Media release – Vica Bayley MP, Greens Member for Clark, 26 October 2023

Harrowing Submissions to Ambulance Ramping Inquiry Published

Dozens of Tasmanians have shared their harrowing stories with the Parliamentary Inquiry into ambulance ramping, with submissions made to the inquiry now published online and publicly available for the first time.

The devastating accounts from patients, families, paramedics, nurses, doctors, and others paint a stark picture of the terrible impacts ramping is having on our community. Tragically, we know the submissions to the inquiry are only the tip of the iceberg, with an average of nearly 2000 people now subjected to ramping every month in Tasmania.

It’s incredibly distressing to read so many awful situations experienced by Tasmanians. In these stories we have patients being put at greater risk while waiting for hours for appropriate care; families being separated from their loved ones while they pass away in pain; young mental health patients escaping to try and take their own life; patients accidentally overdosing on painkillers provided by the hospital; serious mental health impacts on staff; the flow on impact of ambulances not being available to respond when needed – the awful list goes on.

Disturbingly, we know situations like this are becoming more common every year, with ambulance ramping occurring five times more often now than it did in 2015, and waiting times for patients extending further and further.

Despite the obvious harm ramping is causing to so many Tasmanians, the Liberals have been downplaying how serious things are and doing their best to cover up the full extent of the issue. This denial and secrecy is exactly why the Greens moved to establish this Parliamentary Inquiry, and we are hopeful it can help to drive real, positive change.

The Greens offer our deepest thanks to all those who bravely shared their story about ambulance ramping with this inquiry, and we are committed to doing everything in our power to make sure the government takes notice and finally starts taking action.

A collation of key excerpts from submissions to the inquiry is available here (reproduced below).

A list of all submissions, the inquiry’s members, and the terms of reference are available here.


Media release – Anita Dow MP, Shadow Minister for Health, Mental Health and Wellbeing, 26 October 2023

Minister Barnett should commit to making paramedic positions permanent

New Health Minister Guy Barnett must value and respect our paramedic workforce and convert those paramedics on short-term contracts to permanent positions.

Earlier this week, a number of permanent paramedic jobs were publicly advertised despite the fact many paramedics across the state are still on short-term contracts.

Minister Barnett should commit as a matter of priority to appointing those workers currently employed on short-term arrangements to these permanent positions providing much needed job security.

The insecure working arrangements are making it extremely difficult to recruit and retain paramedics in Tasmania, who are enticed elsewhere by better pay, conditions and permanent work.

Across the north-west there are eight full-time equivalent vacancies with a number of paramedic shifts going unfilled, putting further pressure on regional ambulance stations and our emergency departments.

Understandably, our paramedics are burnt-out and any remaining goodwill is fading.

Even the government’s own Operational Research in Health Report shows that an additional 126 paramedics are needed across the state.

Since the Liberals came to office 10 years ago, ambulance response times have increased by almost 10 minutes and Tasmanians and our paramedics spent 31,000 hours ramped from July 2022 to May 2023.

A Labor Government will invest $6.5 million to support our state’s paramedics and improve ambulance response times, creating additional permanent paramedic positions across regional Tasmania.

Looking after workers is in Labor’s DNA and we stand side by side with our hardworking paramedics.

Ambulance Ramping Inquiry Submissions – Key Excerpts

Patient Experiences

Submission #29 – Patient
• Arrived by ambulance to LGH from Bicheno, East Coast Tasmania with >40ºC temperature – hallucinations, dropping in and out of consciousness, sever [sic] abdominal pain, fever, total lethargy… Ambulance staff could not get me into the Emergency Dept on the evening of 5th… 5th to 8th Sept… I saw three sunrises from within the LGH waiting room and only then was seen to by Emergency staff…

Submission #32 – Patient
• I am 93 years old and two weeks ago I fell and fractured my pelvis. An ambulance was called and took 3 hours to get to me, and I arrived in RHH at about 4.30pm. I was ramped until nearly midnight before being transferred to the Emergency Department proper. I was then taken to a ward at 4.00am!

