance (WFA) podcast is a new and exciting project that aims to provide valuable information and insights for the ambulance community. The podcast is dedicated to educating frontline staff on the six-monthly Clinical Practice Guideline (CPGs) updates and delivering the latest developments in pre-hospital care. Through a series of engaging and informative episodes, the podcast aims to give listeners an alternative learning platform that allows for flexible learning whether at work or at home.
The podcast is hosted by the clinical CPG lead and is joined regularly by Wellington Free Ambulance’s two Medical Directors, Dr. Andy Swain, and Dr. Dave O’Byrne who bring a wealth of knowledge and expertise to the show. Each episode features interviews with paramedics, other medical professionals, and experts in related fields. These interviews provide listeners with an in-depth look at the challenges and rewards of working in the ambulance service, as well as the latest developments in emergency medical care.
In addition to interviews, the podcast will also feature segments on a wide range of topics, such as the new CPG updates, the latest medical research, new technologies, best practices for treating patients, and organisational updates via our Chief Executive Officer (CEO) Dave Robinson.
The Wellington Free Ambulance podcast is not just for paramedics on the frontline. It's also for WFA staff who work across multiple departments and are interested in pre-hospital emergency care, public health and safety, and the work of ambulance services. The podcast is designed to be accessible to a broad audience, and the team behind the podcast is committed to making sure that the information is presented in an engaging and easy-to- understand way.
St John WA
Since 2021 St John WA (SJWA) Deputy Medical Director, Dr Gayle Christie (now Medical Director), has worked with the Critical Care team to develop a robust and comprehensive internship program which is contemporary in design and firmly grounded in the most current evidence base. The primary objective was to develop and expand SJWA’s Critical Care capability aboard the RAC Rescue Helicopter, with a view to expand the capability to on-road.
The internship starts with a robust recruitment process involving a physical and a clinical competency assessment, as well as a behavioural-based interview utilising a Behavioural Competency Framework developed in consultation with an organisational psychologist. This is to ensure the most appropriate and well-rounded candidates get selected for this challenging role. Successful candidates are allocated a mentor from the Critical Care Paramedic (CCP) cohort, and have regular structured mentor reports to complete in order to set and achieve individual goals. Within their individual professional portfolio they complete six-monthly self-assessed skills competency assessments, logbooks for ultrasound (USS) and anaesthetic placements, work-based assessments comprising Direct Observation of procedural Skills, mini Clinical Evaluation Exercises and Case-based Discussions. They also have annual Personal and Professional Development Reviews with the Medical Director.
The curriculum is structured to reflect the content and requirements of the Australasian College for Emergency Medicine Diploma of Pre-Hospital Retrieval Medicine in order to prepare the SJWA CCPs for when this is hopefully opened up to non-physicians. It is split into six-month modules and comprises didactic lectures, workshops, case-based discussions, practical SIMEX sessions, clinical exposure, bespoke Human Factors training, aviation physiology and structured hospital placements in anaesthetics, USS, intensive care (ICU), paediatrics and the emergency department. At the end of every six-month module CCP interns undergo a written and practical assessment followed by a panel review of their progress with the CCP Manager, Medical Director and their CCP mentor. As of January 2023, SJWA has started to develop an online platform that will act as a curriculum repository and will be presented in a format similar to many online Masters programs.
Recognising patient experience, improvement, or innovation. When making their submission to this category, each service is emboldened to examine ways that their organisation has assisted specific patient cohorts where learnings were of benefit to the field of paramedicine.
Previous submissions have included Clinical Response to a Global Pandemic, Virtual Emergency Medicine and assisting high frequency 000 callers.
Team: Nick Coley, Mark Cribbens, Malcolm Kendall, Kwan-Lyn Lim, Jess Verdon
Life expectancy for M–aori and Pasifika is significantly less than the general population of Aotearoa (New Zealand). M–aori and Pasifika are also much more likely to die from a heart attack or stroke. Hato Hone St John’s overarching strategy, Manaaki Ora, identifies working towards health equity as one of our five strategic aims.
What is Manaaki Mamao: It is our proactive digital telehealth service, designed around M–aori and Pasifika patients. It takes a culturally competent, people led, and technology enabled approach to addressing health inequities. It is inclusive by design and allows patients to manage their health conditions from the comfort of home and with family support if desired. Our initial focus is on hypertension (high blood pressure) given its relationship with heart attack and stroke.
Manaaki Mamao focuses on the partnerships between four key parties:
• All care centres on the patient and wh–anau (family), as M–aori and Pasifika are a collective rather than an individual-based society and it is important to create opportunity for family involvement.
• Hauora (M–aori health) or mainstream healthcare providers own the relationship with the patient and refer them to the service. Providers receive regular trend reports for each enrolled patient and are notified when follow-up is required
• Hato Hone St John is the link between the patient and the hauora / healthcare provider including onboarding, installation, and training. Our clinicians, who are qualified paramedics, provide regular wellbeing and clinical care; monitoring of vitals; and emergency escalation if required
• Spritely provides locally based software co-designed with people who struggle using technology. Our national footprint and infrastructure combined with hauora / healthcare providers’ strong local community connections creates synergies and drives enhanced health outcomes for M–aori and Pasifika. Within our team, cultural competency training is carried out as part of the induction process when new staff are onboarded. We believe this makes a difference and helps gain the patient’s trust and engagement.
