Awards for Excellence 2022 | 1 2022 ExcellenceAwardsCAAfor Highlighting innovation in our industry events@caa.net.au | caa.net.au
www sdsi com au Y o u r A m b u l a n c e A g e n c y g o e s a b o v e a n d b e y o n d t h e i r c a l l o f d u t y , s o d o w e . SDSI provides software and support services to public safety agencies that support 80% of Australia and New Zealand's population.
Additionally, not only will we celebrate this year’s top programs we also get to celebrate 15 years of CAA Awards for ThisExcellence.yeartheaward 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. The over-arching Star Award winner will be selected from all category winners.
David Waters Chief Executive, Council of Ambulance Authorities
Let’s Celebrate
We are thrilled to be back with the CAA Awards for Excellence Gala Dinner celebrating the winners for 2022.
Thank you to our wonderful judges who donate their time to judge all entries and help us choose finalists and winners from a very stiff competition.
Congratulations to all entries and all the best to finalists.
Thank you to everyone who took their time to enter the CAA Awards, we are honoured to be able to showcase your achievements, innovation, and solutions, and proud that the Australasian ambulance sector and its people keep inspiring the global EMS and pre-hospital space.
Awards for Excellence 2022 | 1
The 2023 CAA Awards for Excellence will open start of November later this year and we invite you all to enter your programs and projects and showcase ambulance sectors best work.
We are excited to share with you the entries for the 2022 CAA Awards for Excellence. This year we received 34 submissions from across Australian, New Zealand and Papua New Guinea ambulance services. After two years of pandemic disruption, it was lovely seeing things return to normal, at least when it came to the CAA Awards for Excellence. In saying that there were quite a few COVID related projects that made it into the awards this year.
2 | The Council for Ambulance Authorities
Awards for Excellence
The Awards for Excellence have been run by the Council of Ambulance Authorities for 15 years with the aim to recognise the hard and innovative work of member ambulance services from Australia, New Zealand and Papua New Guinea. The awards are designed to encourage innovation and to enable services to share their work, learn from each other and contribute to bettering the ambulance sector.
Norma Lane Clinical Governance Lead for the New Zealand Blood and Organ Donation Service. Professor Vivienne Tippett Acting Head of School, School of Clinical Services, Queensland University of Technology. Fellow at QLD Academy of Arts & Science, and fellow at at Jamieson Trauma Institute, RBWH.
Freddy Lippert MD Associate Professor, University of Copenhagen, Denmark. Chair of the European Emergency Medical Services and CEO of Copenhagen EMS.
The awards are independently judged by a panel of industry-respected judges from across the globe. We would like to extend our deepest gratitude to our 2022 CAA Awards for Excellence judges, without their time and expertise we wouldn’t be able to put together such strong and independently judged awards.
Awards for Excellence 2022 | 3 Steve Irving Executive Officer at the Association of Ambulance Chief Executives (AACE). Professor Peter Cameron Academic Director of the Alfred Emergency and Trauma Centre and Professor of Emergency Medicine Monash University. Tony Ahern Retired CEO and current board member of St John WA. Current board member of WA Primary Health Alliance.
1 CE Letter 2 Award History and Judges 7 Excellence in Technology Entrants NSW Computer-AidedAmbulanceDesign and 3D Printing for a Helicopter Retrieval Service St John New Zealand Event Health Risk Assessment Tool St John New Zealand Remote clinical triage supports more patients during pandemic SA Ambulance Service Virtual Video Telehealth Capabilities SA Ambulance Service Volunteer Reimbursement App Ambulance Victoria Smart Moves – Manual Handling Mobile Application Ambulance Victoria Virtual Emergency Department Finalists NSW WorkSecondaryAmbulancepandemicdataReal-timeAmbulanceCarbonTowardAmbulancesNetZeroEmissionsVictoriaCOVID-19linkagetoinformtheresponseVictoriaTriageFromHome 19 Excellence in Clinical Practice Entrants SA Ambulance Service EMDSO Call Taking Training and ProcedureRetrievaNSWRecruitmentAmbulancelTransfusion Finalists NSW SpotlightAmbulanceonAeromedical - Part of an Integrated response to the longest prolonged National emergency in history St John CareRoleClinicalSAAustraliaAmbulance(NT)ClinicalPracticeManualAmbulanceServiceHubHealthNavigationIntegrationintoSAVirtualService 2022 ExcellenceAwardsCAAfor Highlighting innovation in our industry 4 | The Council for Ambulance Authorities
27 Excellence in Staff Development Entrants NSW Ambulance Pandemic Response: Workforce surge experience - Issues and AmbulanceLessons Victoria Mental Health Continuing Education Package Finalists Ambulance Victoria Graduate Ambulance Paramedic Improvement Program Ambulance Victoria AmbulanceShocktober Victoria COVID-19 Surge Workforce 35 Excellence in Patient Care Finalists NSW aClinicalAmbulanceResponsetoGlobalPandemicStJohnWAVirtualEmergencyMedicine 41 Excellence in Leadership Entrants St John New Zealand Improving Equity NSW PatientAmbulanceflow-Deltato Omicron and beyond SA Ambulance Service Clinical Hub Program Finalists SA Ambulance Service National Safety and Quality Health Service (NSQHS) Standards Program St John New Zealand Double Crewing Project QLD Ambulance Service Crisis Leadership – A Leadership Excellence Case Study 49 Excellence in Mental Health and Wellbeing Entrants Queensland Ambulance ServiceMentalHealth Response AmbulanceProgram Victoria Victorian Ambulance Clinicians Unit (VACU) Review and SAExpansionAmbulance Service COVID-19 Response Finalists NSW Ambulance Medic AmbulanceFit Tasmania ‘MyPulse’ Health and Wellbeing Program for Tasmanian Emergency Services Workers Ambulance Victoria Telemental HEaLth Pilot –TeleHELPAwards for Excellence 2022 | 5
6 | The Council for Ambulance Authorities
This category is looking for innovation or capability in fields of equipment, communications and information systems. submissions related to electronic PHCRs, demand resourcing for patient transport, integrated CAD programs and improving analytics to drive performance. 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.
Technology Excellence in Sponsored by Awards for Excellence 2022 | 7
Each
Previous
Computer-aided Design (CAD) is the process of creating 3 dimensional designs using a computer. 3D printing is a process that enables CAD designs to be turned into physical objects. It allows functional equipment to be rapidly prototyped and then printed in a wide variety of plastics. Technology has been rapidly developing over the last decade.
The process of design, rapid iterative templating and printing will be described with a view to inspire other services to explore the possibilities of 3D Printing in Ambulance Aeromedical systems.
Excellence in Technology Computer-Aided Design and 3D Printing for a Helicopter Retrieval Service NSW Ambulance
The NSW Ambulance Aeromedical Computer Aided Design and 3D Printing Program aims to provide the service with a range of purpose-built bespoke equipment to enhance service delivery, protect expensive equipment and pre-drawn anaesthetic medications and produce training models best suited to specialised areas of training, such as front of neck access and ultrasound phantoms for vascular access.
8 | The Council for Ambulance Authorities Entrant Team: Dr Karel Habig
The technology enables rapid prototyping and then functional prints in small runs which specifically suit the specialised nature of the service.
The paper focuses on the use of CAD and 3D printing in NSW Ambulance Aeromedical Operations where it is used to produce a wide variety of bespoke equipment including; training models, protective covers for equipment, predrawn medication syringe protectors, fluid hooks, suction adaptors and other operationally useful devices.
Team: Glen Hoult (leader), Simon Barnett and Dumindri Amerasinghe Health risk is a significant consideration for both event organisers and event medical providers alike.
St John New Zealand Awards for Excellence 2022 | 9
The aim of this tool is to use peer reviewed clinical input and machine learning to develop a risk prediction and resource support tool for Event Consultants, to achieve consistent event health risk mitigation.
To address concerns with the inconsistency of resourcing, EHS, along with the Business Intelligence team developed an online tool to ensure every event was resourced in a consistent and safe manner, ensuring the health risk of the event was appropriately mitigated.
Entrant
EHS Event Consultants have previously attempted event resourcing by first reviewing previous events of a similar nature, taking into consideration the type of event, number of attendees, numbers of incidents, seriousness of incidents, location of event, and the likelihood of drug and alcohol presence etc. Locating and digesting this information in a useful manner was a manual and time-consuming process for event consultants and, took on average, about an hour per event. The manual and clunky process of searching NEMs for event information meant that this was often done poorly, or not completed at all.
Additionally, the health risk profile of events has not been well understood, leading to inappropriate medical resourcing. To improve this and support the Event Consultants deciding on resource levels, an Event Health Risk Assessment Tool (EHRAT) has been developed and deployed into the EHS environment.
Technology Event
The machine learning model can predict likelihood of patient acuity by percentage at any given event type with a high degree of accuracy. This automation will help Event Consultants resourcing the event to better understand the health risk associated with the event, thereby ensuring safe levels of personnel attending and justifies resourcing levels for an event organizer.
Excellence in Health Risk Assessment Tool
The EHRAT integrates with the National Event Management System (NEMS) using Machine Learning, and a peer-reviewed clinical dataset to enable real-time understanding of actual health risk at an event type, and minimum safe crewing for the event.
