Hospital ramping crisis: Leaked ambulance logs show elderly patients struggle to get into Perth EDs

Leaked St John Ambulance case logs lay bare the horrific circumstances endured by patients – many of them elderly – waiting to be admitted to WA’s overflowing emergency departments. Confronting details of nine patients made to wait up to nine hours before finally being admitted to ED, all in the past month, paint a grim picture of experiences “on the ramp” – the term used to describe the period of time between an ambulance arriving and patients being transferred to the care of the hospital. They come as ambulance ramping in WA reaches record levels, spiking from 1794 total hours last July to 4135 in January, before dropping to 2899 in February – a shorter month also impacted by the COVID lockdown. That has contributed to a decline in emergency response times as scores of ambulances and their crews find themselves stuck in hospital car parks for hours at a time. In one case from February 24, an 85-year-old woman on anti-clotting blood thinners and renal dialysis called an ambulance at 7.30pm after falling over and badly cutting the back of her head, arriving at a Perth hospital roughly an hour later. She was and then made to wait until 3am before finally being admitted to ED, despite her head wound bleeding the entire time and her blood pressure dropping to dangerously low levels. In another case, a 79-year-old women suffering from abdominal pain, vomiting and diarrhoea spent nearly three hours waiting for admission with no hospital staff available to assist with cleaning and caring for the patient despite her being incontinent of both urine and faeces. A 91-year-old man diagnosed with pneumonia spent nearly nine hours waiting with St John paramedics to be admitted to a hospital's emergency department, while a 100-year-old man with a fever of 38.3C who had not drank any fluid for the previous 24 hours had to wait in the back of an ambulance for 50 minutes before admission. A 73-year-old man with rectal bleeding was transferred from one hospital to another, arriving at 8.15pm and suffering another "large bleed" while waiting for a bed to become available – which finally occurred at 9.10pm. Another woman with rectal bleeding – this time 93-years-old and living independently – spent more than 75 minutes waiting to be admitted to ED on Valentine’s Day. “The patient was ramped, only coming off the ramp when she became hypotensive (low blood pressure) and complained of being sweaty,” case logs read. An aged care home called an ambulance for an elderly man with an elevated heart rate and temperature of 39.9C – regarded as a high fever – at 00.17am on February 27, with paramedics only arriving more than 2 hours later 2.30am. “The patient’s blood pressure trended steadily downwards whilst on the ramp – at 03.25am it was 95/44,” another case log said. “This was brought to the attention of the ED nursing team. In the hour before the patient was transferred to the resuscitation area of the ED, there with only a single reading with a systolic BP above 100 (considered within the normal range). “He was transferred to the resuscitation area of the ED at 04.30am.” In two other cases — both from February 15 — women aged 81and 89 were made to wait seven and nine hours to be admitted to hospital respectively. A WA Health Department spokeswoman said hospital patients were treated in order of priority and that “if their condition deteriorates, it would be expected that transfer of care would be expedited.” “In relation to the cases listed, the length of time for the transfer of care is much too long,” she said. “Additional information has been provided today by St John Ambulance which has allowed the hospital sites and patients to be identified so that the circumstances can be properly investigated. “The Department and the health service providers have met to discuss this today and the appropriate investigations will be initiated. Any matter that relates to safety and quality of patient care will be carefully examined by the health service providers.” Australian Medical Association (WA) president Andrew Miller said patients were being made to wait in “very uncomfortable and in some cases dangerous situations” for hours on end because there was not enough space in hospitals to accept them. “It’s not fair on either patients or paramedics to be put in situations where hospital care is delayed. At the very least, patients have their anxiety, stress and discomfort prolonged longer than necessary and it can lead to bad outcomes if there is a time-critical problem,” Dr Miller said. “Paramedics do a great job but can’t diagnose or investigate in the same way as hospital staff.” St John WA medical director Paul Bailey said both paramedics and patients were impacted by ramping every day and that the company had “taken every step” to maximise the number of ambulances available to respond to emergencies. “We feel greatly for community members who need care, particularly in instances we believe the system should have done better,” he said.