Manaaki Mamao successfully launched in December 2021 with funding from the Ministry of Health. Initial results are promising:
• A high percentage of patients recording a reduction in their weekly recorded blood pressure and positive lifestyle changes
• 93 patients referred from their GP
• 17 interventions/referrals to other health services
• Feedback from patients using the service is they value being supported in this way.
Team: Alex Thompson
Mater@Home Direct is a collaborative health navigation initiative, developed with the Queensland Ambulance Service (QAS) Clinical Hub and Mater Hospital in May 2022. The initiative provides a referral pathway for Triple Zero (000) callers that require non-acute health interventions within a 24 hour period, and considers the social needs and care access requirements of the patient, initiating a rapid response in the client’s home. As a result of this innovative pathway, several emergency department presentations have been avoided, reducing demand on the wider healthcare system. Mater@Home Direct consists of a multidisciplinary team of Senior Medical Officers, Clinical Nurses and Allied Health team members who ensure a comprehensive clinical review same day, or multi-day interventions with follow-up and discharge planning, in response to a QAS referral.
This project has a binary purpose. Firstly, the innovative concept is designed to provide high quality assessment and care to non-urgent patients which can be safely managed within their own home, that would otherwise result in an ambulance transfer to an emergency department. This joint initiative between the QAS Clinical Hub and the Mater@Home Direct Team can provide tailored resources in a timely manner to multiple vulnerable patients, providing better outcomes for the Queensland community. The second aim is to empower the consumer by improving their health literacy and care experience in accessing quality care, equipped to support their social care needs in their own environment.
Team: Les Drayton
Ambulance Transport Assist COVID (ATAC) was implemented to combat the rising positive COVID patients within the community of SA and to reduce the use of Stretcher Fleet. The opening of the SA borders at the end of 2021 was going to increase our COVID cases here in SA. With this it was going to put extra strain on the Ambulance Service and SA Health. The request to implement a COVID Transport within SAAS was put forward to ease the workload on an already stretched service.
This project had a huge impact on easing the stretcher bearing Ambulances with them not being tasked to stable COVID patients that still required secured escorted transport around the state of SA. This allowed our ambulance operational crews to be tasked to higher level care taskings.
A work group was formed to work on solutions to combat the rise in COVID cases expected to make a huge impact in SA when the borders opened. Within three weeks, ATAC was operational. SAAS engaged Flinders University students to undertake the driver/ clinician role, an ambulance station was identified to dispatch from, vehicles organised including installation of MDTs, radios, pagers and mobile phones. Also, within these three weeks, the students were trained for driving a SAAS vehicle, PPE and general operations. ATAC commenced on 13 December 2021.
By introducing a Paramedic Telehealth Clinician (PTC MH) with additional Mental Health training and experience within the Clinical Telephone Assessment (CTA) team, SAAS aims to improve mental health consumer experience and mental health outcomes by providing more timely access to mental health assessment and/or intervention, in the most appropriate setting, for a person accessing Triple Zero (000) in crisis.
This will be achieved by providing secondary triage and telehealth assessments of suitable mental health cases pending in the community with newly granted access to various Community Mental Health databases supporting the Clinician’s decision making.
The PTC MH will provide mental health telephone triage services within the framework of the National Mental Health Policy and the Standards for Mental Health Services and in a manner consistent with the stated Vision and Values of SA Ambulance Service.
Aim:
• Improved patient care by delivering safe, high quality mental health telephone assessment, intervention when necessary in the most appropriate location following with suitable referral to care pathways.
• Ensure consumers identified as high risk during secondary triage receive urgent ambulance response via priority upgrade.
• Demonstrate a more streamlined and informed approach to emergency responses through sharing of ambulance and mental health databases and networks. Providing advice to ambulance crews on relevant mental health history, assessments and referrals will support actions or interventions aimed at safety and optimum mental health outcomes.
• Triaging of mental health related calls for assistance to increase (where appropriate) referral to the Mental Health core co-response team.
• Triaging of mental health related calls for assistance to increase the referral to alternative care options, for example, community mental health teams and the Urgent Mental Health Care Centre.
• Achieve fewer transports to hospital emergency departments (EDs).
In 2022, St John WA (SJWA) piloted a repeat ambulance caller program, Care Link, to help address the unmet needs of a small cohort of patients who frequently call the ambulance service. An initiative of the SJWA Clinical Services department, Clinical Quality Manager (CQM) and Registered Paramedic Kelly Guest was seconded to lead the development and delivery of the program, working collaboratively with SJWA Project Manager James Knox.
Since Care Link is the first of its kind in Western Australia, SJWA worked closely with interstate ambulance colleagues during the initial phase of development to learn from their experiences with similar programs. Locally, SJWA partnered with the State Department of Health’s (DOH) Complex Needs Coordination Team trialling a co-attendance model and referral pathway. This partnership assisted to build efficiencies into their service delivery and provided both teams with an opportunity for expansion at the completion of the pilot period.