Submission #28 – Family of Patient
• On Friday 24 March at around 8pm, my sister was contacted by Korongee staff, who said that my mum wasn’t well, with stomach pains, and they had called an ambulance. They said they would phone back when the ambulance arrived, so we could meet them (with mum) at the hospital… The ambulance finally arrived at almost 2am – 6 hours after being called. In those 6 hours, my mum’s pain became worse. She could not keep anything down, and so had not had… About 5am, after being scanned and checked by medical staff, I was told that mum had a perforated bowel. She died 5 days later.

Submission #14 – Patient
• In 2018 I was hospitalised after collapsing at work. An ambulance was called and responded rapidly, the crew of two acting quickly and professionally. On our way to the Royal Hobart Hospital I joked about whether I would be “ramped” or not as the topic had been in the news. When we arrived I was told “well, guess you will be after all.” After being unloaded from the ambulance, I was then required to wait on the ambulance stretcher with the two paramedics. This was in a corridor at the RHH, which seemed to have a significant number of ambulance stretchers present. I waited for roughly 2-3 hours before I could be seen in the Emergency Department.

Submission #7 – Family of Patient
• Upon arrival at RHH, the driver was not able to actually park at Emergency. My mother was taken in with one officer, whilst the other moved the ambulance to another area. Why this is an issue is that because paperwork and handover had to be done… no one (for that period) was able to be with my mother in the corridor
• … other patients who had also arrived directly by ambulance had to remain in the corridor, including a mother and her infant. It was four hours before Mum was moved into emergency.

Submission #1 – Patient
• When we arrived at the LGH I was wheeled in through the doors and treated in the corridor. I was then left to sit semi naked in the waiting room. The staff grabbed me a blanket and told me there were “no beds because they are full of people from upstairs” . My medical condition was then discussed in the waiting room. There was a lady in the waiting room who had a drip who I think had had a miscarriage but I can’t remember the details now. So that lady needed a bed more than I did.

Submission #26 – Concerned Citizen
• I rung 000 about 2:30pm requesting an ambulance for the young woman who was sobbing on the floor, holding her stomach, uttering her partner had hit her and she was pregnant.
About 20 minutes later a police car arrived from Huonville, trying to speak to the young woman. Her response was “I need an ambulance, I don’t need police”. One police officer suggested after some time, if the father of the perpetrator, who was present (and also in the house when the assault took place) could drive the young woman to the RHH emergency department???
The police men then got an update that an ambulance was on it’s way and should be arriving in 20 minutes. At about 4pm the policemen told us that the ambulance was not coming anymore.
The young lady got into the car with the father of the perpetrator to seek medical assistance, the police car left, and I was left hoping that nothing bad would happen and thoroughly disappointed with our ambulance service missing in action.

Healthcare Workers and Other Staff

Submission #27 – Youth Worker
• Long ramping times and waits in ED mean that I have seen young people abscond and attempt to go to the bridge to attempt to take their own life… Thankfully these attempts to date have been unsuccessful, however if we continue to have increasing ramping, inadequate supports /reduced capacity in ED then it is only a matter of time until we see a completed suicide from one of the young people we support, who so desperately need our government to step up and take notice

Submission #16 – Paramedic
• I attended a case where I was a single officer, I was told my backup was coming from close by. On arrival the patient was unwell with a significant gastric bleed, after waiting for my back up to arrive for some time, I called to enquire of their location, only to be advised that communications had cancelled them and sent them to another case… I was told I could have a backup crew if they could get one off the ramp. I was located in Orielton at the time, I was then advised that all other crews were ramped and I would have to wait for an afternoon shift to start
• Attended a case of female with recent diagnosis of ?liver cancer, pre-COVID… On arrival at DEM, this patient was ramped along the back corridor near the staff toilets. Whilst being ramped it became apparent that the patient had entered the actively dying phase. I liaised with hospital staff and triage multiple times over the hours of being ramped… The patients daughter and husband were in the waiting room but not allowed to sit with her due to ramping restrictions. Eventually this patient was moved to a room for the last minutes/hour of her life.
• Attended a mental health patient that had actively attempted suicide. This patient had also attempted to abscond from the ramping area. During the ramping time the Mental Health Order, which legally can only be in place for the hours outlined in the order, ran out – meaning that there was no legal standing for holding the patient at the hospital against their wishes.
• I attended a patient with a significant pulmonary embolus, this patient was unwell and had vital signs to support this. We were asked to ramp in the corridor, despite the new “ramping area” being set up at that time – this patient was “too unwell” to go around but also was not given a resuscitation bay or a bed. On moving the patient onto a hospital bed the patient lost consciousness, became apnoeic, with a faint carotid pulse – ultimately pre-cardiac arrest. I pushed the Emergency Bell in the hallway and pushed this patient around to the resuscitation bays. After this occasion I left the hospital and left work for the rest of the day. This particular job had a detrimental effect on my mental health.

