Patients forced to wait in ambulances as emergency departments struggle with thousands of patients daily

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Yvonne James believes ramping “did shorten” her mother’s life.

When Yvonne James’s 88-year-old mother was rushed to hospital after a fall, instead of going straight in she was forced to sit in the back of an ambulance because the emergency department was full.

Key points: 

  • Ramping refers to when patients are left in the backs of ambulances or in a corridor because the emergency department is full
  • The number of mental health patients presenting at emergency departments has soared by about 70 per cent in the last 15 years
  • National emergency department presentations are now at more than 8 million a year

The controversial practice known as “ramping” is on the rise, as the nation’s hospitals buckle under the strain of an average 23,000 presentations each day.

“The ambulance officers said no, she couldn’t go into the hospital, they had to get permission and hadn’t got that permission to go in,” Ms James told 7.30.

If a patient is ramped, paramedics continue to look after them, either in the back of an ambulance or in a hospital corridor.

Ms James said what happened next to her mother, Edna Labrum, was upsetting and undignified.

Edna Labrum wears glasses and white shirt.

Ms Labrum soiled herself in the ambulance after an hour-and-a-half of waiting.

“Mum said, ‘I really need to go, I can’t hold on any longer.’

“It is appalling to see your mother laying there just begging, virtually, to go to the toilet,” Ms James said.

“She was getting quite anxious, quite distressed, and then she said, ‘I’m sorry, but I just have to go,’ and she did soil herself.”

Ms Labrum’s experience was at Adelaide’s Flinders Medical Centre in late 2018. She had leukaemia and while in that hospital her condition deteriorated. She died in the hospital intensive care unit six days after arriving.

“I think the experience we had with the ramping — what I deem was lack of care for those first sort of six hours in the ED — I do think that did shorten her life.

“Something needs to be done. I don’t know what the answer is but something has to be done so that other families don’t have to suffer and patients don’t have to suffer and suffer some of the indignities like my mum,” Ms James said.

Health unions blame ramping for three other patient deaths in South Australia over the past 12 months.

South Australian Health Minister Stephen Wade said ramping was unacceptable and his Government was trying to reduce the practice.Do you know more about this story? Email 7.30@abc.net.au

Stephen Wade wears a suit and tie

“I apologise to Yvonne for the fact her mother was delayed on the ramp at the hospital. I can assure her we’re doing everything that we can to ease ambulance ramping,” Mr Wade told 7.30.

He said his Government was expanding Flinders Medical Centre and had contracted GP clinics to treat patients who would otherwise end up in emergency departments.

“In the second half of last year, we opened four priority care centres across metropolitan Adelaide. They’ve seen more than 1,500 South Australians who would have otherwise needed to go to the emergency department.”

Paramedics and nurses feeling the strain

Ellen Anderson and Lauren Hepher sit next to each other in a hospital.

Lauren Hepher is a paramedic and union delegate in Tasmania. She said emergency department overcrowding was prompting record levels of ramping there.

“The highest I’ve heard is a patient being ramped for 18 hours. I have crews who spend their entire 14-hour shift ramped,” Ms Hepher said.

“We have patients having worse health outcomes because of hospital access delays and in a lot of cases that means they’re dying.

“It [ramping] means we can’t respond to people in the community. It means you’re waiting as a consumer for an ambulance to be free to come out to you and that might cost you your life.”

Royal Hobart Hospital emergency department nurse and union delegate Ellen Anderson said overcrowding was forcing staff to take potentially dangerous actions.

“In order to free up ambulance resources, we often put incredibly unwell people into the waiting room rather than leave them on the ramp,” Ms Anderson told 7.30.

“As ED nurses, it’s incredibly frustrating. It’s incredibly distressing to not be able to care for patients the way we want to care for them.”

Tasmanian Health Minister Sarah Courtney was unavailable for an interview, but in a statement said the Government had hired hundreds more staff and planned to open 250 hospital beds over the next six years to help meet demand. 

“Overall, there are now more than 1,150 new FTE [full-time equivalent] health staff in our system than in March 2014, but we know there is still more to be done and we will keep delivering for Tasmanians,” the statement said.

Number of mental health patients in emergency soars

Brooke Bickley wears a floral top and glasses.

The nation’s emergency departments are under increasing pressure, with more than 8 million presentations in 2018–19.

Patients like Brooke Bickley are getting stuck in EDs because of an overstretched community mental health system and a shortage of acute care beds.

Mental health patient presentations have soared by about 70 per cent over the past 15 years.

“I have a history of PTSD … which is from childhood trauma from child abuse, and I’ve also got a dissociative disorder,” Ms Bickley told 7.30.

“After-hours and on weekends there aren’t other options to get help and support. There’s nothing but the ED.

“You’re often put in a recliner in a busy walkway where you’ve got people coming and going, walking past you. You’ve got ambulances coming, going. It’s busy, there’s lights everywhere, there’s machines beeping, it’s quite a chaotic environment.

“One of my recent experiences, I was in the waiting room for 12 hours. A mental health clinician saw me and basically said they had no beds and I was given a bus ticket and sent home,” she said.

Ms Bickley said more community mental health places were needed and called for a national royal commission into mental health care across Australia.

“You just feel you’re less than everyone else. Just the expressions on everyone’s faces when they see you come in, little comments. ‘Oh, you’re here again? What’s happened this time?’ It doesn’t leave you feeling good,” she said.

“Having somewhere to go other than an emergency department, which isn’t really the right environment, so somewhere that’s sort of a lowstimulus environment where you’ve got peer support workers or lived-experience workers who understand and can relate to what you’re going through … that’d be ideal.”

‘It’s actually torture’

The back of an ambulance.

In Western Australia, figures released by the Australian Medical Association show 180 mental health patients were stuck in an emergency department for more than 24 hours last month — a 64 per cent rise on December 2017.

“Mental health being delivered in emergency departments is almost an oxymoron,” said Dr David Mountain, an AMA spokesman and head of emergency at Perth’s Sir Charles Gairdner Hospital.

“They are not environments conducive to anybody’s mental health.

“The fact that we keep patients for 24, 48 hours, sometimes four, five, six days in those environments is extraordinary. It’s actually torture.”

Dr Mountain said many patients spend days being sedated and restrained. “It’s hard to imagine how any of that helps them heal.” 

In a statement, acting Western Australian Health Minister Rita Saffioti said her Government was opening 50 new mental health acute care beds, as well as new community mental health places.

“We continue to see increased numbers of mental health patients arrive at our emergency departments and are working on a number of strategies to address this, including opening mental health emergency centres at some of our larger hospitals,” the statement said.

“Across the state, the McGowan Government has opened, or is opening, six residential Step Up Step Down centres to help prevent the escalation of mental health issues.”