Report on Government Services 2023
PART E, SECTION 11: RELEASED ON 2 FEBRUARY 2023
11 Ambulance services
The focus of performance reporting in this section is on ambulance service organisations, which are the primary agencies involved in providing emergency medical care, pre-hospital and out-of-hospital care, and transport services.
The Indicator results tab uses data from the data tables to provide information on the performance for each indicator in the Indicator framework. The same data in the data tables are also available in CSV format.
- Indicator framework
- Indicator results
- Explanatory material
Objectives for ambulance services
Ambulance services aim to promote health and reduce the adverse effects of emergency events on the community. Governments’ involvement in ambulance services is aimed at providing emergency medical care, pre-hospital and out-of-hospital care, and transport services that are:
- accessible and timely
- meet patients' needs through delivery of appropriate health care
- high quality — safe, co-ordinated and responsive health care
Governments aim for ambulance services to meet these objectives in an equitable and efficient manner.
Ambulance services comprise:
- emergency and non-emergency pre-hospital and out-of-hospital patient care and transport
- inter-hospital patient transport including the movement of critical patients
- specialised rescue services
- responding to multi-casualty events
- community capacity building to respond to emergencies (for example, cardiopulmonary resuscitation (CPR) and first aid training).
Roles and responsibilities
Ambulance service organisations are the primary agencies involved in providing services for ambulance events. State and Territory governments provide ambulance services in most jurisdictions. In WA and the NT, St John Ambulance is contracted by government to be the primary provider of ambulance services.Across jurisdictions, ambulance service organisations are an integral part of the health system. The role of paramedics has expanded over the past decade to include assessment and management of patients with minor illnesses and injuries to avoid hospitalisation.
In 2021-22, total ambulance service organisation revenue was $4.8 billion, an increase of 6.6 per cent from 2020-21 and representing an average annual growth rate over the past five years of 5.7 per cent (table 11.1).
Jurisdictions have different funding models to resource ambulance service organisations. Nationally in 2021-22, state and territory government grants and indirect government funding formed the greatest source of ambulance service organisation funding (79.1 per cent), followed by transport fees (from public hospitals, private citizens and insurance) (16.4 per cent), and subscriptions and other income (4.5 per cent) (table 11A.1).
Size and scope
Nationally in 2021-22, for ambulance services reported in this section there were:
- 21 740 full time equivalent salaried personnel (82.9 per cent were ambulance operatives)
- 7983 volunteer personnel (89.7 per cent were ambulance operatives)
- 7577 paramedic community first responders. Community first responders are trained volunteers that provide an emergency response (with no transport capacity) and first aid care before ambulance arrival (table 11A.2).
Paramedics must be registered with the Paramedicine Board of Australia and meet the Board’s registration standards to practise in Australia (Australian Health Practitioner Regulation Agency (AHPRA) Paramedicine Board of Australia, 2022).
In 2021-22, there were 22 755 registered paramedics in Australia (including 445 non‑practising registered paramedics) (table 11A.3).
‘Qualified ambulance officers’ must be registered paramedics (table 11A.2). It is possible some registered paramedics are employed by an ambulance service to work in a different role, such as other clinical or communication roles. Some registered paramedics work in other (non-ambulance) organisations.
Demand for ambulance services
Nationally in 2021-22, there were:
- 4.2 million incidents (events that resulted in demand for ambulance services) reported to ambulance service organisations (161.1 incidents per 1000 people)
- 5.3 million responses where an ambulance was sent to an incident (207.6 responses per 1000 people). There can be multiple responses sent to an incident. There can also be responses to incidents where people do not require treatment and/or transport
- 3.9 million patients assessed, treated or transported by ambulance service organisations (153.0 patients per 1000 people) (figure 11.1).
Ambulance service organisations prioritise incidents as:
- emergency — immediate response required under lights and sirens (code 1)
- urgent — undelayed response required without lights and sirens (code 2)
- non-emergency — non-urgent response required (codes 3, 4)
- casualty room attendance.
Nationally in 2021-22, 42.5 per cent of the 4.2 million incidents reported to ambulance service organisations were prioritised as emergency incidents, followed by 31.9 per cent prioritised as urgent and 25.6 per cent prioritised as non-emergency (table 11A.4).
The performance indicator framework provides information on equity, effectiveness and efficiency, and distinguishes the outputs and outcomes of ambulance services.
The performance indicator framework shows which data are complete and comparable in this Report. For data that are not considered directly comparable, text includes relevant caveats and supporting commentary. Section 1 discusses data comparability and completeness from a Report-wide perspective. In addition to the contextual information for this service area (see Context tab), the Report’s statistical context (section 2) contains data that may assist in interpreting the performance indicators presented in this section.
