An experienced paramedic has described how a patient who was taken to the Royal Hobart Hospital after a mini-stroke had a second stroke while being kept waiting in a hospital corridor.
The paramedic, who spoke out on condition of anonymity, said the patient was waiting on an ambulance stretcher in the hospital corridor — a consequence of "ramping", where paramedics become trapped in emergency departments caring for patients because hospital staff cannot take over their clinical care.
Staff were alerted that a waiting patient had suffered a stroke, but the wait in the corridor continued for another hour.
The experience was "extremely stressful", according to the paramedic, who has been in the industry for over a decade.
"They're only 30 metres away from the CT scanner … the definitive care is within arm's reach," the paramedic said.
"The patient needs a scan to confirm whether it's either a bleed or a clot — if it's a bleed, you're within the facility where they can be potentially admitted to surgery, or if it's a clot they can be taken into a resuscitation bay and [have the clot dissolved] with the same ED.
The paramedic said the incident happened a little over a year ago, but the reintroduction of COVID-19 to Tasmania since had only worsened the stress on an already strained system.
The paramedic said ambulance staff shortages due to underfunding were being exacerbated by illness and COVID-19 exposures.
They said they decided to speak with the ABC because staff were being pushed "harder than ever before" and they feared for the impact it was having on staff and patients.
Overtime and missed meal breaks are a daily reality for many paramedics, the insider said, and the extra time needed to clean equipment and vehicles between patients was forcing ambulance staff to rush from job to job.
"When night shifts are 14 hours long, having to do a late job could easily mean a 16-hour shift," the paramedic said.
"I wouldn't know how many times I've done that. We really put ourselves, and therefore the community, at risk when you've got staff driving around, trying to implement patient care after such a long shift without adequate breaks."
Because paramedics must be paid compensation for overtime or missed meal breaks, the system was "extremely inefficient from a cost perspective", they said.
"And it's quite scary. I don't think people realise just how stretched so many aspects are, not just the ambulance service, but the hospitals in general."
The paramedic stressed that hospital staff were not to blame for wait times.
But the strained system was hurting paramedics badly – and morale amongst Ambulance Tasmania staff was now the lowest they had seen in their career, they said.
"We're seeing the signs now of gross underfunding of the health system over a long period of time.
"If you had to point a finger of blame, it would be at both sides of politics … whether you're talking about infrastructure or policy, there are lots of things that fall into the 'too-hard basket'."
'We have felt their increased stress'
Documents seen by the ABC show leadership at Ambulance Tasmania described the workforce as under "extreme pressure" during two periods in March when there were large peaks in the hours ambulance staff spent ramped at Tasmania's public hospitals.
The high demand for ambulance and emergency department services, combined with a "large number" of hospital staff furloughed due to COVID-19, saw ambulance staff stuck waiting to offload patients for so long that management escalated their concerns to the secretary.
Royal Hobart Hospital emergency medicine specialist Juan Ascencio-Lane told the ABC they and colleagues across the state were aware of high stress amongst the ambulance workers.
"We work extremely closely with [the paramedics] and we certainly do see when the workload has increased," said Dr Ascencio-Lane, who is also ACEM's Tasmanian faculty chair.
"We have felt their increased stress over the last year, and have been in constant communication with their chief of operations and other managers regarding how we as an emergency group can improve the situation across Tasmania."
Dr Ascencio-Lane said patients being stuck in the ED for eight hours or more – known as "access block" – takes a toll on health workers and patients.
Union raises the alarm
The unnamed paramedic's concerns echo the results of a staff "resilience scan" commissioned by Ambulance Tasmania in September, in the wake of concerning testimonies at the inquest into the death of paramedic Damian Crump.
Documents obtained by the ABC revealed that more than a third of the 323 Ambulance Tasmania staff participating reported suffering from depression, anxiety, stress, or post-traumatic stress disorder, and 11 per cent were self-medicating with drugs and alcohol.
Last week, the Health and Community Services Union (HACSU) wrote a letter to Ambulance Tasmania chief executive Joe Acker expressing alarm over the wellbeing of staff.
In the letter, seen by the ABC, Industrial officer Chris Kennedy said several staff broke down when asked how they were.
"I've never encountered this level of concern in my eight years in this role," he wrote.
"I hold grave concerns for the psychological safety of our members."
Mr Acker told the ABC that Ambulance Tasmania had made improvements over the past three years in providing mental health and wellbeing services, but that he and other senior executives would meet the union this Friday to discuss the issues raised.
Government responds
Last year's state budget included funding for an additional 48 paramedics, with Health Minister Jeremy Rockliff saying in February that 41 of these positions had been filled.
Department of Public Health Secretary Kathrine Morgan-Wicks told the ABC the department was implementing a state-wide "Access and Patient Flow Program" to reduce access block and ramping delays.
"This includes increasing bed capacity, piloting direct admission pathways and virtual care at home programs to avoid the emergency department," Ms Morgan-Wicks said.
"We are also working directly with the primary care sector to increase after-hours GP services to avoid unnecessary hospital attendances."
She said work was underway to improve workplace culture.
"This is why we have done a resilience scan across our employees in Ambulance Tasmania – we are listening to our staff and working to improve our mental health and wellbeing support to staff, including a Peer Support Team, employee assistance programmes and MyPulse resources to enable timely referrals to psychologists and other professionals."
Fears for the future of the workforce
The paramedic said they were actively looking for other jobs as a result of the stress and was aware of a handful of other staff doing the same.
They were particularly concerned that paramedics were using sick leave to combat fatigue, and recruits were increasingly asking to drop to part-time work due to burn-out.
"At the age of about 22, 23, we're finding paramedics going part-time, which is concerning because they should be able to cope with the lifestyle and workload at that age," they said.
"A lot of them are trying to get established — buy a new car, buy a house — and they're choosing to take a pay cut because of fatigue rather than being able to progress in life."
The Department of Health said that since January 2021, 13 Ambulance Tasmania staff have dropped from full-time to part-time, but 12 others increased their part-time hours to full-time.
