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Ramping and multiple patients

By 10 October 2020April 9th, 2021No Comments

We have received reports from our interstate colleagues of incidents where ramped patients (who were being looked after as part of a ‘multi-patient care’ model) have deteriorated while in the care of their crew.

This has had very serious outcomes for the patients and the officers involved.

With the imminent deployment of Hospital Liaison Managers at metropolitan hospitals we would like to remind our members to carefully assess any request from a HLM to ‘double up’ as to the potential clinical risk involved and your available resources (e.g access to sufficient monitoring equipment). As a registered clinician, officers will be accepting clinical responsibility for each patient in their care and may be responsible for any adverse events that occur while ‘on the ramp’. Our Clinical Governance department have issued advice confirming that ramping ‘represents a time of enhanced clinical risk’ and that a ‘higher level of operational demand and ramping [have resulted in a] increase in serious adverse clinical events’. Often these incidents can occur with patients who can appear ‘otherwise well’ hence being ramped in the first place. The relevant SOP states that ‘at least one officer will remain with the patient at all times’. Please consider if this will be possible if you are asked to accept responsibility for an additional patient (i.e should a patient require toileting, refreshments etc) Other factors to consider prior to accepting responsibility include (but are not limited to) patient acuity, patient demeanour, patient disability and crew capability (AP/AO: AO/AO PTS).

As per SJA guidance, there are certain types of patients that may not be suitable for the multiple patient care model including: Patients such as those affected by drugs (and/or) alcohol Patients that require one on one care or have complex needs Patients with more complex social or medical issues that still require one on one care, for example contagious illness, potential absconders Higher risk could also include patients requiring ongoing medication administration (these patients will likely require constant monitoring not just 20 minute vital signs), and spinal patients. CG have advised that 20 minutes is the minimum monitoring interval and patient condition may mean vital signs are required more frequently or patients be monitored constantly. Any concerns regarding the above should be raised with the HLM referencing the relevant SOP ‘Patient Flow and Ramping Guidelines’ which outlines the above. Should a disagreement occur between HLM and the ramped crew regarding the suitability of a patient for ‘multi-patient care’, please highlight your concerns clearly to the manager (for example, lack of available monitor) or consult with the CSP SOC. You are welcome to contact a delegate should you have concerns. While the AEAWA committee understand the pressure upon the service in recent months which has led to the implementation of the HLM role, our focus is always the interests and safety of our members and the safety of patients in our care. Finally we would like to remind officers that in the interest of members safety, SJA have confirmed that clinical care is limited to ambulance treatment areas such as the Ambulance Ramps/Triage/ABAY areas (i.e. we should not be taking or permitting our ramped patients to attend x-ray etc only to return to the ramp). If you encounter any difficulties please contact a delegate. Regards AEAWA Executive