Resourcing events with the appropriate number and skill level of clinicians has traditionally relied on the experience of the Event Consultant responsible for the event. This approach has led to inconsistency of resourcing which exposes St John to significant risk –both clinical and commercial.
Entrant
Previously, Clinical Support Officers could only work based physically in one of St John’s Communications Centres, but the new remote triage solution allows them to work from five additional locations to support the team.
New technology has enabled St John’s Clinical Support team to provide secondary phone triage to patients and clinical advice to ambulance personnel from outside of the Ambulance Communications Centres. The exponential rise of COVID-19 in the community saw major delays for patients waiting for a call back from clinical personnel for secondary triage, with as few as a third of patients receiving a follow up call within 30 minutes.
10 | The Council for Ambulance Authorities
Team: Blair Andrews (Leader), Sean Lester, Michelle McInnes, Ryan Eden, Olive Taylor, Scott Tizard, Daryl Tomlinson, Jono Meadowcroft and Ryan Bailey
In the first three weeks of being operational, 1,646 incidents were reviewed and assessed remotely. Nearly half of these did not require an ambulance response, with patients receiving advice on managing their condition at home or being referred to self-present to a GP or emergency department, where assessed as safe to do so. The remote triage option has proven invaluable in strengthening St John’s business continuity during the pandemic and improving patient safety.
The project aimed to strengthen St John’s COVID-19 response and improve patient safety by implementing a temporary technology solution, which enables clinically excellent staff working outside of the Auckland and Christchurch Ambulance Communications Centres to support St John’s Clinical Hub remotely. Using the new technology setup, these remote working clinicians can undertake secondary triage of patients and review pending 111 calls to ensure an appropriate response, without being physically based in one of St John’s Communications Centres. This not only enables additional incident triage to occur during severe pressure, but also significantly increases the pool of clinically qualified staff who can support the Clinical Desk nationally, improving resilience.
Excellence in Technology Remote clinical triage supports more patients during pandemic St John New Zealand
• Health Navigators who arrange patient referrals to alternate pathways
Awards for Excellence 2022 | 11 Entrant
Instigating a Virtual Emergency Service (VES) and rolling out new technology across SAAS maximises the use of alternative care pathways to be able to support care of patients in the community and avoid unnecessary Emergency Department presentations.
Excellence Ambulance Service
in Technology Virtual Video Telehealth Capabilities SA
• Clinical Telephone Assessment paramedics who use telehealth to assess patients sooner
While the Health Direct platform was chosen and implemented to ensure patients could access and benefit from clinicians pulled together as part of a service (now known as the Virtual Emergency Service (VES)), the delivery of a videoconferencing platform enables integration and collaboration between patients, SAAS crews and clinicians across the system and allows a safe but effective way of treating patients. This, in turn, eases the pressure on the hospital system.
The connection of patients in the community to other services had previously been brokered via a SAAS Health Navigator (HN) over the phone.
All patient and SAAS crew interactions with the HN and VES are documented on the state health system based electronic medical record system, known as Sunrise EMR.
This was particularly integral in the support of patients during the Omicron surge in January 2022 which saw a 30% increase in demand Ambulance Services in South Australia.
The project has already proven effective in ensuring a patient receives the right care, in the right place, the first time.
• A comprehensive strategy which has introduced 10 non-ED pathways to the SAAS service delivery model in the last three years
The move is part of a broader project to successfully divert low acuity patients away from hospital Emergency Departments (EDs), connecting them to more appropriate care through:
Team: Kate Clarke SAAS has implemented a number of initiatives over recent years to ensure low -acuity patients have access to alternative care pathways.
Since December 2021, SAAS has been successfully connecting emergency medical clinicians with patients at the ‘bedside’ via video link. Using the Health Direct platform this Virtual Emergency Service (VES) has enabled patients to access the best outcome for their health care and is avoiding a physical ED presentation where not needed.
Since opening on the 8th of December 2021 – 18th March 2022, 2242 patients have been referred to VES with an ED Avoidance rate of 74%.
Additionally, the intent was to ensure that the app looked and felt like a SAAS ‘product’; and aligned with existing technology and processes.
The principal driver for this was to ensure volunteer ambulance officers were reimbursed and paid allowance entitlements as quickly as possible.
Team: Gary Pentland and Team
SAAS volunteers have previously used a paper-based reimbursement process which relied on multiple people to handle and approve. The innovative app, designed by SAAS’s own ICT Communications Administrator, allows for online and rapid submission, review and approval of the reimbursement or allowance and has been a collaboration between SAAS teams, SA Health and Shared Services.
The app needed to be user friendly for SAAS volunteers, many of whom are only just starting out on their mobile IT access journey with the organisation. The intent was to allow for electronic approval of claims (for mileage and subsistence) and a quicker way to receive payments for overall out of pocket expenses incurred while volunteering.
SAAS has an extensive volunteer entitlement package to encourage, support and retain volunteer ambulance officers and nonoperational volunteers.
The aim of this project is to develop and implement an electronic Volunteer Reimbursement Claim Form solution utilising existing technologies, user access and security, with approval workflows, mobile accessibility, and volunteer email address connectivity.
SAAS has created a smartphone app using Office 365 PowerApps to streamline volunteer reimbursement claims, making claim submissions accessible at the tip of a finger. This ensures timely payment of volunteer out of pocket expenses as well as reducing time and cost to manage administratively.
12 | The Council for Ambulance Authorities Entrant
Excellence in Technology Volunteer Reimbursement App SA Ambulance Service
The Smart Moves app was developed to assist the clinical operations workforce provide safe, high quality, expert care to patients through rapid access to manual handling practices, similar to the Clinical Practice Guidelines in the clinical setting.
(AV) strives to deliver new and innovative ways to achieve organisational goals.
The Smart Moves app addressed the need for in-field manual handling recommendations via digital means. Staff can now easily access safe, contextual information in stressful environments. The aim was to meet staff requests for greater support without the need for traditional paper-based workbooks, laptops, or computer devices.
In January 2021, Ambulance Victoria implemented ‘Smart Moves’, a three-day continuing education program for paramedics and first responders covering safe manual handling practices. In addition to the usual printed materials, AV delivered a mobile phone application for facilitators – creating a more interactive experience for participants and enabling facilitators to quickly refer to manual handling knowledge via their smartphones during training, without relying on a physical copy. Following positive feedback and requests, use of the app was expanded to all paramedics and first responders.
The Smart Moves app was developed in-house by AV’s Manual Handling team using the latest technical project methodologies. The team worked together to develop a user-friendly app focused on what front-line staff needed to support patient care. This app was the first of its kind to be used within AV.
The team recognised the potential of several in-house ICT tools; working from home as a result of COVID-19, the team took the opportunity to experiment and innovate. Acting as Citizen Developers, they leveraged and adopted the cutting-edge tools of PowerApps and Agile Ways of Working to deliver the app within six weeks.
Mobile Application Ambulance
Team: Shannon Andrew (leader), James Ho, Stefanie Culver, Shaun Wilkinson, Barry Curtain and Brook AmbulanceSumnerVictoria
The app is a sustainable solution and aligns to AV’s digital transformation strategy.
Excellence in Technology Smart Moves – Manual Handling Victoria
Awards for Excellence 2022 | 13 Entrant
The app represents a continual learning opportunity for the organisation to transform the mindset around learning and what it means to deliver world-class support tools that underpin a world-class patient care model. The app can be continuously updated, easily searched and referenced, and developed for a low-cost base.
The Smart Moves app contains videos, images and instructional material relating specifically to performing safe manual handling tasks, supporting AV to build its safety-first culture.
ExcellenceEntrant in Technology
The Victorian Virtual Emergency Department (VVED) is a video telehealth medical service that provides inhome clinical assessment, medical advice, treatment and, where required, local referrals to appropriate services for ongoing management of patients who would normally attend an ED via ambulance or selfpresentation. Operated by Northern Health, it was the first public virtual ED service established in Victoria.
To help manage increased demand for ambulance services during the COVID-19 pandemic, AV developed this project, establishing a dedicated pathway for paramedics to refer selected patients when in-field. AV wanted to provide greater flexibility for patients and their families to access emergency care whilst minimising the need for ED presentation. This project aimed to provide patients with the virtual equivalent of attending an ED whilst continuing to deliver outstanding care and ensuring patient comfort and peace of Followingmind.comprehensive patient assessment, paramedics initiate the in-field video telehealth consultation for eligible patients via a device with camera and internet access. Where appropriate, the consulting physician will refer the patient to an alternative care pathway. In the first six months of the project, paramedics referred almost 3,000 patients to virtual ED, with approximately 75 per cent referred to an alternative care pathway.
The COVID-19 pandemic increased the pressure on ambulance and hospital resources, with community demand for these services growing year-on-year and COVID-19 regularly impacting resourcing, for example, staff needing to isolate due to illness or exposure, and/or take leave to care for friends or family.
Virtual Emergency Department
Ambulance Victoria Team: Amanda Thornton (leader), Dr Loren Sher, Ariana Carrodus, James Oswald, Nicole Magnuson, David Shearer, Bernadette Miller and Susanne Scott
14 | The Council for Ambulance Authorities
As a result, alternative care pathways for patients and ways to support changes in workload and demand became more important than ever.
NSW Ambulance
The first initiative is the installation of solar panels on ambulance stations, with the solar power generation being used to reduce grid power consumption, and stored in batteries for use as an Uninterrupted Power Supply (UPS) for the building’s essential services.