Upholding the Australian Charter of Healthcare Rights, the pilot program addressed two of the eight National Safety and Quality Health Service Standards – Partnering with Consumers Standard and Comprehensive Care Standard. Developed with the patient placed at the centre of their care, the pilot Care Link program is proactive and considerate in its management of repeat ambulance callers and avoids engaging in historically punitive and paternalistic conventions.
With wider organisational pressures restricting the timeframe to deliver the pilot program, case management was provided to a total of seven repeat callers, with their enrolment in the program staggered to allow for optimal resourcing. Overall, a 40 to 70 per cent reduction in ambulance activity was noted in six of the seven clients enrolled, as one client discontinued their enrolment and support service engagement. The pilot period ended in September 2022 and SJWA has begun work to implement the program permanently.
AV has complied with new timelines and followed the requirements set out in the Victorian Duty of Candour Guidelines (legislative instrument), as outlined below.
In late August 2022, Safer Care Victoria (SVC) advised Ambulance Victoria (AV) that changes relating to open disclosure requirements would come into effect on 30 November 2022, in line with the introduction of the newly legislated Victorian Statutory Duty of Candour.
AV’s Patient Safety and Experience team responded swiftly to considerately introduce the Victorian Statutory Duty of Candour into AV’s Patient Safety Incident Management system.
The Victorian Health Legislation Amendment (Quality and Safety) Act 2022 introduced new reforms and amended existing Health Acts. Under the changes, health services were required to provide a patient with a Statutory Duty of Candour if they had suffered a serious adverse patient safety event (SAPSE) while receiving health care. AV is required to provide the patient, and/or their next-of-kin/carer, with:
• Written accounts of facts regarding the SAPSE.
• Apology for harm suffered by the patient.
• Description of AV’s response to the event.
• Summary of steps AV has taken to prevent reoccurrence of event.
• Apology provided to patient/next of kin/carer within 24 hours of identification of a SAPSE.
• Duty of Candour meeting within 10 business days of identification of a SAPSE with the patient/next of kin/ carer (to provide apology/discuss incident).
• Review and report of the SAPSE provided to the patient/next of kin/carer within 50 days of identification of a SAPSE.
Team: Natasha Krajcar, Ariana Carrodus, Natalie Bemrose, Nicola Reinders, Lindsay Mackay, Diana Zimmermann, Gareth Becker, Larissa Walsh, Ange Iliopoulos, Amanda Thornton, Lina Hawi, Aidan Hill, Melanie Burns, Brent Driscoll, Rob Lasslett
In 2022, Ambulance Victoria’s (AV) Patient Care Academy (PCA) initiated a program of work known as AV Care Connect to introduce alternative care pathways to better connect patients to clear-cut care specific to their needs, and to avoid unnecessary ambulance transportation.
To address patient care efficiencies, the first pathway AV introduced was the Residential Aged Care Enhanced Response (RACER) pathway. This aimed to better connect and coordinate Triple Zero (000) calls made from residential aged care facilities (RACFs).
This priority was informed by extensive data analysis of dispatches. In early 2022, daily data demonstrated that approximately 85 emergency ambulances attended to patients in RACFs, equating to roughly 5% of all emergency ambulance dispatches made by AV. Up to 40% of those patients transported to an ED did not need to be and returned home without admission.
Additionally, a comprehensive review found that following transfer to hospital, a significant proportion of aged care residents experienced increased rates of pressure ulcers (19%), delirium (38%) and a three-fold rise in hospital acquired infection. The team recognised that avoiding unnecessary transfer to hospital EDs was deemed vital in reducing the increased risk of morbidity, hospital re-admission and preventable death in elderly patients.
RACER was therefore developed to apply the existing Victorian Virtual Emergency Department (VVED) infrastructure to connect eligible patients to a specialist emergency telehealth service.
Eligible patients, as of December 2022, include patients residing in RACFs triaged as not needing an emergency ambulance. The pathway relies on AV's Triage Practitioners (TPs) to refer these eligible low acuity patients directly to the VVED when the RACFs Residential In-Reach (RIR) or the patient's own General Practitioner (GP) are unavailable.
In the first three months of its operation, AV’s TPs referred 641 patients to RACER. Of those 641 patients, 448 (70%) were able to safely remain in their home environment or be referred to an Alternative Service Provider (ASP). Daily referrals to ASPs have more than doubled since RACER’s introduction, from an average of three to eight cases per day. Based on this trend, RACER is projected to reduce unnecessary ED presentations by over 2,000 cases annually, and more as the RACER pathway expands to include additional patient cohorts.
As of January 2023, AV has commenced recruitment of an aged care specialist to work alongside TPs, providing capability building and advice to better connect patients to the right care.
Team: Lianne Pepperell, Olesya Zaglyadimova
Hato Hone St John has seen an increase in complex need cases, including frequent callers, patients across the continuum of mental health and mental illness, and vulnerable people experiencing domestic abuse, neglect and social vulnerability.
Due to the sensitive nature of these cases, types of referrals required, and increased documentation (including outcomes and community care notes), it became apparent that our previous patient report and referral approach was not fit-for-purpose. Having the ability to clearly document the care provided and interventions completed, not only gives the ability to recognise patterns in calls, but also identifies failed referral outcomes, frequent abuse referrals and gives a clear history.