Improvements to performance reporting for ambulance services are ongoing and include identifying data sources to fill gaps in reporting for performance indicators and measures, and improving the comparability and completeness of data.
Outputs are the services delivered (while outcomes are the impact of these services on the status of an individual or group) (see section 1). Output information is also critical for equitable, efficient and effective management of government services.
Outcomes are the impact of services on the status of an individual or group (see section 1).
Text version of indicator framework
Performance — linked to Objectives
- Equity — Access
- Response times by geographic area – most recent data for all measures are comparable and complete
- Effectiveness — Appropriateness — Clinical
- Pain management – most recent data for all measures are comparable and complete
- Effectiveness — Quality — Safety
- Sentinel events – no data reported and/or no measures yet developed
- Effectiveness — Quality — Responsiveness
- Patient satisfaction – most recent data for all measures are comparable and complete
- Effectiveness — Sustainability
- Ambulance workforce – most recent data for all measures are comparable and complete
- Expenditure per person – most recent data for all measures are either not comparable and/or not complete
- Cardiac arrest survived event rate – most recent data for all measures are comparable and complete
A description of the comparability and completeness is provided under the Indicator results tab for each measure.
This section presents an overview of 'Ambulance services' performance indicator results. Different delivery contexts, locations and types of clients can affect the equity, effectiveness and efficiency of ambulance services.
Information to assist the interpretation of these data can be found with the indicators below and all data (footnotes and data sources) are available for download above as an excel spreadsheet and as a CSV dataset. Data tables are identified by a ‘11A’ prefix (for example, table 11A.1).
Specific data used in figures can be downloaded by clicking in the figure area, navigating to the bottom of the visualisation to the grey toolbar, clicking on the 'Download' icon and selecting 'Data' from the menu. Selecting 'PDF' or 'Powerpoint' from the 'Download' menu will download a static view of the performance indicator results.
1. Response times by geographic area
‘Response times by geographic area’ is an indicator of governments’ objective to provide ambulance services in an accessible manner.
‘Response times by geographic area' is defined as the time taken between the initial receipt of the call for an emergency at the communications centre, and the arrival of the first responding ambulance resource at the scene of an emergency code 1 incident (illustrated below), by geographic area (capital city and state-wide), for the 90th and 50th percentile.
Capital city response times are currently measured by the response times within each jurisdictions' capital city — boundaries are based on the ABS Greater Capital City Statistical Areas.
Response times are calculated for the 90th and 50th percentile — the time (in minutes) within which 90 per cent and 50 per cent of the first responding ambulance resources arrive at the scene of an emergency code 1 incident.
Many factors influence response times by geographic location including:
- land area
- population size and density
- dispersion of the population (particularly rural/urban population proportions), topography, road/transport infrastructure and traffic densities
- crew configurations, response systems and processes, and travel distances — for example, some jurisdictions include responses from volunteer stations (often in rural areas) where turnout times are generally longer because volunteers are on call as distinct from being on duty.
Short or decreasing response times are desirable. Short response times potentially minimise adverse effects on patients and the community of delayed emergency responses. Similar response times across geographic areas indicate equity of access to ambulance services.
In 2021-22, the time within which 90 per cent of first responding ambulance resources arrived at the scene of an emergency in code 1 situations ranged from:
- 16.5 minutes (ACT) to 71.3 minutes (SA) in capital cities
- 16.5 minutes (ACT) to 58.3 minutes (SA) state-wide (figure 11.2).
In 2021-22, the time within which 50 per cent of first responding ambulance resources arrived at the scene of an emergency in code 1 situations ranged from:
- 9.9 minutes (ACT) to 16.4 minutes (SA) in capital cities
- 9.9 minutes (ACT) to 15.8 minutes (SA) state-wide.
Supporting data on triple zero call answering times are available in table 11A.6. Nationally, in 2021-22, 81.3 per cent of calls from triple zero emergency call services were answered by ambulance services communication staff in 10 seconds or less. This is a reduction from 90.8 per cent in 2020-21 and is the lowest proportion of calls answered in 10 seconds or less over the ten years of available data (table 11A.6). These data do not measure the time taken for triple zero calls to be answered by emergency services telecommunication staff prior to re-direction to ambulance services communication staff.
2. Pain management
‘Pain management’ is an indicator of governments’ objective to provide pre‑hospital and out‑of‑hospital care and patient transport services that meet patients’ needs through delivery of appropriate health care.
‘Pain management’ is defined as the proportion of patients who report a clinically meaningful reduction in pain severity. Clinically meaningful pain reduction is defined as a minimum 2-point reduction in pain score from first to final recorded measurement (based on a 1–10 numeric rating scale of pain intensity).