Team: Peter Elliott (leader) and Ols Duerr-Reuther NSW Ambulance has started the journey towards net-zero carbon emissions by 2040. As part of the program, NSW Ambulance has designed two innovative systems that have enhanced organisational capability and improved business continuity, while supporting the reduction in our carbon emissions footprint.
2022 | 15 Finalist
As at April 2022, NSW Ambulance has installed solar PV panels on 62 sites around NSW. These 62 sites are generating 1.8 Gigawatt hours of electricity per annum, which is an equivalent to supplying electricity to run 250 residential homes for a year. There has also been an 8.5% reduction in the organisational electricity costs per annum.
In addition, before the rollout of the lithium batteries and solar panels NSW Ambulance workshops were replacing one to two lead-acid batteries per emergency ambulance per year. This replacement is equal to 1,000 to 2,000 annual battery replacements per year at $300 per battery. Based on the 107 Intensive Care Unit ambulances not requiring a battery change in the first 12 months and the average three hour replacement time, an estimated cost-saving efficiency is forecasted as at least $450,000, in Technology Towards Net Zero Carbon Emissions
Awards for Excellence
Excellence
The second is the installation of lithium batteries and solar panels on emergency ambulance vehicles to reduce wastage, provide an additional power source for the vehicle’s electrical system and increase the availability of the vehicles. Both initiatives are linked to NSW Ambulance’s corporate objectives to leverage technology and infrastructure through integrative models of care, to better support our paramedics responding to the community. Through innovative design, technology and infrastructure, the project deliverables are aimed at using solar energy generation from ambulance stations and from emergency ambulance vehicles to contribute to a reduction in the NSW Ambulance carbon emissions footprint while concurrently providing enhanced business continuity for these assets.
16 | The Council for Ambulance Authorities
This project, led by Ambulance Victoria’s Centre for Research & Evaluation, established Australia’s first ongoing data linkage initiative between ambulance clinical/operational data and a register of confirmed COVID-19 patients managed by the Victorian Department of Health.
• Provide critical intelligence and real-time reporting of ambulance attendances to COVID-19 patients.
Insights gained from the project have helped drive critical improvements to the pandemic response, including the isolation and quarantining of staff, ambulance resourcing decisions, changes to the ambulance response priority, and enhancements in clinical practice. The initiative now represents an easily transferrable model of surveillance that can be implemented into ambulance services internationally and is likely to support the ongoing emergency response to the Victoria’spandemic.unique experience with the pandemic has helped drive significant innovation in the use of surveillance data to monitor and respond to the evolving threat posed by COVID-19. Between 30 January 2020 and 23 January 2022, AV attended 31,496 patients who were confirmed COVID-19 positive. Of these, 14,362 (46 per cent) were presented to paramedics prior to a COVID-19 diagnosis.
• Establish a mechanism to identify vulnerable staff exposure and initiate isolation procedures.
Real-time COVID-19 data linkage to inform the pandemic response
The project aimed to:
Ambulance Victoria Team: Professor Karen Smith (leader), Ms Emily Mahony, Ms Nicole Magnuson, Ms Emily Andrew, Dr Sarah Hopkins and Dr Ziad Nehme In Australia, the collection of COVID-19 surveillance data has been at the centre of the public health response and has supported critical decision-making around testing and hospital capacity. However, comparatively little is known about the way surveillance data is being used to inform the preparedness of emergency medical services for the COVID-19 pandemic.
ExcellenceFinalist in Technology
• Provide an evidence base for the ambulance response priority to patients with COVID-19.
AV’s Secondary Triage Team of paramedics and registered nurses can connect Triple Zero (000) callers whose condition does not require an emergency ambulance to an alternative service which may be more suitable, such as a nursing service or a locum.
On 27 January 2020, Ambulance Victoria (AV) identified serious challenges to its operations posed by COVID-19. AV faced the possibility that overwhelming call volumes and staff furloughs would significantly hamper the Secondary Triage Team’s ability to manage Triple Zero calls.
The primary aim of the WFH project was to increase the capacity of the Secondary Triage Team, enabling it to respond to a projected 4,000 Triple Zero (000) COVID-19 related calls within a 24-hour period.
The initial trial was immediately successful — the participating Triage Practitioners were as effective as the on-site workforce, and the trial was a success from a technical, clinical and procedural perspective. In addition, significant wellbeing improvements were also highlighted by participants, who reported a reduction in fatigue and an increased ability to work shifts at short WFHnotice.has now formed part of AV’s business-asusual surge process and is referenced in the Extreme Workload and Demand — ERP Sub-plan.
The secondary aim was to provide a surge workforce that could immediately deploy – any time, any place –without the need to commute to an on-site location and enabling staff working in rural and remote areas to use their expertise without traveling to a metropolitan location.
The project allowed Secondary Triage Team members to work from home to minimise the risk of catching or passing on COVID-19 and allowed AV to mitigate the impact of staff furloughs.
Team: Gareth Becker (Leader), Lindsay Mackay, Caley Geary, Angela Iliopoulos, Flynn Snell, Paul Crole, Catherine Spiden, Tom Bawden, Larissa Walsh, Patrice Bottcher, Hayden Peucker and Jenny Davis
A Work from Home (WFH) project was designed and implemented to address this problem. The project provided significant organisational resilience and met the challenge of surge capacity. Prior to the commencement of AV’s WFH project, no ambulance jurisdiction had successfully accessed both Triple Zero callers and the Computer Aided Dispatch applications within an ‘at home’ environment. AV developed vital technical and procedural enhancements to achieve this. Since the successful pilot, the WFH functionality has been refined and has significantly minimised the impact of staff furloughing, as well as delivering greater surge capacity. Within seven minutes of receiving a request for surge capacity support, Triage Practitioners can be online, providing full operational support within the home Home-basedenvironment.Triage
Practitioners can now access the full suite of software and tools that allows them to operate as effectively as office-based practitioners.
Excellence in Technology Secondary Triage Work From Home Ambulance Victoria
Awards for Excellence 2022 | 17 Finalist
Clinical Practice Excellence in Sponsored by
This category is looking at innovation or capability in fields of skills mix, pharmacology and clinical intervention. It relates to patient treatment and outcomes. Previous submissions focused on high performance CPR, cardiac arrest outcomes, stroke protocols and improvements in pain management. 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 revolutionize the world of paramedicine.
Awards for Excellence 2022 | 19 Entrant
The requirement to be able to increase access to trained EMDSO staff was identified as a high risk requiring immediate strategies to be developed and implemented. Training had historically been delivered over an eight week course timeline and was considered too long and therefore a radical review was undertaken. The aim of the review was to provide a streamlined, efficient yet effective training course that was flexible and could surge up as needed, while still remaining compliant to RTO standards and importantly ensuring uninterrupted service in triple zero call answering at SAAS.
Excellence in Clinical Practice
20 | The Council for Ambulance Authorities Entrant Team: Kate Clarke EMDSO (Call Taking) staff are the first point of contact for anyone calling Triple Zero in SA Ambulance Service. With the very real possibility of COVID-19 outbreaks amongst staff within the Emergency Operations Centre recognised as a risk with potential catastrophic outcomes with the ability to answer Triple Zero calls from the South Australian community impacted, the risk was seen as critical to community, SAAS and SA Health to resolve.
Current training is contemporary, robust and recognised nationally as the Certificate III Ambulance Communications – Call Taking which is issued by SAAS as a Registered Training Organisation. COVID resilience planning required this training content and delivery to be reviewed to ensure SAAS was able to quickly create surge capacity in staff numbers to answer Triple Zero calls. This required current training to be redesigned to be responsive to the community and staffing needs during COVID peak periods. A key objective in the review was to ensure the training package continued to meet the standards required to maintain Accreditation as a Centre of Excellence, deliver a robust certified training course that was agile and contemporaneous. The training course was completely reviewed, redesigned, and achieved the outcome of competent and confident EMDSO staff ready to independently answer Triple Zero calls in 4 weeks.
EMDSO
Call Taking Training and Recruitment
SA Ambulance Service
NSW
NSWA Aeromedical teams routinely carry packed red blood cells and extended life plasma, however the RTP enables larger quantities and mixed-product transfusion. Once the need for additional blood products is confirmed, the Aeromedical Control Centre clinicians utilise the iTRACC online tool to locate additional blood products from an appropriate blood bank and then coordinate the logistic plan for delivery. This process is the first of its kind worldwide.
As anticipated, prehospital trauma is the predominant cause of catastrophic haemorrhage, but obstetric and medical patients have also received blood products from the RTP and approximately one fifth of transfused patients are interhospital transfers.
The aim of this project is to provide life saving blood product transfusion to patients suffering catastrophic haemorrhage in New South Wales.
Awards for Excellence 2022 | 21 Entrant
Team: Sophie Knott
NSW Ambulance (NSWA) has successfully developed and implemented the Retrieval Transfusion Procedure (RTP) to facilitate the delivery of blood products to pre-hospital scenes, during extended transfers and to hospital facilities.
Excellence in Clinical Practice Transfusion Procedure Ambulance
Retrieval
Rural and remote communities in NSW are particularly challenged by their distance to definitive care. There is an obvious need for the availability of additional blood products during long aviation transfers, with rural and regional patients representing 82% of RTP cases. However, patients in metropolitan regions have also benefitted from the RTP, particularly in cases of entrapment or complex extrication.