For the twelve-month period of January 2022 to January 2023 there were 6,176 referrals generated by our road ambulance personnel, including 813 vulnerable persons referrals (or approximately 68 cases per month). Within the New Zealand health context, vulnerable persons referrals for patients aged between 18 and 65 are managed in primary care, therefore 34% of referrals were being made to General Practice, with no robust way for Hato Hone St John to share information with GPs.
In 2022, Hato Hone St John introduced My Practice to manage patient information and document clinical notes, augmenting existing patient reporting. The tool introduces the ability to refer to external providers and share critical information with existing healthcare providers.
Since the implementation of My Practice in July 2022 we have been able to provide secure messaging to and from GPs and allied health providers. The tool has enabled communication between the ambulance service and primary healthcare services. My Practice has been pivotal in allowing the addition and review of patient clinical notes for our vulnerable person’s referrals.
The benefits include:
• Seamless transition of care between providers.
• Alignment of data sharing practice to other providers of allied health.
• Record of referrals and interventions against a patient’s National Health Index number (NHI).
• Secure messaging to and from providers ensuring patient privacy.
• Secure clinical notes for every interaction.
• Ability to see previous interactions and any alerts.
Team: Melissa Robinson, Dr Andy Swain
Interhospital telestroke has been used in New Zealand's Central Region to allow Wellington stroke physicians to provide remote assessment and care to acute stroke patients presenting at other hospitals since 2016. It has been shown to increase reperfusion rates and reduce door-to-treatment times. In 2019-2020, Wellington Free Ambulance (WFA) participated in a pragmatic, community based, cluster randomised controlled trial with the University of Otago. This study applied telestroke to the prehospital environment and showed that it was safe, highly accurate and achievable. It provided strong evidence to support all frontline ambulances in the Wellington Region becoming mobile telestroke units (MTUs) providing an opportunity to build a model of care that crosses traditional organisations/sector boundaries.
The MTU system has opened opportunities for further enhancements to stroke care and reduced the time to reperfusion for these patients. Further studies are planned to evaluate the outcome from these improvements and build a system that brings together the efforts of ambulance and hospital staff to the benefit of stroke patients.
Key aims of the project include:
• Implementation of a prehospital telestroke system (MTUs)
• Improvement in diagnosis and exclusion of patients with stroke mimics
• Direct transfer of patients to computed tomography (CT)
• Paramedic access to specialist medical guidance to improve stroke care
• Enhanced education for paramedics
• Establishment of a district hospital bypass system for likely SCR patients.
Recognising management practise and operational improvement and innovation in: Management culture, open communication, accountability, management development, professional standards, and diversity of workforce; and operational protocols and work practices relative to how service delivery is provided.
When making their submission to this category, each service is encouraged to analyse the programmes they have implemented that paves the way in leadership for future generations.
Previous submissions have included National Safety & Quality Health Service Standards programme, the Double Chewing Project and the use of intentional leadership and Incident Management Systems to lead an organisation through the COVID-19 pandemic.
by
Team: Cassandra McKenzie, Joe Acker, Jordan Emery
Ambulance Tasmania is a dynamic organisation, growing rapidly in the context of dispersed geography, significant increases in operational demand, an incongruent growth in the maturity of systems and a strong sense of passion, community and commitment amongst its operational workforces. Operational Readiness and Transformation (OR&T) is a program of work which centres on the mechanisms required to effect meaningful change in a challenging, high tempo operational environment and which focuses on building the structural elements of teamwork, transparency, collaboration, staff recognition & support and functional harmony for Ambulance Tasmania. Based on a corporate structure of shared services, the utility in undertaking a program like OR&T is the ability to leverage appropriate stakeholders without overwhelm, to exemplify, build and create a culture of shared leadership & knowledge expansion and to build and promote sustained high performance of Ambulance Tasmania operationally and culturally. Supported by adjacent strategic plans including the Cultural improvement action plan, and the refresh of Ambulance Tasmania’s strategic plan, OR&T defines the required activities from inception to benefits realisation.
The importance of systems to reduce the likelihood of error, to create purposeful and repeatable outcomes and to support the welfare and practice of our staff is reinforced by the nature and intent of the OR&T program. Beginning with the Communications Centre, what became obvious for Ambulance Tasmania was multiple occasions where systems of operation worked well unilaterally, with little evidence of face value integration.
Researched examples personified a distinct lack of ‘leaning in’ with an immense draw on the role and function of the Emergency Medical Dispatcher as the orchestrator of all things dispatch – and whose role has come to symbolise the harmonisation of all operational systems at a central point of intersection.
What was required was that each system needed to understand and be aware of how its neighbour systems operated, so leaning in could be achieved at appropriate times and in appropriate ways. This was noted to occur because of high levels of altruism and commitment amongst staff, which was at times poorly controlled by the systems employed to support the overall function of operations and service delivery. This led to duplication and isolation for some regions of AT.
The OR&T program also provides, by nature of its implementation, a significant opportunity to focus on and improve the safety, quality, and performance of the Operations Leadership team as a pivotal interface with patients, their families, and our partner agencies.
