Audrey Fraizer

Audrey Fraizer

Best Practices

By Audrey Fraizer

South Australia’s arid and semi-arid rangelands and low mountain ranges create a haven for outdoor adventure. Situated in the south-central part of the country, it is the fourth largest of Australia’s six states and two territories.

The Mediterranean climate in the southern part of the state makes for long, hot summers and mild winters that are ideal for year-round fishing, boating, and surfing along South Australia’s 2,361-mile (3,800-kilometer) coastline. The Flinders Ranges, Cleland Wildlife Park where much of the wildlife is free roaming, self-drive Aboriginal Dreaming Trail with stops at sites of ancient cave wall paintings, and the Arkaroola Wilderness Sanctuary are among the sites in the arid interior.

Because of the geographic size and unique terrain of South Australia, it’s clear that South Australian Ambulance Service (SAAS) must and does go the distance and beyond in providing emergency medical services (EMS) using several modes of transport in urban, remote, and regional areas of the country.

“We are South Australia’s sole provider,” said Nichole Bastian, Service Development Manager, Operations & Systems, SAAS. “It’s both a tremendous responsibility and opportunity.”

Volunteer and operational service

More than 1,500 volunteer ambulance officers provide services in the smaller regional parts of the state, while another 1,100 operational staff direct services in the metropolitan and larger regional areas; according to the 2013–14 SAAS annual report, the SAAS Emergency Operations Center (EOC) received about 470,000 calls, sending ambulance response to more than half (265,000).1

The SAAS EOC coordinates response (ground ambulances and rotary and fixed-wing air ambulances). Interestingly:

Emergency (lights-and-siren) incidents were reduced by 10.3 percent, (115,786 incidents in 2014 compared to 129,142 in 2013), which was attributed to the increase in the number of Priority 3 cases as a result of the Medical Priority Dispatch System (MPDS) reallocation of some Priority 2 cases to Priority 3 level where the P3 response was deemed appropriate.2

EOC staff handles and organizes all transport requests received by SAAS, whether received by telephone, fax, or electronic means, including emergency, urgent, and routine journeys at its centralized location in Adelaide—the state’s largest city. Their response area covers 1.7 million people in a land area of 379,725 square miles (983,482 square kilometers).

In addition, the EOC staff coordinates the response of ambulance resources across the state, manages collaborative rescue operations, and coordinates SAAS MedSTAR, including clinical staff members providing assessment and support to health professionals across South Australia via telephone. MedSTAR provides teams for all prehospital and interhospital retrievals.

Why accreditation?

There was no doubt SAAS would achieve an Accredited Center of Excellence (ACE) despite anything that might present an obstacle, such as potential support issues considering the significant time difference between the operations center in Adelaide and the headquarters of the International Academies of Emergency Dispatch (IAED) in Salt Lake City.

That was counter-balanced by the Web and the SAAS staff’s hands-on drive.

“Our staff is extremely passionate about the service we provide,” Bastian said. “We were happy to continue to engage in the ongoing requirements to make sure we achieved accreditation.”

And, of course, the same goes for the IAED.

“They were a joy to work with,” said IAED Associate Director Carlynn Page. “They were very accommodating and very hospitable.”

Bastian said they were motivated.

For starters, ACE reflects their effort and hard work. The EOC measures its achievements against the MPDS, and SAAS continues to achieve a high level of compliance with the MPDS standards. In 2014, SAAS averaged 99.1 percent compliance.3

As Bastian said, ACE recognizes the staff’s proficiency, acknowledges their important and integral role in delivering emergency medical services, and elevates their stature in the EMS community worldwide.

“ACE sets us apart from other organizations,” Bastian said.

The accreditation also represents an achievement that meshes with the SA Health and SA Ambulance Service objective of protecting and improving the health of all South Australians and paves their way into the future.

“It’s the means by which we deliver our services,” she said. “We must invest the effort and resources to make our workforce successful, and ACE is a significant step toward our organizational goals.”

The process

To drive the process, Bastian established clear time frames to reach the objectives and gather the appropriate data.

Foremost to any success, she said, is keeping staff in the loop on a regular basis and providing recognition, which includes everything from acknowledging high compliance to simply saying “hi” to staff in the hallway. The ongoing conversation between management and staff saves surprises (nobody wants to be blindsided at the annual performance review) and increases job satisfaction from involving staff in the center’s initiatives. It also makes the road a lot smoother when staff is sold on the ACE concept as a reflection of their exceptional work.

As mentioned, time zone differences complicated the ACE online submission process, but they got through it “with the excellent support from the [Academy’s] Web support team,” Bastian said.

“It is important not to lose the focus of what we’re trying to achieve,” Bastian said. “This is not just a pretty certificate to hang but recognition that the service you are providing to the community when they are most vulnerable is gold standard and recognized internationally.”

Unique qualities

The MPDS reflects possible encounters with wildlife unique to Australia and New Zealand. On Protocol 2: Allergies (Reactions)/Envenomations (Stings, Bites), the ANZ version has additional Key Questions regarding jellyfish—“(Jellyfish) Is s/he out of the water?” and “What part of the body was stung?”—and separate Determinant Codes for Funnel-web spider (FWS) bite, MAJOR jellyfish sting, and Minor jellyfish sting. Protocol 2 also has DLS Links for “Snakebite/FWS Bite,” “Stingray/Stonefish,” and “Box Jellyfish Sting,” and corresponding definitions, Rules, and Axioms for these different dangers.

Also, while most people live in urban settings, the significant number of people in remote regions poses a particular EMS challenge heightened by increasing cellphone use. Tourists lost in the outback or even native Australians may find themselves unable to identify where they are when calling 0-0-0 to report police, fire, or medical emergencies. To remedy the situation, in December 2013, South Australia launched the Emergency+ smartphone app, designed by Australian emergency services, that allows users to read out their latitude and longitude GPS coordinates.

The address locator is one of many improvements coinciding with the SAAS’ five-year strategic plan, “Vision 2020,” anticipated for release this year.

What does Bastian see for the future: A continual improvement through the organization’s commitment to deliver an effective and innovative ambulance service.