22 | The Council for Ambulance Authorities Finalist Team: Cameron Edgar Emergency services are responding to an enormous volume of calls with people missing and patients severely injured or ill. Operating conditions are extreme, the smoke from state-wide bushfires that turned day into night is now replaced with low clouds and driving rain from state-wide floods. Communities across the state are isolated with widespread local infrastructure drastically affected. Normal ‘business as usual’ workload continues to rise as does the volume of disaster related emergency calls. Community angst and uncertainty continues as an infectious disease is putting highly trained health professionals and staff into isolation, including their loved ones. Staff, the greater community, government, and media need accurate, timely and constant information. There is no clear end date to this latest state-wide emergency and when the next one may occur. In many cases, the only means of getting essential critical care to these patients is by air. This has been the experience across New South Wales since 2019. The state had just finished burning, a global pandemic is in its third year and the state is now flooding. Direction and reassurance was required, leading to the establishment of the NSWA Aeromedical Incident Management Team.
The mission of the NSWA Aeromedical Incident Management Team (IMT) is: To safely support the broader NSWA response to statelevel incidents and disasters through the application of aeromedical critical care and retrieval via a coordinated network of specialist staff and resources.
The IMT’s activities focused on maintaining Critical Care Search and Rescue during back-to-back state-wide emergencies whilst upholding the highest standards of team and patient safety. This was achieved by creating innovative procedures, communication networks and enhancing current practices to ensure the best clinical practice. During these uncertain times, the Aeromedical IMT was able to create practices that would help frontline personnel and control centre staff respond to diverse patient requirements, aligned with the NSWA vision and integrated with broader NSW Health. Since 2019, the team has been led by senior leadership of the Aeromedical Directorate and supported by a highly experienced multi-disciplinary clinical and aviation team. This team’s extensive experience and dynamic leadership throughout the 2019 Bushfires, COVID-19 and the recent NSW Floods has allowed the IMT to support the timely, effective and efficient deployment of Aeromedical teams whilst ensuring sufficient safety controls were in place to prevent harm to patients, staff and the greater NSW community.
Excellence in Clinical Practice Spotlight on Aeromedical - Part of an Integrated response to the longest prolonged National emergency in history NSW Ambulance
• Delivery of training to all clinical staff (operational and volunteers), across the Northern Territory, providing them with both theoretical and practical learning experiences.
• Production of a new CPM that is evidence-based and in line with the latest clinical standards, procedures and drug therapy guidelines drawing on clinical expertise from ambulance services across Australia.
Roll out of the new guidelines included both online and face to face training for all clinical staff setting a new standard in the provision of clinical care for St John NT paramedics. The overall project involved significant engagement from across the organisation, supported by external design and digital agencies. This project was developed over 14 months, followed by an intensive four-month training program which was delivered during a COVID-19 response period. The aim of the project was to set a new benchmark in clinical practice which would encompass all clinical practice at St John NT from volunteer first responders through to ICPs.
Awards for Excellence 2022 | 23 Finalist
• Development and implementation of St John NT’s first CPM Mobile App.
Development of the CPM involved reviewing the clinical practice and management guidelines of many of the services represented by the Council of Ambulance Authorities leveraging off the research and development of these services as well as consulting with Medical Practitioners through the Medical Advisory Panel. The CPM was produced as a printed, online and digital app.
Excellence in Clinical Practice Clinical Practice Manual St John Ambulance Australia (NT)
• Recognition of cultural safety and diversity. With approximately 46% of the Northern Territorypopulation identifying as culturally or linguistically diverse St John NT acknowledged that cultural groups presented dynamic situations in which their clinical service was provided.
The project included:
Team: Andrew Thomas (Leader), Duncan McConnell and Paul Bellman (dec.)
The CPM needed to address the unique presentations St John NT experienced and incorporate in all aspects of care including guardianship, end-of-life wishes and palliative care, as well as cultural considerations for Aboriginal and Torres Strait Islanders and other identified groups. This was an opportunity to establish a significant new approach to learning and development within the organisation.
The Clinical Practice Manual (CPM) project was developed to support the clinical decision making of St John NT. It includes up to date clinical practice guidelines and drug therapy protocols for all clinical levels from Advanced Responder (volunteer clinical roles) through to Intensive Care Paramedic (ICP). The project demonstrates St John NT’s commitment to the best possible pre-hospital care and improved health outcomes for its community.
SAAS consistently diverted between 20% and 30% of patients from EDs since mid-2021. Commencing in 2019, as a unique and innovative role within SAAS Clinical Hub, Health Navigation has played a pivotal role in the development, improvement and utilisation of care pathways and expanded service delivery model.
• Maintaining patient’s connection to their existing care providers to facilitate continuity of care.
• Remaining collaborative and integrated within SA Health as a partner, ensuring patients are connected and supported within the System. With challenges in service delivery remaining, it was evident that further opportunities and support for SAAS crews and their patients necessitated the continued innovation and trajectory of Health Navigation.
• Health Navigators facilitate patient referrals from crews to alternate pathways
All of this is underpinned by a commitment to:
Excellence in Clinical Practice
SAAS has undertaken a significant body of work in the last two and a half years to navigate more low-acuity patients to non-ED care pathways and collaborate with other health services to design, develop and implement new pathways.
• Easing pressure on hospital systems by avoiding unnecessary ED presentations
• Broad stakeholder collaboration on a statewide level.
Clinical Hub Health Navigation Role Integration into SA Virtual Care Service SA Ambulance Service
24 | The Council for Ambulance Authorities Finalist
• A comprehensive strategy which has introduced fifteen non-ED pathways to the SAAS service delivery model in the last three years
• Connecting patients to services that can provide comprehensive assessment, outreach and ongoing care.
Team: Kate Clarke SA Ambulance Service (SAAS) is successfully diverting low acuity patients away from hospital EDs, connecting them to appropriately tailored care through:
The design of the new SA Virtual Care Service (SAVCS) identified the role of Health Navigation within the SAAS Clinical Hub was well aligned with the strategic direction of tailored patient care and utilisation of alternate care pathways, contributing to improved patient flow and health care within South Australia. With models around the world showing higher success with integrated models, SAVCS has become the first fully integrated, multidisciplinary Virtual Care provider in Australia. The role of Health Navigation was a key enabler in providing a SAAS interface and is now integral in development and expansion of SAAS.
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26 | The Council for Ambulance Authorities
Awards for Excellence 2022 | 27 Sponsored by
This category is looking at education improvement or innovation in fields of: Program design, delivery, assessment and accreditation; professional development, skills maintenance and practice standards, including community education; and research and/or innovation supporting evidence-based practice. Previous submissions looked at leadership development, programs implemented around mental health of Ambulance staff, and community education campaigns.
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.
Staff Development Excellence in
28 | The Council for Ambulance Authorities Team: Mike Richer
NSWA Education embarked on a project to support the workforce surge plans in preparing and designing, implementing, and reviewing three separate programs all designed to provide a safe, confident, fit for purpose surge workforce.
Excellence in Staff Development Pandemic Response: Workforce surge experience - Issues and Lessons NSWEntrantAmbulance
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Our aim was to identify strategies ensuring workforce capacity could be maintained. This included identifying and operationalising additional workforce capacity. We targeted three primary areas where additional surge was required and a source available, these being: Paramedics Clinical Assistants Emergency Call Takers
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The project goals were to identify, recruit, train and deploy these workforces in a timely manner and at times where greater impact was predicted. To achieve these goals, significant modifications and enhancements were necessary to existing methods and resources. This included identifying skilled and available applicants, rapid recruitments strategies, development of alternative onboarding educational delivery methods and production of learning materials.
The COVID-19 pandemic has presented the government, the community, and its health system with multiple challenges over an extended period. Ambulance services across the globe have had to consistently develop and implement strategic and tactical responses to these challenges over the last two years. Surging the frontline workforce at different stages of the pandemic has been an important strategy in supporting maintenance of service delivery, staff safety and wellbeing.
The ability to identify and recruit safely on-board and deploy this workforce has required unprecedented commitment to innovation, integration, and agility across all parts of a large and complex organisation. It has also required consultation and collaboration with multiple external stakeholders spanning the state, including Ministry of Health, education and health service providers, and peak clinical and industrial bodies.
Nearly 1,000 paramedics and call takers have been inducted as part of this surge workforce since the first program in 2020. This is in addition to standard recruitment.
In response to the COVID-19 pandemic, the training was adapted into online learning modules, increasing accessibility for staff who could complete the training at a time and place of their choosing.
The training project sought to:
• improve patient care by ensuring that patients with mental health concerns received best-practice, patient-centred support; • minimise the potential harm caused by AV’s systems, practices and biases, to ensure that all patients receive the care they need, at the time that they need it;
Team: Dr. Megan Dobbie (Team Leader), Kaitlyn Harrington, Felicity Garland and Claire Henley
The Mental Health Continuing Education Package was developed to increase the confidence and capability of operational AV staff (paramedics and first responders) when treating patients with mental health disorders.
The Mental Health Continuing Education Package provides AV’s operational workforce with the skills and confidence to respond to the increased frequency and complexity of mental health presentations.
