Ambulance ramping: Leaked WA Health email reveals plan to get St John WA paramedics back on road

A leaked WA Health email lays out plans to cease the majority of ambulance ramping, place overflow patients on “trolleys” in emergency departments and use police cars to transport patients to hospitals. It reveals St John WA would stop performing most non-emergency patient transfers between hospitals in a move designed to preserve ambulances for emergency situations. The email — sent to staff in the Armadale Hospital emergency department on Friday evening — said St John was “in a situation that is now out of their control” and that additional measures “may be acted on imminently in the coming hours/day/days”. The West understands the correspondence was prematurely circulated after staff at Armadale Hospital were incorrectly advised by a senior St John employee — not believed to be CEO Michelle Fyfe — that the “Business Continuity Plan Level 3 measures” were immediately coming into effect. That forced Ms Fyfe to issue a clarification later on Friday acknowledging the mistake and that the unprecedented step had not been activated, and would not be activated without advanced notice. The West understands St John cannot unilaterally activate the Level 3 measures. An application must be made to the State Health Incident Coordination Centre and ticked off by WA Health Director General David Russell-Weisz. However, the leaked email provides a detailed insight into how St John will operate in the event Level 3 measures are enacted in response to a severe shortage of available ambulances, which would making ramping “unviable”. “For patients that can walk, post triage… St John will depart and after (a rapid antigen test) they will be directed to the waiting room as per normal practice for walk-ins,’ the email said. Patients that cannot walk — or “who are vulnerable or elderly” — would be triaged and then taken directly to a bay in the emergency department or placed on a “trolley” in “multiple areas of the department”. “We have sourced extra trolleys… over the weekend to ensure that there is adequate supplies of trolleys if required. (St John) will offload onto the trolley, provide handover and then depart,” the email said. “If required, (St John) may be able to provide extra stretchers to hospitals to assist.” In a section dedicated to patient transfer services, the email detailed how St John would only perform “high acuity” transfers “but warned to expect that there “may be delays” and that alternate providers should be used for low acuity cases. “’Hot swaps’ will no longer be practicable (where we swap 1 patient on the ramp for a patient needing to go elsewhere). This will cease entirely from the 31st May 2022,” the email said. It also warns that ED staff might see “an increase of patients being brought in by alternative means”. “(St John) will be utilising (WA Police) to support their operations and in some cases they might assist with transport,” the email said. “Should they need to, they will also have alternative personnel working with paramedics on-board ambulances as support.” The correspondence finished by informing staff that Armadale Hospital executives had visited all wards late Friday afternoon to advise them of the need “to accept ED patients as soon as practically possible”. “This will be an evolving and dynamic situation into the weekend. We will provide ongoing updates as further information comes to hand,’ the email ends.