Spike in triple-zero calls sparks health system warnings

Calls to triple-zero reached levels on Monday not seen since the 2016 thunderstorm asthma event and a record-breaking number of people clogged a major hospital’s emergency department, prompting warnings that the Victorian health system will struggle to cope with an expected rise in hospital admissions from COVID-19.

Marty Smyth, chief executive of the Emergency Services Telecommunications Authority, said 3250 Victorians made ambulance calls on Monday, when a night-time spike caused average waits to rise above three minutes and up to 24 calls were on hold at once. Between 1600 to 2000 calls were received per day this time last year, he said.

Call numbers have continued to grow during this year’s lockdown and the authority’s modelling predicts a sustained increase as more COVID-infected people require care and injuries in the community rise when lockdown is eased.

Authorities will investigate the case of a three-year-girl who died from a cardiac arrest near Bendigo on Monday night after the family’s triple-zero call was placed on hold for a minute and 41 seconds – longer than the target time of five seconds that was almost always met before the pandemic.

At the same time, a video uploaded to social media on Monday showed an unmoving line of more than a dozen parked ambulances outside the Northern Hospital waiting to offload patients. The hospital serves the northern suburbs of Melbourne, which is at the epicentre of the current COVID-19 outbreak.

Northern Health’s acting chief operating officer Debra Bourne said about 320 patients presented to emergency in person and about 80 via a virtual portal (which allows COVID patients to see a doctor online), compared to an average number of daily emergency presentations at the hospital of 280.

Ms Bourne it was not the first time there had been a large number of ambulances waiting outside the hospital, but the demand on Monday was unprecedented.

She said a number of factors, including the demands of more than 60 COVID patients being cared for at the hospital, were combining to create an “extreme challenge”.

Ambulance ramping Northern Hospital Melbourne. pic.twitter.com/IkydGq0PKw

— dramynicho (@DrAmyNicho) September 27, 2021

“We have three wards that have now been converted to COVID wards and we’re treating patients that are really unwell,” she said.

High demand at the emergency call centre means Victorians dialling triple-zero may soon have their calls picked up by interstate call takers amid strain on the system, which caused some to wait on hold for up to 13 minutes.

Mr Smyth said the demand was comparable to that seen elsewhere in the world but it was the highest since the thunderstorm asthma episode five years ago, which saw 1900 emergency calls made in just five hours, ambulance delays and 10 deaths.

He said Monday’s surge could not have been foreseen and flagged plans to divert calls to interstate agencies during surge periods.Unions, however, said ESTA was chronically undermanned and called for minimum staffing levels.

Mr Smyth said the Bendigo girl’s case would be investigated internally and by the Inspector-General for Emergency Management because of the time it took to answer the call. “We send our condolences to the family … It’s a real concern,” he said, adding it was too early to say whether the call wait contributed to the outcome.

Ambulance Victoria’s acting regional director for Loddon Mallee, Trevor Weston, said paramedics arrived 14 minutes after the call – within the target time of 15 minutes – and were met some time later by MICA paramedics, who have a higher level of training. The girl did not survive.

Victorian Ambulance Union secretary Danny Hill said even a one-minute delay for a cardiac arrest “could mean the difference between life and death”.

“Those calls need to be answered within seconds,” he said.

ESTA, which was funded to receive 43 new staff as part of the last state budget, answered about 95 per cent of calls within the target time before the pandemic but call volumes spiked in 2021, driven partly by the poor health of Victorians who deferred care during lockdowns.

A Victorian government spokeswoman said ESTA would review its ability to cope with ballooning demand and report back to the government. “Our sincerest condolences and thoughts go out to the family on this tragic incident, and to the paramedics in attendance yesterday,” she said.

Victoria’s hospitals have been facing a soaring level of demand and increased numbers of patients needing emergency care have led to longer wait times in emergency departments.

Doctors are reporting that patients are arriving sicker after putting off seeking treatment or having their surgeries delayed due to the pandemic, and there is widespread burnout of healthcare workers, even before the worst of the expected wave of coronavirus patients.

There are about 375 Victorians in hospital with COVID-19, but that number could increase tenfold by the end of the year, according to Burnet Institute modelling produced for the government.

The Northern Hospital’s Ms Bourne said hospital staff had the skills and training to operate under high pressure, but there were some patients presenting that didn’t need to be there, as they had conditions that could be managed by their GP.

While images of lines of ambulances idling outside hospitals may shock the public, paramedics and emergency doctors say similar situations occur outside major Melbourne hospitals most days.

But Australasian College for Emergency Medicine president, John Bonning, said ambulance ramping was a symptom of a stretched health system and the COVID-19 pandemic had exacerbated long-standing issues.

Ambulance Employees Australia Victorian secretary Brett Adie is among those warning the health system is already at capacity. He called for a more cautious reopening from lockdown to avoid the scenario forecast by the Burnet Institute, where 3000 or more COVID patients ended up in hospital by mid-December.

Mr Adie said it was only possible to push healthcare workers so far before they burnt out and were no longer willing or able to work extra shifts, leading to preventable deaths. “The message that is coming from many people out there is ‘too bad, the hospital system just needs to cope’,” he said.

However, he said the way things were heading a young person that might have survived a cardiac event in 2019 due to prompt care “may not” in 2021.

Mr Hill said he had been told that the ESTA was understaffed on Monday night. Mr Hill said Victoria’s emergency and health systems were so strained it didn’t take much to tip the system over the edge.

“It doesn’t need to be anything phenomenally extra to occur, it’s just with our population growth and people not going to their doctors and calling an ambulance instead, sometimes for quite trivial things… all those things come into play,” he said.

Community Workers’ Union secretary Sue Riley said the agency was underfunded for years before the pandemic and was not equipped to handle heightened demand.

“The organisation is at the lowest point it’s ever been,” Ms Riley said, adding that many staff members had departed in the past two months due to the pressures.

Ms Riley and an ESTA worker said the organisation relied on staff working overtime and not having breaks. Ms Riley said workers who may have finished a traumatic call were sometimes hiding in their cars to avoid being called back from work.

“Since the middle of last week it’s got even worse,” one call taker said. “We have 16-20 calls waiting at all times; it’s not just a spike for something like a massive car crash, it’s constant. We’re in a crisis.”

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