Excellence in Staff Development Mental Health Continuing Education Package Ambulance Victoria
• increase the competence and confidence of AV staff; and • reduce the anxiety of operational staff when working with this diverse and complex patient cohort. AV is responding to increasing numbers of mental health cases, and patients with more complex needs.
Awards for Excellence 2022 | 29 Entrant
The project involved research, design, development and delivery of mandatory mental health training for development of operational staff. The training package provided practical strategies and tools on how to best work with patients who present with acute mental health symptoms.
Since mid-2021, 75 per cent of operational staff have commenced or completed the training. The remaining 25 per cent are expected to complete the training by June Participant2022. feedback from 145 respondents to a survey seeking feedback on the training indicated that 82 to 86 per cent were satisfied or very satisfied with the training, and the vast majority believed their learning could be successfully implemented in the field.
• Provide graduates some scope to self-manage and progress at their own pace, acknowledging that personal circumstances, types of case presentations, area of work, workload and other factors that can delay or enable progress.
30 | The Council for Ambulance Authorities
• Implement appropriate systems to ensure program governance, accountability and transparency.
ExcellenceFinalist in Staff Development
Ambulance Victoria Team: Lauren Olney (Leader), Peta Reilly, Lisa Bourke, Paul Giagnacovo and Nicole Magnuson, The primary goals of the project were to increase the number of students completing the program within 12 months and to improve the graduate paramedic experience.
• Map learning tasks to Paramedic Competencies, enabling consistent and objective assessment.
The new program was launched in March 2018, with a three-year trial period. Evaluation in March 2021 demonstrated that the new program was highly successful, with over 90 per cent of graduates completing their program within 12 months (compared to 50 per cent under the old program) and the vast majority of graduates who responded to surveys feeling that the new program prepares them well for their AP12 year.
Alongside this were a variety of objectives, including:
• Implement a student management system which enables the graduate, program staff and all paramedic support staff to track a graduate’s progress in real time and access the learning history of the graduate if Followingrequired.areview of AV’s Graduate Ambulance Paramedic program, AV’s Commencing Practice Team identified the opportunity to improve the experience of graduates and to increase the number of graduates who successfully completed the course within the scheduled 12-month timeframe.
• Provide opportunities for graduates to participate in structured, off-road training days to support transition to practice and development needs.
Graduate ParamedicAmbulanceImprovement Program
• Better support graduates’ psychological health and wellbeing, and physical safety.
Over the following three years, the Commencing Practice Team developed a more supportive and robust program, starting with organisation-wide consultation and benchmarking with similar programs in other Thejurisdictions.resultwas a new program in which roles and responsibilities are clearly defined and embedded to support and develop graduates and the learning framework is progressive, objective and standardised, with multiple checkpoints to report, action and support graduates to develop their clinical, operational and safety competencies.
• Reduce the incidence of performance management initiated by not passing the final program assessment at first presentation.
• Implement a structured supervision framework in which Team Managers, Clinical Instructors and other support staff would actively monitor graduates, identifying and addressing areas of risk.
As the state’s frontline emergency health provider, Ambulance Victoria (AV) needed to mitigate this crisis and equip Victorians with essential, life-saving skills in the event of cardiac arrest.
The resulting month-long awareness and education campaign named October as ‘Shocktober’, promoting the need for education in cardiopulmonary resuscitation (CPR) and the three critical steps to save a life: ‘Call, Push, Shock’.
Excellence in Staff Development
• Increase community awareness of AEDs, how to use them and where they are located.
• Encourage schools, businesses and sporting grounds to make their AEDs publicly accessible.
• 134 online sessions delivered, reaching over 6,900 Victorians.
The campaign also encouraged Victorians with these life-saving skills to register on the GoodSAM app – a free, global smartphone app alerting registered responders that someone nearby is in cardiac arrest. GoodSAM responders can then support the patient until paramedics arrive. Their project also aims to:
Shocktober Ambulance Victoria
Team: Joel Marley (leader), Phil Cullen, Andrea Lenaghan, Julian Hanton, Tahryn Mant, Rebecca Danslow and Reyyan Atmaca, Cardiac arrest survival rates in Victoria plummeted by 50 per cent during the first three months of the 2020 COVID-19 lockdown.
2022 | 31 Finalist
Following the success of the 2020 campaign, Shocktober was held again in 2021, proving to be one of the most successful community engagement campaigns ever undertaken by AV. It resulted in:
• More than 510,000 people reached through Shocktober-related social media posts. Shocktober is now a permanent fixture on AV’s community engagement calendar.
• 1,010 community members registered via the GoodSAM app.
• Increase AED registration on AV’s website so the public can find a device in the event of cardiac arrest.
Awards for Excellence
The key objectives were to:
The ability to staff peak periods when all available local ambulance resources are deployed is a problem faced by ambulance services worldwide. Solving this issue would smooth performance and guarantee better care to thousands of Victorians in the AV setting, and many more on a global scale.
The project activated the ‘Mutual Assistance’ clause of AV’s Bioevent Subplan to the AV Emergency Response Plan demand management strategy, which enables AV to access emergency support and resources from other services, private providers, and the Victorian and Commonwealth Governments.
• Maintain service to the community during a period of extreme duress in the health system.
• Use a surge workforce as a force multiplier for the available paramedic skillset to increase the probability of success in delivering best care.
Ambulance Victoria Team: Justin Dunlop (Team leader), Michael Stephenson, Matt McCrohan, Kathryn Haden, Brett Drummond, Olivia Howarth, Simon Jensen, Michael Wood and Danielle Saxton,
• Develop training systems that enable rapid and effective deployment of a second tier, non-paramedic Allworkforce.relevantpartner agencies engaged to provide direct support to AV entered into a memorandum of understanding with AV. Student paramedics were directly employed by AV, leveraging existing education partnerships with universities.
• Prepare to manage a significant loss of staff and/or significant increase in workload.
• Ensure clinical safety for patients.
Trained surge responders were rostered with qualified paramedics to support the delivery of exceptional patient care. The surge responders also provided a safe and stable driving platform to carry patients to hospital.
• Ensure the safety of surge responders and the paramedic workforce.
Personnel were screened and selected based on a range of key criteria focused on suitability and safety. Individuals received tailored training based on existing skills and experience, with a focus on occupational and patient safety. The training programs used AV’s systems and services, including online learning, information systems, peer support and welfare services as well as a dedicated forum for surge responders.
The surge workforce provided approximately 120 rostered shifts each day during the peak of the Omicron outbreak. The expanded workforce allowed AV to manage demand as needed. This successful program demonstrated the efficacy of AV’s longstanding contingency to use a temporary surge workforce in response to extreme demand.
ExcellenceFinalist in Staff Development COVID-19 Surge Workforce
The project aimed to develop a surge workforce to supplement the paramedic workforce during a period of increasing demand and staff shortages due to COVID-19.
32 | The Council for Ambulance Authorities
Awards for Excellence 2022 | 33 SIMULATION PLATFORM FOR INCIDENT COMMAND & CONTROL TRAINING AND EDUCATION XVR POWERED BY TIGERTAIL AUSTRALIA; BUILDING FIRST RESPONDER CAPABILITY THROUGH STATE-OF-THE-ART TRAINING SOLUTIONS TIGERTAIL.COM.AU | 02 8097 1900
34 | The Council for Ambulance Authorities
Patient
This category is looking at patient experience, improvement or innovation. Previous submissions looked at mental health responses, individual patient stories, community paramedicine, and assisting high frequency 000 callers. Each service is emboldened to examine ways that their organisation has assisting specific patient cohorts where learnings were of the benefit for the field of paramedicine.
Care Excellence in Awards for Excellence 2022 | 35 Sponsored by
The pandemic modifications to clinical practice continue to be reviewed monthly by the COVID-19 Clinical Practice Expert Reference Group, with oversight from the Clinical Practice Committee. This has involved both an ongoing review of emerging evidence as well as monitoring the use of AGPs to measure the ongoing impact of the pandemic modifications protocol in influencing clinical care decisions (i.e. MDI instead of nebulisation, and supraglottic airway used in preference to endotracheal intubation).
36 | The Council for Ambulance Authorities Finalist
The COVID-19 ICP Update program was evaluated weekly through participant feedback and a review of clinical performance by the participants. The performance of participants was strong and the feedback evaluations reflected a high level of participant satisfaction with the program. Frequent comments included ‘best course I have ever attended with NSW TheAmbulance’.NSWAclinical response to the pandemic can be best evaluated and demonstrated by the low incidence of clinicians who have contracted COVID-19 in a clinical setting where PPE and new clinical intervention instructions have been followed. NSW Ambulance clinicians are better prepared, informed, and skilled in practices that are new or have been reviewed and articulated clearly to our front-line clinicians.
Accordingly, NSW Ambulance commenced planning for the pandemic operationally and clinically to ensure an effective response to the pandemic. One key initiative was the establishment of an Incident Management Team (IMT) which has been operational since early 2020. Additionally, NSW Ambulance embarked on a number of clinical initiatives to ensure that the needs of patients and clinicians were met. These initiatives included the establishment of a clinical lead role in the IMT; the establishment of a COVID-19 Clinical Practice Expert Reference Group; development and implementation of specific pandemic protocols; and the introduction of a number of clinical interventions to reduce the risk of aerosol generating procedures. These interventions included mechanical cardio-pulmonary resuscitation devices (mCPR), video-laryngoscopy, syringe drivers, continuous positive airway pressure (CPAP), and enhanced monitoring for Intensive Care Paramedics.
