A record number of South Australian paramedics are under investigation following a spike in adverse outcomes, including death, stemming from their decisions not to transport a patient to hospital. In the first calendar year since the $2.4 billion Royal Adelaide Hospital opened, up to 20 “adverse events” were identified, up from about a handful in previous years, according to sources within SA Ambulance Service. In correspondence circulated to paramedics, SAAS management said there was “a large and renewed focus on non-transport decisions as a result of a number of adverse events” that had resulted in deaths. Each event is being investigated, with “absent, poor or incomplete patient assessment and observations” a common theme, according to internal documents. It is unclear how many cases have involved a person’s death. “A preliminary review of these cases indicates there was often a lack of appreciation of the clinical risk associated with the patient’s presentation,” an SAAS memo to staff on December 20 said. The same document, issued by SAAS’s executive director of clinical performance and patient safety, Keith Driscoll, acknowledged that “system-based distractions such as ramping” had upped pressure on paramedics. “However, it is vitally important that we remain focused on providing the safest possible care,” he said. “We have a responsibility to contribute towards addressing this concerning trend in adverse patient outcomes.” Ramping — a term used when an ambulance is parked outside a hospital because there are no free beds to treat a transported patient — has been rife at the RAH since it opened in September 2017. The problem is not isolated to the RAH, with one woman developing bed sores after being ramped at Flinders Medical Centre in Adelaide’s south for eight hours on Monday. Ambulance union boss Phil Palmer said his members were “furious” at the extent of ramping that occurred within a system crippled by a lack of capacity. Mr Palmer conceded last year’s rise in adverse outcomes, but said a lack of resources rather than incompetence was behind the problem, which had coincided with a decline in quality assurance and clinical support for paramedics. “We said this pressure-cooker environment would cause mistakes … it’s a human thing,” Mr Palmer said. “There’s absolutely no doubt this whole issue with workload and ramping has already led to adverse incidents and will undoubtedly lead to others. “It’s a failure of the system, it’s not a failure of the individual.” Following Mr Driscoll’s memo to staff, SAAS team leaders held one-on-one meetings with paramedics. The service’s “treat no transport” guidelines were also updated. One paramedic welcomed the focus on education, but questioned whether it was a “box-ticking” exercise by bureaucrats. The same paramedic said some within the service had ignored protocol requiring them to call for clinical assistance when assessing a patient.