In New Zealand, the first COVID-19 case was reported on the 28th February 2020, with a state of National Emergency declared on the 25th March 2020. Globally, there were many learnings from how different countries responded to this pandemic. But, in its early stages, one of the consistent issues was the lack of availability of personal protective equipment (PPE) to protect people working in healthcare.
In June 2020, the office of the Auditor-General released its report on the Ministry of Health’s Management of PPE during the early stages of New Zealand’s response to COVID-19. The report makes clear that stocks of PPE held in NZ were inadequate during this initial period. Hato Hone St John (HHSJ) also encountered similar issues noting shortages in PPE exacerbated by high demands in other countries leading to breaks in the supply chain. This meant that protecting our people required an innovative organisation wide solution supported by good change management to imbed change in practice. We needed to understand the supply chain landscape, stock holding and derive a strategy to optimise available PPE supplies. Throughout the COVID-19 response, we demonstrated iterative improvement to processes to improve supply chain efficiency.
The National Crisis Coordination Centre (NCCC) –Logistics Manager enlisted a cross-functional team to support the response. The team was set up to discuss issues, ideas and test solutions to proactively manage necessary PPE equipment for the safety of our people and patients. We also mobilised internal corporate teams affected by the lockdown to set up a distribution chain. Typically, our supply chain is paper-based, which creates disjointed data systems that lead to information silos. This has led to an inability to track and visualise critical stock holdings across the organisation. We improved:
• The collection of PPE stock data,
• Supplemented the analysis with clinical and response data to create meaningful/proactive reporting.
• Attitudes and altered behaviours of corporate and operational staff to actively support, trust clinical PPE standards, demands and logistical requirements.
We applied modern supply chain methods with change management of personnel to create a unified collection and use of data to quickly respond to the ever-changing response environment presented by COVID-19 and understand how behaviour can drive PPE usage. The information gathered and reported also allowed for best practice of PPE to be reinforced where required to our staff to make it safer for all.
The Remote Area Access Training program was developed to meet the demand for remote area cases received by St John NT paramedics operating in the Southern Region of the NT.
Southern region coverage extends throughout Central Australia with the township of Alice Springs providing primary road services for up to 150km from the CBD.
Cases outside this limit are managed on a case-by-case basis involving collaboration with other emergency service agencies dependent on location, appropriateness and availability. Once outside the immediate town limits of Alice Springs, the remote setting of operational cases has proven to present a unique set of challenges that require specialised training and response.
The Larapinta Trail, part of the Northern Territory Parks and Wildlife Commission, was identified as a frequent remote access location that St John NT responds to. The Larapinta Trail has quickly emerged as one of the most popular trails in which to trek in Australia and as such its popularity has led to an increase of hikers of up to 5000 each year. The increase in traffic has led to an increase in calls for service to St John NT by both experienced and inexperienced walkers.
The trail covers 231 kilometres along the West McDonnell Ranges and runs from Mt Sonder through to Alice Springs. The terrain is rough, remote, very steep and subject to harsh weather conditions with little vehicle access and is ranked as a moderate to difficult (Grade 4 or Grade 5) hiking trail. This means that walkers should have a moderate to high level of fitness, should have bushwalking skills or be highly experienced with excellent navigation skills.
St John NT Alice Springs’ staff routinely attend incidents in remote areas that have difficult access. This raises a number of health and safety risks which were identified by staff and management. Such risks include injuries from prolonged hiking in difficult terrain, load bearing injuries from equipment carried and extrications, not having task specific equipment or safety gear, dehydration, exposure to extreme temperatures, movement at night, poor signage/pathways – getting lost, lack of skills or equipment to navigate, personal health and fitness, food, water and shelter, poor or no communication and also the need to maintain regular services to the community during these protracted cases.
In identifying these risks to staff and patients the need for remote area access trained paramedics was identified and the necessary training program was developed and implemented.
Team: Nicholas Ridley, Kate Worthington, Chris Matthews, James McGregor, Stuart Glover
Beginning in 2020, Wellington Free Ambulance (WFA) and the New Zealand Police (NZP) conducted a 2.5 year long joint initiative. This pilot program involved the founding and development of a Tactical Emergency Medical Support (TEMS) team for deployment to highrisk environments by both ambulance and police. Throughout the trial the TEMS team consisted of 2-3 Paramedics with supporting management and logistical staff in WFA and NZP. To facilitate rapid response, real time intelligence updates, technical skill maintenance, and high-performance interoperability, TEMS staff were embedded fulltime with the NZP Special Tactics Group (STG). The team worked and trained alongside STG on a daily basis and were able to move freely between ambulance and police databases and radio frequencies. TEMS was deployable by both organisations and maintained an on-call capability outside of standard work hours.
The team also frequently worked alongside a number of other specialist teams from within Police, New Zealand Defence Force, Fire and Emergency New Zealand, and other government agencies. Due to the embedded nature and small size of the team, TEMS staff were able to develop a wide range of capabilities.
These included but were not limited to tactical operations, active armed offender response, hostile crowd operations, siege/hostage rescue support, hazardous materials (HAZMAT) response, airborne/ maritime deployment, remote medical care, and training provision. The TEMS team was deployed to a wide range of high-risk situations and took part in a number of high profile events during the trial. At the conclusion of the pilot, it was agreed by both WFA and NZP that the TEMS team was a highly valued asset, and that the trialed model was successful.