The aims of the NSW Ambulance (NSWA) clinical response during the COVID-19 pandemic were:
Team: : Martin Nichols
In early 2021 the NSW Health Agency for Clinical Innovation (ACI) Critical Intelligence Unit conducted a rapid evidence review of NSW1. This review did not identify any significant deviation from the evidence base and provided an added layer of external validity for the treatment modifications.
• Maximise safety for clinicians Provide safe and contemporary care to patients, families and careers • Ensure clinical practice is contemporary, evidence based, high quality, patient-centred and delivers value
•
Excellence in Patient Care Clinical Response to a Global Pandemic NSW Ambulance
In early 2020 as Australia was observing the effects that the COVID-19 pandemic was having internationally.
Awards for Excellence 2022 | 37
Excellence
A concerted push for VEM consults in November resulted in one of FSH’s highest primary ED bed avoidance rates to date (n=105 out of 1235 ED cases or 8.5%) and signaled improved patient turnaround times. With SMHS providing initial and ongoing funding and resources, the WA government committed a further $2.3 million in the 2021 budget for SMHS to expand the service to Rockingham and Peel hospitals. As Omicron spreads in WA, much effort has gone into utilising VEM for COVID-19 cases, with the aim of expanding to Royal Flying Doctor Service admissions, burns patients, and engage with GPs. Eventually other patient cohorts can be identified, such as mental health consumers and direct patient/family contact.
Virtual
St John WA
38 | The Council for Ambulance Authorities Finalist
in Patient Care
Team: Rudi Brits (Team leader), Prof. Paul Bailey, Dan Rose and Kerryn Welke St John WA in collaboration with Fiona Stanley Hospital (FSH) and the South Metro Health Service (SMHS) is revolutionising emergency patient care thanks to its Australia-first, Virtual Emergency Medicine (VEM) service – designed to improve ambulance and emergency department (ED) flow. VEM allows paramedics to initiate a remote consult for non-priority 1 patients aged 16 years and over, with the aim of discharging on scene or diverting them to another suitable inpatient/outpatient service. The initiative is particularly beneficial for geriatric cases. It has successfully operated for about a year at FSH since its launch in February 2021. VEM was designed to improve patient outcomes with the aim of having far reaching impacts by significantly easing pressures on busy EDs and improve overall patient care and flow throughout hospitals and the wider WA health system. It could revolutionise ambulance patients’ transfer of care through its game changing emergency medicine model. VEM allows for a rapid pathway (e.g. ambulatory care, chest pain clinic or imaging) at FSH, or direct transport to Fremantle Hospital’s Geriatric Medicine.
Emergency Medicine
YOURFORTHANKRESPONSE.YOURDESERVESWORSTSOMEONE’SDAYBESTYOUGIVINGBEST.
This category is looking at management practice and operational improvement and innovation in: Management culture, open communication, accountability, management development, professional standards and diversity of workforce; and operational protocols, work practices. (Related to how service delivery is provided). Previous submissions looked at accountability in leadership, enhancing opportunities for junior managers, taking the lead in occupational violence, and increased health outcomes for ATSI people. Each service is encouraged to analyze the programs they have implemented that pave the way in leadership for future generations of paramedics.
Leadership Excellence in Awards for Excellence 2022 | 41 Sponsored by
The project builds tools and initiatives to better enable informed decisions to drive equity improvement across Ambulance Operations, with a focus on M aori, Pasifika and patients in lower socio-economic areas. These patient cohorts have been shown to have worse health outcomes and lower life expectancy. With this work we endeavour to weave health equity initiatives throughout our patient journey to ensure equitable access to ambulance services and cater for the holistic health needs of our communities.
Hato Hone St John is committed to providing an equitable ambulance service. To achieve this we have developed tools to identify inequities and support decisions to remedy them. This includes an Equity Scorecard, PowerBI Equity Dashboard, regular equity reporting and incorporating demographics in our simulation tool to apply an equity lens across resource planning.
42 | The Council for Ambulance Authorities Team: Dave Richards, Dan Spearing, Aroha Brett and Dumindri Amerasinghe
In addition, our Te Aka strategy (St John’s overarching M aori strategy) and Waka Manaaki Plan (delivering the key outcomes of Te 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, ultimately improving M aori health equity. We have already made decisions based on this equity framework, including locating additional resources in areas with high Pasifika populations and changing the priority of stations in patient centred deployment plans to improve access and response times to Pasifika patients. With our simulation tool now incorporating demographics, an equity lens will be applied to all future resource planning decisions.
This project aims to combine our theoretical framework with practical strategies to initiate organisational change; leading to equitable outcomes for all patients regardless of ethnicity, socioeconomic background and demographic. Part of this project is accepting that our systems are biased and that we need to take responsibility for the things that we are able to control and influence. Furthermore, this project places an impetus on M aori health equity. Not only do M aori have significant disparities in terms of health inequity but Hato Hone St John are determined to move towards an organisation that is aligned to the principles of te Tiriti o Waitangi.
Once we address these initial equity access issues, we will focus on equity in the quality of service we provide. With a focus on skill mix, ethnicity and the cultural competency of our workforce.
Excellence in Leadership Improving Equity St John New Zealand Entrant
During the 2021 Delta outbreak, NSWA transported more than 200 suspected or confirmed COVID-19 patients daily. This increased during Omicron outbreak, to an average of 270 per day. Paired with record breaking daily Triple Zero call volume peaking at 5,120 on 1 January 2022, NSWA has maintained emergency response capacity and the provision of high-quality care to the communities served, through a broad range of operational strategies, under the NSWA COVID-19 response.
With impacts from the global pandemic felt across the organisation, from a record demand for ambulance services through to staff furloughed from COVID-19 exposure or infection, the aim of NSWA response was to ensure the priority of the organisation to protect its people and ensure emergency response capacity. With the ongoing need to adapt to changing Public Health Orders and emerging variants and public health advice, NSWA has provided clear direction, through management procedures and concepts of operations and policy.
Team: David Dutton, Tony Gately and Wayne McKenna
As experienced across the broader health system, NSW Ambulance (NSWA) was presented with a range of pressures during the respective Delta and Omicron COVID-19 outbreaks.
Excellence in Leadership Patient flow - Delta to Omicron and beyond NSW Ambulance
Surging the NSWA workforce from frontline paramedics to control centre staff, implementing innovative IT driven dashboards and platforms, enhancing coordination with state partners and advancing new models of care and procedures, NSWA has demonstrated excellence in leadership through a broad range of strategic, agile and proactive strategies implemented across the organisation.
As an integral part of the NSW Health System, NSWA provides essential mobile health services and high quality clinical, rescue and retrieval services to the people of NSW with emergency and medical health needs.
Awards for Excellence 2022 | 43 Entrant
SA Ambulance Service Entrant
• Keeping on-road ambulance resources available for medical emergencies, e.g., using telehealth paramedics to provide clinical assessment via telephone and arranging alternative transport including taxis.
SAAS has consistently diverted more than 20% of patients from EDs since mid-2021, and some weeks the ED avoidance is nearly 30%.
• Health Navigators who arrange patient referrals to alternate pathways.
All of this is underpinned by a commitment to:
44 | The Council for Ambulance Authorities Team: Kate Clarke SAAS has undertaken a significant body of work in the last two and a half years to navigate more low-acuity patients to non-ED care pathways and collaborate with other health services to design, develop and implement new pathways.
• Connecting patients to services that can provide ongoing care, e.g., geriatrician and community-based mental health services.
• Maintaining the patient’s connection to their existing care providers, so the patient’s own GP and existing service providers are the first options considered by SAAS crews.
SA Ambulance Service is successfully diverting low acuity patients away from hospital EDs, connecting them to more appropriate care through:
Of note, unlike a number of other ambulance jurisdictions, SAAS includes all low acuity workload in its transport data, including interfacility transfers, which is not comparable to other ambulance jurisdictions. With this service delivery model and data set, a hospital avoidance rate of 20-30% is significantly high.
Clinical
Excellence in Leadership Hub Program
• Integration of 15 non-ED pathways into the SAAS service delivery model in the last three years.
• Providing more timely access to the appropriate level of care and services closer to home, e.g., by arranging Priority Care Centre referrals instead of ED presentations.
• Clinical Telephone Assessment paramedics who use telehealth to assess patients sooner.
• Easing pressure on the hospital system by avoiding unnecessary ED presentations.
• Remaining collaborative and integrated within SA Health as a partner, ensuring patients are connected and supported within the system.
The main objectives of the NSQHS Standards project were for SAAS to, firstly, implement the NSQHS Standards across the organisation and, secondly, achieve accreditation in the NSQHS Standards. Both objectives have been accomplished, consequently, the project has been an ongoing success.
Awards for Excellence 2022 | 45 Finalist
The most obvious outcome of success is the fact that SAAS has been externally assessed and successfully achieved accreditation twice in the NSQHS Standardsand is the first ambulance service in Australia to do so. Accreditation has assisted SAAS in:
In 2013, the National Safety and Quality Health Service (NSQHS) Standards were introduced by the Australian Commission on Safety and Quality in Health Care to assist health service organisations with their delivery of safe and high-quality care. Implementing the NSQHS Standards is mandatory for all hospitals and day procedure services across Australia, but this mandate currently does not apply to ambulance services.