Submission #5 – Healthcare Worker
• I have worked at the LGH for over 15 years. And l have never seen it like it is now.
• Doing an ECG to look at [the patient’s] heart is a project because there is no private space to remove their gown and place dots on their chest, connect an ECG machine and look at heart patterns and rhythm.
• You expect quality care and good decision making in a very suboptimal environment where the basic work cannot be done and expect no deaths. You expect no mistakes. You set the staff up to fail with a patient who is sick who can not be examined.
• How do you expect us to toilet a patient in the hallway when they can’t walk?
• Paramedics, who are not employed as nurses, are sitting for hours at the bedside of a ramped patient. Instead of being out on the road helping in emergencies, their role has changed to babysitter. It was not what they trained to do.

Submission #38 – Paramedic
• We were dispatched to a 24YO patient (Patient Y) who had come off a motorbike and slid into a street sign… we suspected Y had a fractured femur or pelvis. The patient was extricated from the scene utilising full spinal precautions and treated with intravenous fentanyl – a potent analgesic for their leg pain. We transported Y to the Royal Hobart Hospital and were ramped in the corridor immediately on arrival.
Because it was the end of our shift, I handed Y over to another paramedic that was commencing their nightshift… The next day, I was advised by the other paramedic that Y was subject to further fentanyl administration whilst ramped for pain, and then further analgesia from the hospital at the same time.
However, no one had recorded how much fentanyl the hospital had administered, because they had not written it in the patient chart of Y… The patient was subject to an adverse event through the administration of too much narcotic medication, by two separate agencies at the same time… Luckily, patient Y recovered from this overdose.
• … I heard some screaming and a call for help. I was sitting at the computer station in the ramp corridor immediately adjacent Ramp Room 6 and was shocked by what I was confronted with walking through the door; a half-naked patient lying on the floor, screaming in pain, and their foot was at right angles, with blood coming out from a compound (open) fracture. There was a large pool of blood on the floor and blood sprayed up the wall.
To top off a very confronting, messy, stressful scene, when I returned to my own ramped patient, I passed Ramp Room 6 and saw a colleague cleaning up the blood with a box of tissues, because we have no access to proper cleaning supplies in the corridor. This broke my heart, and I think of this often.
I assisted them in this task, and completion of the SRLS, and then went back to the Ramp – my own patient had been left unattended for quite some time whilst I was holding patient Z’s foot on.

Submission #43 – Acting Director of Royal Hobart Hospital ED
• The lack of appropriate spaces to see patients leads to increased adverse events, longer hospital stays and increased morbidity and mortality.
• Adverse patient outcomes and poor patient experiences are associated with ambulance ramping. Significantly, new patients presenting to an ED have a 10% greater chance of dying when more than 10% of patients waiting for admission are access blocked. In the RHH context that means patients are 10% more likely to die if we have 3 access blocked patients in ED. It is a rare day if we start below 20-28) patients who are accessed blocked. By extrapolation, the effect on mortality is obvious.
• There is good evidence to show that TOCDs [ramping] also delay access to definitive assessment and care because of slowed ambulance response times, including clear evidence of increased 30- day rates of death. Anecdotally we have firsthand knowledge of paediatric cardiac arrest on the Tasman Bridge due to unavailability of an emergency ambulance (whilst multiple ambulances were only 2 kms away at the hospital unable to offload their patients).
• Violence to staff has become an unwelcome daily companion to ED staff. This further impacts staff retention with cumulative moral, psychological and physical injury resulting in senior staff leaving the workplace.

Stakeholder Submissions
• Health Consumers Tasmania
• ANMF
• AMA Tasmania
• Pharmaceutical Society
• Pharmacy Guild
• Australasian College of Emergency Medicine
• HACSU
• Australasian College of Paramedicine
• Primary Health Tasmania
• Rural Doctors Association of Tasmania