The aim of the Patient Incident Analysis Framework was to identify current barriers to reporting patient incidents and determine possible solutions in line with what is best practice. Furthermore, the objective of the project was to identify a strategy for reinforcing the benefits of patient safety incident reporting, consistent with the goals and measures of the quality and safety strategy outlined in the Peter Hibbert Report of 2018.
When there is a potential risk to a patient's safety, it is important we know we are taking the right measures to address it, now and in the future. Incident management helps those responsible for patient safety to respond and reduce the harm to patients/families and providers when incidents (including near misses) do occur.
The development of a framework within SAAS aimed to improve the reporting culture, provide practical strategies for analysis, resources to manage incidents effectively, develop sound quality improvement initiatives and keep patients safe.
Early access to telehealth assessment, intervention and referral to alternative care pathways for mental health consumers accessing triple zero (000) in a crisis via a Paramedic Telehealth Clinician Mental Health could be introduced across all ambulances
Team: Dave Richards, Dan Spearing, Malcolm (Makorama) Kendall, Robbie Blankenstein, Bridget Dicker, Aroha Brett, Verity Todd
Hato Hone St John is committed to providing an equitable ambulance service for our patients. Furthermore, the organisation is committed to M–aori (indigenous) health equity. To achieve this, we have created a space for M–aori leaders within the organisation to co-lead and provide guidance on important projects that aim to address health inequity. Maintaining the concept of mana Motuhake (selfdetermination) within and also outside the organisation has been and continues to be a crucial success factor. At its core, it aims to follow the needs, aspirations, thinking and knowledge of our indigenous people.
In addition, our Aka strategy (Hato Hone St John’s overarching M–aori health strategy) and Waka Manaaki Plan (delivering the key outcomes of the Aka Strategy in an ambulance context) provide a framework to ensure Ambulance Operations effectively navigates through our journey of becoming aligned to te Tiriti o Waitangi (New Zealand’s founding document), ultimately improving the quality and longevity of health for M–aori.
Projects delivered to improve M–aori cultural competency (Aka Whiri) include:
• Aka Whiri App – an interactive app designed to teach our staff M–aori language, customs and protocols.
• The entire Ambulance Operations Senior Leadership Team and a number of board members completed a full year te reo M–aori course in 2022.
Key projects delivered to improve M–aori Health Equity (Aka Matua) include:
• Waka Rongo–a – mobile wellness units with full cold chain capability to store vaccinations. These were given to two M–aori health providers to operate in rural and isolated areas to facilitate vaccination outreach.
• Whare Manaaki – a video telehealth pilot to help M–aori patients living in rural/remote areas with access issues to primary health. It comprises live video conferencing and real time transmission of vital signs taken by our ambulance officers at the patient's home to referring primary or secondary care specialists or doctors.
• Manaaki Mamao – a telehealth programme for M–aori and Pasifika with uncontrolled hypertension; designed to monitor blood pressure at home with connection via videoconference to our clinicians to provide regular guidance.
• New Waka Manaaki (ambulance) design & Hato Hone St John name and logo – honouring our uniqueness, indigenous peoples and new approach to health access via authenticity, inclusiveness and trust.
• An equity score framework that can be consistently applied to weight the impact of ambulance planning decisions on equitable patient outcomes.
Team: Cameron Edgar
A Review of Ground to Air Radio Communications in Remote Areas was established to identify safe and practical ways to improve radio communications between NSW Ambulance ground and helicopter teams, particularly when winching. This operational improvement initiative was initiated by aeromedical leadership and had clear objectives to ensure the innovation was focused and purposeful to the needs of NSW Ambulance.
NSW Ambulance offers emergency medical response to an area spanning more than 800,000sq kilometres. Within this expansive environment aeromedical services completed more than 13,200 missions in 2021-2022 which included 5,783 fixed wing missions, 4,677 helicopter missions, 2,822 aeromedical road retrievals, 169 winch missions and 59 flood rescues.
In these diverse and challenging response situations, innovating improvements to our operational protocols and work practices fulfills the corporate commitment of offering the right care to the right patient at the right time as well as putting staff and patient safety at the centre of everything we do.
In response to this challenge and to improve safety and workability for our radio communications with crews, NSW Ambulance has applied improvements to our radio communications which greatly enhances operational function and safety.
We have:
• updated all our radio channels in our aircraft as a rapid update
• updated command and control checklists to include increased guidance for communicating in remote areas.
• tested a range of hand signals and hi-visibility gloves that will now be taught and issued to all specialist ground teams
• created a Statewide Telecommunications Group with subject matter experts that specifically looks at remote area communications and new technology.
• drafted a new Remote Area Radio Communications Procedure that will set a new standard and be a benchmark for training and education in remote area communications.
Excellence in leadership has been achieved by identifying and addressing risk, implementing improved operational protocols which improve radio communications in remote areas and linking these improvements directly to improved service delivery in remote situations alongside caring for our people through improved safety for staff and patients.