• Implementing tools to improve performance, outcomes and quality assurance.
• Building a more efficient organisation with increased capability.
• Building an improved culture of quality.
• Reducing risk.
• Providing the South Australian community with confidence that SAAS services are continuously being improved.
Excellence in Leadership National Safety and Quality Health Service (NSQHS) Standards Program SA Ambulance Service
Team: Graeme Rayson
In December 2021, SAAS was awarded accreditation for the second time, sending a clear and powerful message to the community and ambulance sector that SAAS is committed to safe, quality patient care.
SA Ambulance Service (SAAS) was first awarded NSQHS Standards accreditation in January 2018 and, by doing so, became the first Australian ambulance service to achieve this recognition. The latest accreditation was significantly different to the first and a significant undertaking.
Accreditation in the NSQHS Standards is a milestone event and validates the professional attention to detail which has characterised SAAS’s approach to the accreditation program and, specifically, to the quality of care provided to our patients. With accreditation recently received, we recognise the need to continuously review and improve our systems and processes to ensure patient care in South Australia is SAASoptimised.isusing 2022 to transition the program to a sustainable ‘business as usual’ model. Integrating a revised NSQHS Standards committee structure into the organisation’s existing governance framework, a decision approved by the organisation’s executive leadership team (ELT).
• Improved cardiac arrest survival as double crewed ambulances have higher survival rates.
The Double Crewing Project was established to deliver our new service delivery model, adding approximately 375 new staff and allowing St John to deliver on its vision to end the single crewing of emergency ambulances in New Zealand by 2021. During this project 135 stations underwent some form of assessment or change process and new transport-capable first response units for volunteers were introduced. This project demonstrates a successful approach to large change management for ambulance services.
A previous issue impacting major incident support equipment deployment was expertise around equipment and process being held by senior clinicians, that during the incidents, had no capacity to focus on the support process in favour of being directly involved in the treatment and transport of acute patients. The aim was to delineate clinical and support roles, and ensure consistent deployment of MIST resources unimpeded by clinical workload or current personnel availability.
At project completion, 99.8% of ambulances are double crewed, essentially eliminating single crewing. The increase in double-crewed responses has also had a positive influence on out-of-hospital cardiac arrest survival to 30 days, which increased from 11.1% to 16.8%. Inequalities have also been addressed, previously only 90% of M aori patients received a double crewed ambulance compared to 95% for non-M aori; only 92% of patients in high deprivation areas received a double crewed ambulance compared to 97% for low deprivation areas. There is now equality and a better ambulance Thisservice.project aimed to eliminate single crewing of ambulances in New Zealand through the implementation of a new service delivery model (NSDM) and the addition of approximately 375 new staff over four years.
Excellence in Leadership Double Crewing Project St John New Zealand
• A decreased number of ambulances and an increased number of volunteer First Response Units in rural Toareas.increase the utilisation of this equipment by supporting this with a dedicated, non-clinical team focused solely on the supporting and peripheral aspects of major incidents, rather than getting distracted with the provision of prehospital care.
• Improved clinical care of our patients by having an ambulance clinician with them enroute to hospital.
46 | The Council for Ambulance Authorities Finalist
The goal of the project was that by June 2021, 100% full crewing of transporting ambulances would be realised and that nationally we would see:
In the 2016/17 financial year, only 91.2% of ambulance responses at scene were double crewed, meaning that over 35,000 ambulance responses a year had only one crew member.
The implementation of the NSDM resulted in a steady decrease in single crewing of transporting ambulances, from over 35,000 responses in 2016/17 to almost zero.
Team: Susanne Doddrell and Dave Richards
• Improved health, safety and wellbeing for our staff, by reducing fatigue, manual handling injuries and associated levels of stress.
• A sustainable volunteer model with volunteer numbers in Ambulance Operations maintained at 3,000 with approximately 1,500 on ambulances and 1,500 on First Response Units.
Awards for Excellence 2022 | 47 Finalist
Team: Craig Emery
The rapid emergence of the COVID-19 threat posed significant challenges for all organisations, in particular for those responsible for health care delivery. The potential impacts of the COVID-19 pandemic event were both complex and unpredictable, with the constantly evolving environment presenting a substantial challenge for planning and response.
3. Provided leadership across the organisation, identifying opportunities to inform future leadership capability and development frameworks;
Excellence in Leadership Crisis Leadership – A Leadership Excellence Case Study: The use of intentional leadership and Incident Management Systems to lead an organisation through the COVID-19 pandemic
1. Delivered an agile and scalable approach to ensure that ambulance service delivery capacity is maintained on a statewide basis;
The strategic intent of the QAS response to the COVID-19 Pandemic was to provide appropriate direction to the organisation by maintaining the level of ambulance service capacity required by the Queensland community in an environment where demand is substantially escalated. To this end, the QAS:
4. Consolidated shared alignment, optimal performance management, and a mindset of continuous improvement;
7. Established a sustainable command and control structure across the QAS, having regard for the event, including the management arrangements for human resourcing, fleet, critical inventory items, personal protective equipment, Central Pharmacy, and infection control consumables.
The QAS made a commitment to ensuring a flexible and innovative approach to planning using crossdisciplinary teams, providing a new standard for ambulance operations in Queensland and in particular, for the planning associated with large scale events or disruptions.
The true legacy of COVID-19 for the QAS is the development of the QAS leadership capability development framework and the enhanced collaborative capability that can be extended to other aspects of QAS service delivery.
6. Enhanced existing disaster management practices to provide holistic oversight of organisational challenges associated with the pandemic response and related demand surge;
2. Supported the Whole of Government COVID-19 response through the continued delivery of the QAS Mission to deliver timely, quality and appropriate, patient focused ambulance services to the Queensland community;
Queensland Ambulance Service
5. Provided improved levels of emotional, strategic and operational intelligence;
The Queensland Ambulance Service (QAS) leveraged well practiced disaster management prevention, preparation, response, and recovery functions, and combined these with Incident Management System frameworks, project management principles and the commitment to future capability and development to lead the organisation through the COVID-19 pandemic.
48 | The Council for Ambulance Authorities
CAA welcomes the introduction of this new category in 2021. With mental health in our patients and our staff such a prominent focus in the field of paramedicine in the past decade, we are seeing exciting innovation and excellence by all. Each service is encouraged to continue to shine in this field and share with us their innovation and improvements in mental health and wellbeing.
Mental Health & Wellbeing Excellence in Sponsored by Awards for Excellence 2022 | 49
50 | The Council for Ambulance Authorities Team: Sandra Garner
The QAS Mental Health Response Program supports paramedics and Emergency Medical Dispatchers in their assessment and decision making around people experiencing mental health crisis. Along with improved education and training, the QAS has implemented at a statewide level, the Mental Health Liaison Service (MHLS) in the Operations Centre, 24 hours a day and QAS Mental Health Co-Responders (MH CORE) program.
The QAS considers mental health crisis as a broad range of conditions, including risk to self or others, poor decision-making capacities/capabilities, distress, and abnormal behaviours. These presentations are marked by distress, including an inability to cope and the requirement for alleviation of the presenting symptoms.
Excellence in Mental Health and Wellbeing Mental Health Response Program Queensland Ambulance Service Entrant
The QAS Mental Health Response Program aims to pivot and adapt their delivery of service to new and innovative systems of care, to provide the best possible outcomes for all patients. The QAS has embraced new models of care for people experiencing a mental health crisis. The QAS also has a strong appetite to utilise appropriate alternate pathways to hospital Emergency Departments (ED), to ensure that people in mental health crisis receive the most appropriate care, in a timely manner.
The MHLS involves a Senior Mental Health Clinician working in the Brisbane Operations Centre to provide information, advice and assistance to EMDs, supervisors, managers, paramedics statewide, 24 hours a day, in an effort to support the timely and appropriate dispatch of resources to people in a mental health crisis, and to assist attending paramedics’ clinical decision making on scene.
The QAS MH CORE pairs a senior Queensland Health Mental Health Clinician with a QAS paramedic, operating both in metropolitan and regional areas throughout the state. The MH CORE provides timely, appropriate and specialised services to people in mental health crisis in the pre-hospital setting.
The QAS responds to all people in crisis and does not discriminate on age, geographical location, intellectual capacity, drug and alcohol intoxication or mental health status. The service is available 24 hours a day and is often the first step in accessing health services, or a last resort once all other avenues have been exhausted.
The QAS Mental Health Response Program aims to create a better life for people experiencing a mental health crisis, who access services through Triple Zero, through timely access to appropriate mental health assessment and treatment.
By undertaking a robust and comprehensive review of all elements of the VACU network, AV strove to build confidence and improve access and outcomes for its people.
AV’s goals were to decrease barriers to accessing support for treating psychological illness and stress and to improve the mental health and wellbeing of AV people at a time when this support was needed more than ever.
Strong clinical and commercial governance was essential to deliver a high-quality service and increase access for staff in regional areas (through more service providers and/or telehealth).
At a time when supporting the mental health and wellbeing of AV’s people is more important than ever, this project resulted in an increase in the number and quality of clinicians and increased service use, despite an extraordinary strain on the mental health profession due to the COVID-19 pandemic.
