Changes to the way Ambulance Victoria triages and dispatches ambulances are leading to better patient outcomes and quicker response times.
Not everyone who calls Triple Zero (000) needs an immediate Code 1 “lights and sirens” ambulance response. When ambulances are tied up on cases that are not emergencies, they are less available for people in the community in genuine need.
In 2015, Ambulance Victoria undertook a comprehensive review of its dispatch grid – a database of more than 1000 classifications that are assigned to patients during Triple Zero (000) calls.
The review found 255 classifications that previously resulted in a Code 1 “lights and sirens” response were more suitable for a less-urgent ambulance response or more comprehensive triage by paramedics or registered nurses.
A further 71 case types that previously automatically led to a Code 2 response (not lights and sirens) were suitable for further assessment triage to provide patients the most appropriate response.
As a result, Ambulance Victoria progressively introduced a revised Clinical Response Model, with each stage subjected to stringent assessment, trial, evaluation and rigorous clinical oversight by medical experts.
Safer Care Victoria, the peak state authority for leading quality and safety improvements in healthcare, convened an independent clinical panel to review the evaluation of the revised Clinical Response Model. Based on its review, Safer Care Victoria have advised Ambulance Victoria that:
Safer Care Victoria are satisfied with the approach taken by AV to evaluate the impact of the revised clinical response model.
Safer Care Victoria are further satisfied that AV have implemented the revised model in a manner that is staged, monitored, and clinically appropriate.
Safer Care Victoria support the revised clinical response model as a clinically appropriate, evidence based improvement to resource allocation.
Safer Care Victoria acknowledge that changes to the AV Clinical Response Model were delivered safely through a rigorous and evidence based approach, including clear and effective oversight and planning, risk identification and mitigation, staged implementation, and extensive monitoring and audit.
Benefits of the changes
The changes have been fully in place since October 2016 and are leading to better patient outcomes, even with an increase in calls to Triple Zero (000):
More Victorians are surviving cardiac arrest than ever before and ambulances are reaching them in record time, with – an average response time to cardiac arrest patients of 7.7 minutes in 2016-2017. Paramedics attended 6,034 cardiac arrest patients in 2016-2017 – the most ever – and survival for patients in a shockable rhythm to hospital discharge was the highest ever at 34 per cent. In 2016-17, a record 379 patients were discharged alive from hospital – 21 more than the previous year.
The percentage of suspected stroke patients transported within an hour to specialist stroke facilities has climbed to 97.8 per cent in the final three months of 2017 compared with 87.9 per cent in the three months to September 2015.
81.4 per cent of Code 1 ambulances arrived within 15 minutes in the final three months of 2017, compared with 74.6 per cent before the new clinical response model.
Average response times for less-urgent Code 2 patients has have also improved to 26 minutes and 20 seconds in the final three months of 2017, compared with 30 minutes and 45 seconds before the new clinical response model.
What happens when I call Triple Zero (000)?
All Triple Zero (000) calls for ambulance undergo a rigorous triage to assess patients’ individual requirements and ensure they get the right care that they need.
The safety and wellbeing of patients is our priority, and when people call Triple 000 there are multiple safeguards built into how we assess individual requirements and prioritise urgent health needs.
Experienced paramedics or registered nurses ask a series of questions of less-urgent Triple Zero (000) callers to find out more information about an individual’s health issue and explore alternative options to emergency ambulance.
This can include sending non-emergency transport, connecting patients with a doctor or pharmacist, or providing health advice to treat conditions safely at home.
If someone has an emergency and they need an ambulance, they will get one, with an ambulance dispatched to more than 90 per cent of calls to Triple Zero (000).
The call taking and dispatch system
The computer aided call taking and dispatch system used by Ambulance Victoria is also used by more than 3000 ambulance services worldwide.
When categorising Triple Zero (000) calls, the system assumes people are calling for an acute emergency whee this isn’t always the case.
For example in the “Burns/Explosions” category people’s injuries range from minor sunburn through to injuries due to an explosion. Before the changes, patients in this category were often getting an immediate lights and sirens response when there wasn’t a genuine or time-critical emergency.
While Ambulance Victoria cannot alter the names of the case classifications of this commercial product, we use our experience and a clinical database of more than 10 million patients to determine the right response. This is our dispatch grid.
It ensures that emergency ambulances are dispatched Code 1 to patients seriously injured in an explosion, and patients with sunburn get a response more appropriate for this condition.
Changes we have made decreased the proportion of Code 1 emergency ambulance from 51.8 per cent of Triple Zero (000) calls to 40.5 per cent. This matches proportions seen in ambulance services internationally, such as the UK.
Ambulance Victoria has been making, and will continue to make, every effort to explain these changes and what they mean for Victorians.
Patients can be assured that they are getting a better response as a result of these changes.
Types of cases that were Code 1 under the previous model
Minor burns, including sunburn and minor scalds
Minor animal bites
Minor traffic accidents with very minor injuries such as a sore hand
People who have fainted and fully recovered
People who feel sick and a little drowsy but have no other symptoms.
Real examples of patients receiving a Code 1 ambulance when their condition was not time critical under the previous model:
Patient stuck in a window. No injuries. No ambulance transport.
Dog bite, small puncture to hand. No ambulance transport.
Spilled boiling water. Minor 1% burn to hand.
Fallen over and rolled ankle.
Laceration to finger/thumb.
Irritated foot after wading in sea seven hours earlier.
Patient anxious after seeing a scorpion. No ambulance transport.
Minor irritation of eye after rubbing on bedsheet. No ambulance transport.
Wet from being exposed to rain. No illness.
Blocked tear duct for four months.
The specific changes to the way Triple Zero (000) calls are triaged and ambulances dispatched to less-urgent cases are published here for the first time.
While this information could be easily misinterpreted without explanation, Ambulance Victoria has accepted advice from the Office of the Victorian Information Commissioner that it is in the public interest to explain the specific changes introduced through Ambulance Victoria’s revised Clinical Response Model.
The revised Clinical Response Model was further reviewed and endorsed by an independent multi-disciplinary advisory panel convened by the Victoria Minister for Health and Ambulance Services. This panel comprised of emergency medical specialists, a medical epidemiologist, a senior nurse, primary care physicians, community members and an independent chair.
On review, Safer Care Victoria acknowledge that changes to the AV Clinical Response Model were delivered safely through a rigorous and evidence based approach, including clear and effective oversight and planning, risk identification and mitigation, staged implementation, and extensive monitoring and audit.