Team: Nathan Williamson, Benjamin Johnson, Elizabeth Santillan, Susanna Morgan
In recent years, the Queensland Ambulance Service (QAS) has undergone significant change, both internally and in response to complex factors impacting Queensland’s broader system of health care service delivery. These changes have driven our organisation to become more agile and innovative as we explore new ways to meet the challenges and capitalise on the strategic opportunities inherent within our future operating environment, whilst ensuring that our organisation remains capable of meeting the health care needs of Queenslanders. We have expanded our models of service beyond the traditional concepts of an ambulance service, we have found new ways of working, new ways to care for our patients, and new ways to support and develop our people. However, we also recognise that these achievements have been founded on the understanding that to continue to meet patient and community needs will require continual improvement across our organisation.
With this in mind, from 2021-22, the QAS embarked on a process to redefine its 5-year strategy and ensure that the directions required to ensure the sustainable, adaptive, and responsive delivery of contemporary health care to Queensland by the QAS are welldefined and understood by our organisation, and its stakeholders.
This process culminated in July 2022 with the release of the QAS Strategy 2022-2027. While the Strategy is essential towards ensuring the ongoing success of the organisation, it is the process development of the document, which delivered significant, immediate and ongoing benefits to the QAS as a whole.
During three distinct and planned phases: ‘Preparation’, ‘Engagement’ and ‘Implementation’, the development of the QAS Strategy was underpinned by continuous, broad and consistent stakeholder communication and engagement to ensure that the final product delivered a relevant, meaningful and useable plan for the organisation to ensure it remains capable of achieving its Vision of ‘Excellence in Ambulance Services’.
Across this process, from March to July 2022, the QAS engaged on a face-to-face basis with over 2,000 employees and other key stakeholders, holding meaningful discussions to shape the design of the Strategy. This process of meaningful staff led, employee co-design and stakeholder engagement provided a strong foundation to ensure ongoing understanding and alignment of organisation and employee performance as the Strategy is implemented over its five-year lifespan.
First introduced in 2021, this category recognises innovation and excellence a service has provided both staff and patients in improvements in mental health and wellbeing, including programmes, training and support. When making their submission to this category, each service is encouraged to share their undertakings in mental health and wellbeing for all stakeholders in the ambulance sector, including patients, staff, and leaders.
Previous submissions have included Medic Fit, MyPulse Health & Wellbeing programme and Telemental HEaLth Pilot – TeleHELP.
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Team: Kimin Lim
NSW Ambulance has developed a first-of-a-kind NSW Emergency Services, internal staff psychology service. This service reflects that NSW Ambulance is committed to supporting the health and wellbeing of its employees and offers a range of staff support initiatives to help achieve positive mental health and wellbeing. Establishing the NSW Ambulance staff psychology service in 2018 has led to the growth of a strong and trusted team of experts within the organisation’s broader support initiatives.
The staff psychology service provides high quality, evidence-based psychological services and programs to all staff. The organisation’s psychology activities, services and programs aim to help staff optimise their wellbeing, manage mental health risks, identify signs of mental ill health and access best practice intervention.
The staff psychology service has doubled from a team of five to ten internal senior staff psychologists and one chief psychologist. These clinicians are uniquely placed to offer a decentralised model of support which is integrated into how we care for our people. Services include employee counselling, post incident support, wellness checks and advice on employee support.
In 2021/22 the service offered care to 1043 employees referred for psychological support and 597 referrals for trauma support. This builds on strong patronage through the service’s early years. From 2018 to June 2021 the service managed 4358 referrals for individual employee and trauma support, delivering 20,563 support activities. This included 2582 referrals for employee support and 1776 referrals for individual trauma support. In this time the service completed 1467 outreach and promotional activities for staff working across more than 220 sites around NSW.
NSW Ambulance
Team: Elizabeth Simeoli
The workshop delivers strategies and tools for managing staff wellbeing, mental health and resilience, physical health, personal safety and risk, and occupational violence prevention. The strong commitment to improved wellbeing within the workforce will see around 98% of 6700 eligible staff complete the innovative, multi-day workshop by 30 June 2023.
NSW Ambulance covers an area of more than 800,000sq kilometres and is committed to caring for its paramedics, nurses, doctors, control centre and nonoperational staff. The workshop helps those working across more than 220 locations gain simple and powerful strategies and skills that may be implemented in their lives for enhanced health, safety, self-awareness, and overall wellbeing.
The Wellbeing Workshop is presented over three days for operational staff and 1.25 days for nonoperational staff. The workshop is divided into three key areas, ensuring staff are well at work, safe at work and protected at work.
In years where NSW Ambulance has faced record demand, we have held firm on caring for our people and delivered this wellbeing initiative. The workshop is now permanently embedded in inductions for all new staff and has also been adapted into an online learning format, which allows staff to continue to refresh on their Wellbeing Workshop journey.
Post workshop surveys show strong staff support with 84% of staff noting a positive change in their wellbeing and 84% feeling more confident in using their professional judgement around being well, safe and protected at work. These strong results and the internal support for the workshop have drawn attention of other emergency and ambulance services around the country looking for tools to improve the wellbeing and mental health of their people.
