Your negotiation team met today with senior management for the fourth scheduled EBA meeting.
This was planned short meeting due to the unavailability of several managers in the afternoon, and focussed on CCP and Special Ops claims, with some time spent outlining and justifying claims for the Deferred Salary Scheme, Ambulance Officer Exam Leave, Single Crew Activity Limitation, Health and Wellbeing Allowance, Workers Compensation and Career Progression. The meeting opened with SJA presenting some evidence regarding the usefulness of CCP on road, in relation to the Clinical Appropriate Model of Care (CAMC).
SJA conceded that they believe the ideal on-road implementation of this model would be a CCP in a car with a Doctor on board. SJA believe there are around ‘3 patients per day’ who may benefit from CCP on road. SJA presented a 2019 research paper by Ben Beck* which indicated up to 20% of trauma deaths are potentially preventable, by bringing CCP skills to the patient (advanced airway, blood products, thoracostomy, point of care ultrasound), *B. Beck et al., Potentially preventable trauma deaths: A retrospective review, Injury (2019)
In regards to the Ben Beck’s 2019 paper, it is worth noting that out of 2752 pre-hospital or early in-hospital traumatic cardiac arrests (over a 7 year period between 2008-2014) the study identified 23 ‘potentially preventable or preventable’ traumatic deaths. Of these 23 cases, 8 were identified as having areas for improvement in the response system, including 4 that had long response times and 4 that had potential issues related to dispatch or recognition of the emergency. There was also 5 cases that had prolonged on scene times.
SJA also outlined a 2019 report by Dr Chris Armstrong (specifically undertaken to look at implementing critical care interventions on road here in WA) of 2500 medical and trauma patients where up to 571 could have benefited from advanced CCP skill set.
In regards to the report by Dr Chris Armstrong, the document presented seems extremely light on actual data and methodology. It is unclear how Dr Armstrong arrived at this these figures, and they appear to be purely a case sheet data extrapolation. It’s ‘summary of recommendations’ suggested it would be viable to deploy most skills to the existing CSP model. For instance, the most frequently identified/indicated intervention unavailable to Ambulance Paramedics in this report was Non-Invasive ventilation (1 patient per day was identified) for Acute Pulmonary Oedema.
To be clear, the AEAWA are NOT opposed to Critical Care on road, but the study cited above by Beck et al, also highlights the importance of having sufficient ambulance resources to enable a timely ambulance response, and does not reflect the latest traumatic cardiac arrest guidelines in place in WA, which emphasise short scene times. The proposed CAMC model does nothing to address the shortage of resources, does nothing to address ramping and the inappropriate prioritisation by ProQA, and in fact proposes to de-skill the general Ambulance Paramedic and focus skills on a small cohort of on road CCP + Doctor model.
It is worth noting here, that St John seem entirely concerned with ‘up to 3’ trauma patients per day, and entirely unconcerned with the multitude of patients waiting for ambulances, often with serious complex medical conditions, who need an ambulance dispatched to them urgently. The Acute Pulmonary Oedema patient doesn’t necessitate a CCP, they need a timely paramedic response with GTN, oxygen, and ideally CPAP as trialled, possibly a loop diuretic. We suggest that the emphasis on CCP is misplaced in the context of the current ambulance service crisis, which all on road staff know is at breaking point, and highlights how out of touch our managers are.
Other discussion topics were:
In regards to CCP on road, discussions occurred as to whether it would be mandatory to have worked as an on road CCP prior to being eligible to be a Helicopter CCP. SJA were unsure and would not commit to answer.
It is SJA’s position that CCP’s would lose their allocated position in exchange for a permanent CCP position.
SJA feel the ideal number of CCPs on road would be 3, but the number ultimately ‘comes down to affordability’.
There are currently 14 CCP’s and all of them would be guaranteed a permanent position even in the event SJA lose the helicopter contract.
SJA propose to increase CCP base hourly rate by 4.7% to account for using CCP skills being used on road.
As SJA indicated clearly last week, the proposed CACM will see a reduction in skills of Ambulance Paramedics. This will have mean the majority of patients receive a lower standard of clinical care, and have damaging knock on effects when Metro Paramedics work on country relief, where they will bring a lesser skill set, without a CCP as backup.
In regards to Special Operations Paramedics, SJA wish to implement a on-call allowance, and reduce overtime incurred for training purposes to ‘SINGLE TIME’. The AEAWA will not support any clause which seeks to introduce single time rates for hours worked about normal hours, and see this as a mechanism to set a precedent to roll out single time overtime to other areas of the business. The AEAWA would also like to see sufficient expansion of numbers of Special Ops Paramedics, in preference to implementing an on-call system/allowance, as members should be able to enjoy their downtime wherever possible.
The AEAWA want to see recognition for the skills and experience within Special Ops and want an actual role developed for Special Ops, with its own classification and Payscales, which will see an actual pay rate allocated to the role, rather than officers receiving the normal rate only when they are Special Ops Paramedics.
Other topics covered included:
Deferred Salary Scheme
Discussions took place with the AEAWA outlining the reasoning behind this claim, which is currently available to WAPOL and Ambulance Victoria. This scheme is cost neutral for St John and will be a good benefit to encourage staff retention.
Exam Leave for SAO’s
The AEAWA argued that it is patently unfair and unjust that SAO’s are not allocated time to sit exams required for the progression within the organisation, often being required to sit an exam following night shift. St John will examine the issue and report back.
Single Officer Activity
The AEAWA feel strongly that the EBA needs to have a clause limiting the duties to which a single officer can be tasked. As you are all well aware, there has been a recent tendency for St John to attempt to dispatch single officers responders in ambulance vehicles to attend jobs. The AEAWA feel this is unsafe instruction as it is a clear deviation from the baseline role for which we are trained, that of being part of an ambulance ‘crew’, in addition to putting undue pressure and risk upon an officer, where clearly the prevailing situation would indicate you have no opportunity for a backup. In addition, there has been recent attempts by St John to legitimise the practice of single officer ramping duties by altering the ‘SOP Patient Flow and Ramping Guideline’. Again, this is a high risk environment as repeatedly stated by CG, and exposes our members to additional clinical responsibility and risk, as well as increasing the risk to our patients who cannot by monitored as closely by a single officer. There is also the added risks whenever the single officer needs to undertake a break / food / cleaning / toilet.
Career Progression – Recruitment Process
The AEAWA argued strongly that the current ‘merit based’ recruitment process is in fact entirely based upon the applicants personality, ‘interview performance’, and with who SJA ultimately want to put in a role…with absolutely no weighting given to an applicants past experience, aptitude, resume, or courses or education they may have completed. We will continue to advocate for a recruitment and career progression clause to ensure fairness and transparency in the process.
Please feel free to contact a delegate with any questions.
AEAWA Negotiation Team