Team: Sophie Barrett and Kerry Duncan
As the demand for this service provision grew, AV recognised that governance was essential to ensure a high standard of clinical expertise; all clinicians, existing and new, were required to undertake a tender process. This has ensured a robust, compliant process, the integrity of funds spent, and quality health care providers.
Excellence in Leadership Victorian Ambulance Clinicians Unit (VACU) Review and Expansion: Improving the quality and access of psychological support, counselling and treatment to all Ambulance Victoria employees, first responders and their family members
Contracts were managed directly with clinicians rather than by an external EAP (Employee Assistance Program) provider, a unique model compared to most healthcare or emergency services agencies.
The aim of the project was to improve VACU services and increase uptake by Ambulance Victoria (AV) employees, first responders, and their families.
The project involved AV’s in-house Wellbeing and Support Services Team, in close collaboration with AV’s Procurement & Commercial Team, contracting a panel of psychologists and social workers to deliver mental health support through AV’s VACU network.
Ambulance Victoria
The VACU Review and Expansion project focused on improving the quality of and access to psychological support, counselling and treatment for all AV employees, first responders and family members.
Awards for Excellence 2022 | 51 Entrant
Supporting all staff in their physical and psychological health has been a fundamental principle of the 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, and this has helped create opportunities to proactively tailor the support and services provided to our people.
Staff mental health and wellbeing became, and continues to be, a core focus of our organisational response to the COVID-19 pandemic. The service has made a real difference to COVID positive staff members and close contacts by offering extensive proactive welfare checks, developing and distributing staff quarantine care packs and providing proactive advice through regular communications.
a holistic approach is a priority within all our staff wellness and assistance activities, ensuring we promote the ‘whole of person’ when looking at health and wellbeing. To encourage this, particularly within a COVID-19 quarantine environment, the provision of quarantine welfare packs was identified as a simple way for SA Ambulance Service (SAAS) to demonstrate organisational care and support for our people and foster positive health outcomes, even when separated by isolation requirements.
Increasing our staff wellness response has been pivotal to the positive engagement and feedback experienced by our staff, ensuring our staff feel both supported and valued throughout the prolonged period of the pandemic.
SAAS included a Staff Wellbeing role as a staff member within its COVID-19 Incident Management Team (IMT), strengthening, enhancing and pivoting staff mental health and physical wellbeing services to meet the varied challenges created by the pandemic.
At SAAS we generally adopt and encourage a shared responsibility approach to wellbeing, however in response to COVID-19 we refocussed to increase our proactive support. Ensuring access to services was easy, seamless and timely was imperative to help protect the physical and psychological safety of our people.
Excellence in Mental Health and Wellbeing COVID-19 Response SA Ambulance Service Entrant
52 | The Council for Ambulance Authorities Team: Chris Howie COVID-19 presents many unique challenges for all health and emergency services personnel, however, when these are then overlayed with the individual experiences and challenges faced by our people at a professional, but equally importantly - a personal level, the potential cumulative effect of these factors cannot be Maintainingignored.
Ongoing collaboration between our Staff Wellness and Assistance (SWA) team, our EAP provider and the IMT has also ensured a wellbeing lens was cast on all decision making, enabling the welfare of our people to remain at the core of everything we undertook.
What makes the program unique is the internal support available from the NSWA Health and Fitness team -health coaches, injury prevention specialists and psychologists. As part of the program, tailored resources including a Medic Fit Program Guide, an online exercise library, and NSW Ambulance injury prevention program have been developed to support staff in safe use of the exercise equipment.
There is mounting evidence that suggests exercise is an effective component of treatment for people living with mental health issues. Exercise can make a big difference in mood and promoting positive mental health. It can also help reduce the symptoms of mental illness.
Medic Fit NSW Ambulance
in Mental Health and
Team: Nam Le NSW Ambulance (NSWA) recognises that supporting our staff’s health and wellbeing is vital for gold standard ambulance service delivery. To assist our paramedics with the requirements of their role, in 2019/20 NSWA developed the Medic Fit program. The program provides exercise equipment at over 240 worksites to provide staff with accessible opportunities to undertake low intensity and functional exercises in the workplace.
An evaluation survey requesting feedback from participants using the Medic Fit program found:
Excellence Wellbeing
The Medic Fit program encourages our staff to exercise when time allows, while promoting a culture of physical activity. The aim is to foster a positive health and wellbeing culture that supports our staff to better manage the demands of their role, reduce the risk of injury and improve their overall physical and mental health and wellbeing.
Participation in the Medic Fit Program is voluntary and designed to fit around work demands. It focuses on helping reduce the risk of mental illness and physical injuries.
• 70% of employees agree or strongly agree that the Medic Fit program has helped them improved their physical health.
Awards for Excellence 2022 | 53 Finalist
• 64% of employees agree or strongly agree that the Medic Fit program has helped them improve their mental health and improve their ability to meet the inherent requirements of their role.
As of March 2022, there are over 1600 NSWA employees inducted into the Medic Fit program.
• 80% of employees surveyed used the Medic Fit exercise equipment at least once a week.
The MyPulse program is a collection of health and wellbeing content and services offered to Ambulance, State Emergency Service, Fire, and Police in Tasmania and is tailored specifically to their unique needs and place in the community.
Ambulance Tasmania (AT) together with the Department of Police, Fire and Emergency Management (DPFEM) recognised that significant issues existed with the wellbeing of emergency service responders (including career, volunteer and state service personnel). An analysis of the issues identified that there was a need to reimagine our approach to wellbeing, with a particular focus on the proactive dimension. The result – the tremendously innovative MyPulse Health and Wellbeing Program.
Excellence in Mental Health and Wellbeing ‘MyPulse’ Health and Wellbeing Program for Tasmanian Emergency Services Workers Ambulance Tasmania
The effectiveness of the program is measured through the data and insights developed through participation and inform the evolution of the program. MyPulse provides emergency service responders and their families access to tools and resources to help improve their physical, mental health and overall wellbeing both on the job and in their personal lives, with 24/7 access.
MyPulse provides proactive and preventative pathways designed to empower emergency service responders and their families to enact positive behavioural change. Emergency service responders can do this with the assistance of face-to-face sessions with wellbeing Whistcoaches.MyPulse commenced in late 2019, 2021 saw significant changes to the service that amounted to a major re-orientation of the program to ensure it was available to, and appropriate for, volunteers. In addition, as part of a vigorous reshaping of our concept of wellbeing, a comprehensive engagement strategy including the development of Lived Experience videos, was implemented.
MyPulse is a comprehensive suite of information and resources to be delivered to emergency service responders and their families. It provides access to a range of fundamentally important screening tools to assist emergency service responders to understand their mental and physical health needs. Should an emergency service responder display moderate to high risk factors they are entitled to access face-to-face coaching sessions to address the specific area of need. Ultimately, it is leading to a healthier emergency service sector.
MyPulse was created to enact positive behavioural change within emergency services. It demonstrates the organisational commitment to the importance of our people, establishing trust in the ethos by providing access to the best quality coaching services available - all at no cost to the employee (including volunteers).
54 | The Council for Ambulance Authorities Finalist Team: Tessa Campin, Matthew Richman
The model allows mental health nurses within AV’s Secondary Triage team to conduct remote, face-to-face assessment of patients as part of the triage process.
Awards for Excellence 2022 | 55 Finalist
Evaluation received funding from the Better Care Victoria Innovation Fund to trial video triaging of mental health patients through an initiative called TeleHELP AV Telemental HEaLth Pilot).
AV’s goals were to improve access to and quality of care for mental health patients calling Triple Zero (000).
AV also sought to reduce unnecessary transport of mental health patients to hospital emergency departments (EDs) by implementing the SMS-initiated video Overall,triage.the15-month
TeleHELP pilot demonstrated that video triage can be successfully implemented into Secondary Triage Services. Despite relatively low uptake of the video triage, results from the pilot demonstrate that video triage by a specialist mental health clinician is associated with a reduction in emergency ambulance dispatches and increased referrals to alternative service.
TeleHELP allowed mental health nurses within AV’s Triage Services to conduct remote face-to-face assessments with patients who contacted Triple Zero.
Previously, low acuity mental health patients were transferred to a mental health nurse for triage within AV’s Secondary Triage Service. Through TeleHELP, eligible patients who are transferred to a mental health nurse are now offered the option of video triage as an extension of voice-only triage. Patients who consent to video triage are sent a video link via SMS that enables two-way live video streaming between the mental health nurse and patient.
The TeleHELP model uses a patient-centred approach and upholds patient safety and quality of care. The model also provides mental health patients with an alternative to receiving an emergency ambulance and/or being transported to a hospital emergency department (ED).
Excellence in Mental Health and Wellbeing
Telemental HEaLth Pilot – TeleHELP Ambulance Victoria
The use of video triage facilitates a more accurate assessment by mental health clinicians who can then refer patients to the most appropriate pathway of care at the time of call.
Team: Professor Karen Smith, Nicole Magnuson, Lindsay Mackay, Gareth Becker, Mark Wilson, Angela AmbulanceHodgkinsonVictoria’s (AV) Centre for Research &
56 | The Council for Ambulance Authorities 2023 ExcellenceAwardsCAAfor Keep an eye out on CAA’s social media for updates on the 2023 CAA Awards for Excellence
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