Team: Megan Walkley
Supporting all staff in their physical and psychological health has been a fundamental principle of the SA Ambulance Service (SAAS) Peer Support, Employee Assistance Program (EAP) and physical health programs since their inception. The negative effects of COVID-19 upon wellbeing have been broadly documented throughout the pandemic, which informed our organisational direction to proactively tailor the already available support and services provided to our people.
Staff mental health and wellbeing became a core focus of our organisational response to the COVID-19 pandemic. COVID positive or close contact staff members were supported through the delivery of extensive proactive welfare checks, developing and distributing staff quarantine care packs and providing regular updates and advice through internal communications.
SAAS included Staff Wellbeing as a functional role within its COVID-19 Incident Management Team (IMT), strengthening, enhancing and adapting staff mental health and physical wellbeing services to meet the varied challenges created by the pandemic.
Ongoing collaboration between our Staff Wellness and Assistance (SWA) team, our EAP provider and the IMT also ensured a wellbeing lense was cast on all decision making, enabling the welfare of our people to remain at the core of everything we undertook.
The SAAS mental health and wellbeing response for our staff throughout COVID-19 has been unprecedented, totalling in excess of 3,700 contacts, 342 hours of contact time and the delivery of over 1600 staff welfare packs
Team: Lauren Carr (Palliative Care Queensland), Jessica Bell, Darren Lawrence
The Ambulance Wish Queensland program provides Queenslanders living with life-limiting conditions access to planning, coordination, specialist transport and the clinical care they require to fulfill their last wish and create everlasting memories.
The objective was to improve the standard of care available to patients with life-limiting conditions, to benefit their mental health and wellbeing, by ensuring patients receive holistic and compassionate care that meets their individual needs, preferences, and goals at the end of their life.
This program elevates our palliative care system and is a powerful reminder of how simple acts in these final days can bring joy and peace to a person, while connecting with their friends and family who love them.
Team: Danielle North, Dr Megan Dobbie, Gina Mammone ESM, Sophie Barrett, Ruth Dale
Ambulance Victoria’s Mental Health and Wellbeing
Action Plan 2022-2025 (MHWAP) provides an invaluable framework and holistic approach for how Ambulance Victoria (AV) embeds mental health and wellbeing into all undertakings within the organisation. It cares for and safeguards all AV employees, first responders and their families through the cumulative support of knowledge building, tools and services which are indispensable in managing their mental health and wellbeing.
AV’s goals were to realise a workforce supported to protect wellbeing and to improve the mental health and wellbeing of all our people.
To accomplish this, we needed a gold standard program addressing staff wellbeing. The strategic development and implementation of the MHWAP draws on previous plans and analysis, and aligns with support to address increasing risks of mental ill-health and injury within the organisation.
The MHWAP’s development followed extensive consultation, including interview and focus groups with AV’s people and family members, union representatives, trusted mental health partners, and the Victorian Ambulance Clinicians’ Unit (VACU).
We undertook rigorous analysis of AV’s Independent Psychosocial and People Matter survey data, conducted an external research review, and considered recommendations from the Victorian Equal Opportunity and Human Rights Commission (VEOHRC) Review into Workplace Equality in Ambulance Victoria. This enabled AV to develop a contemporary, evidence-based plan aligned to the specific needs of AV’s people and the risks identified. The resulting MHWAP centred around four pillars: Prevention and Education, Early Intervention, Building on Strengths, and Partnering for Success.
Team: Katrina Henderson, Kaya Yambe, Ata McGregor, Mikyla Melville, Alesha Hazlewood, Nathan Shippam, James Crombie, Gus Feltham
As a 24/7 emergency ambulance service the burden of shift work has many implications not only for staff and their families, but also for patients and the wider community. As a service we are committed to exploring options that reduce the burden of fatigue in the long term. This project aimed to explore and evaluate the impact of differing shift patterns on fatigue, using robust evidence-based research.
Wellington Free Ambulance is committed to the wellbeing of our staff by prioritising reducing fatigue. The aim of this project was to explore and quantify if possible, a causal link between shift pattern and levels of fatigue amongst frontline Emergency Ambulance Staff (EAS) in Wellington. Having robust evidence of a causal link would allow us to consider options for change to our existing shift pattern and/or the introduction of a new shift pattern to reduce the burden of fatigue on our staff.
Amongst Wellington Free Ambulances shift working staff, there are many opinions and anecdotal views about the impact of shift patterns on both fatigue levels and wellbeing. Therefore, it was important this project took an objective approach to shift pattern review using analytical tools to establish verifiable facts on the impact shift patterns have on the fatigue and wellbeing levels of EAS staff.
With special thanks to our
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TOTAL COACHING ACADEMY
Excellence in Mental Health & Wellbeing
On average, men apply for a job when they meet only 60% of the qualifications, but women apply only if they meet 100% of them.
We believe that the ambulance sector has a large pool of hidden talent - women currently in leadership roles or who aspire to be leaders but are unsure about how to take that next step in their careers.
The Women in Leadership Forum will provide attendees with practical skills, tools, perspectives and takeaway tips to help these women take the next step.
We invite you to meet and network with some of the Australasian ambulance sector’s most talented women in person at the 2023 CAA Women in Leadership Forum.
Tickets now available. Scan this QR code to book yours today.
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