This indicator includes patients who:
- are aged 16 years or over and received care from the ambulance service, which included the administration of pain medication (analgesia)
- recorded at least 2 pain scores (pre‑ and post‑treatment)
- recorded an initial pain score of 7 or above (referred to as severe pain).
Patients who refuse pain medication for whatever reason or have an unrecorded/missing date of birth are excluded.
A high or increasing proportion of patients who report a clinically meaningful reduction in pain severity at the end of ambulance service treatment is desirable. It suggests ambulance services are appropriately meeting patient needs.
Nationally in 2021-22, the proportion of patients who reported clinically meaningful pain reduction at the end of ambulance service treatment was 84.3 per cent. Results for most jurisdictions were above 80 per cent, except Tas (79.9 per cent) and the NT (70.0 per cent) (figure 11.3).
3. Sentinel events
‘Sentinel events’ is an indicator of governments’ objective to deliver ambulance services that are high quality and safe.
‘Sentinel events’ is defined as the number of reported adverse events that occur because of ambulance services system and process deficiencies, and which result in the death of, or serious harm to, a patient.
Sentinel events occur relatively infrequently and are independent of a patient’s condition.
A low or decreasing number of sentinel events is desirable.
The purpose of sentinel event reporting programs is to facilitate a safe environment for patients by reducing the frequency of these events. These programs are not punitive. They are designed to facilitate self‑reporting of errors so that the underlying causes of events can be examined and action taken to reduce the risk of these events re-occurring.
Changes in the number of sentinel events reported over time do not necessarily mean that ambulance services have become more or less safe. Changes might reflect improvements in incident reporting mechanisms and organisational cultural change. Trends should be monitored over time.
Data are not yet available for reporting against this indicator. The Council of Ambulance Authorities is developing a national data collection. Table 11.2 provides an overview of state and territory sentinel event policy settings.
Table 11.2 Overview of ambulance sentinel event policy settings
Version 2 of the Australian sentinel events list applies to all health services in NSW, including NSW Ambulance.
Under the Health Administration Act 1982 , NSW Health requires all incidents identified as ‘Australian sentinel events’ to be notified by NSW Ambulance to the NSW Ministry of Health via a Reportable Incident Brief and to be investigated accordingly.
The Clinical Excellence Commission is a statutory health corporation responsible for the collation and dissemination of clinical quality and safety performance, including sentinel event oversight. https://www.cec.health.nsw.gov.au
Version 2 of the Australian sentinel events list applies to all health services in Victoria, including Ambulance Victoria. In addition to the existing 10 national sentinel event categories, Victoria has an 11th category: All other adverse patient safety events resulting in serious harm or death.
All 11 categories of sentinel events must be reported to Safer Care Victoria by Ambulance Victoria according to the Health Services Act 1988 (Vic) .
Safer Care Victoria (SCV) oversees the sentinel event reporting program. SCV publishes the total number of health service sentinel events each year, although data are not disaggregated by ambulance sentinel events. https://www.safercare.vic.gov.au
There is no definition of sentinel events applicable to the Queensland Ambulance Service, including Version 2 of the Australian sentinel events list. ‘Reportable Event’ is defined in section 36A of the Ambulance Service Act 1991 (ASA).
The Queensland Ambulance Service (QAS) is not required to notify sentinel or reportable events to Queensland Health. The QAS proactively reports ‘reportable events’ to the Office of the Health Ombudsman.
The Office of the Health Ombudsman receives 'reportable events' for ambulance services. https://www.oho.qld.gov.au
Version 2 of the Australian sentinel events list applies to all health services in WA.
Sentinel events are a subset of Severity Assessment Code (SAC) 1 clinical incidents. SAC 1 incidents are clinical incidents that have or could have (near miss) caused serious harm or death that is attributable to health care provision (or lack thereof) rather than the patient’s underlying condition or illness.
Sentinel event reporting is mandated by the Clinical Incident Management Policy (MP 0122/19). The Clinical Incident Management Policy (MP 0122/19) is a mandatory requirement under the Clinical Governance, Safety and Quality Policy Framework pursuant to section 26(2) (a), (c) and (d) of the Health Services Act 2016 .
St John Ambulance WA is a contracted non-government organisation. Its compliance with the Clinical Incident Management Policy (MP 0122/19) applies to the extent described in its contract.
The Clinical Excellence Division of the Department of Health is the policy custodian of the Clinical Incident Management Policy (MP 0122/19) and provides oversight of the SAC 1 Management Program. The Purchasing and System Performance Division of the Department of Health manages the contract with St John Ambulance WA. https://ww2.health.wa.gov.au/About-us/Department-of-Health/Clinical-services-and-research
Version 2 of the Australian sentinel events list applies to all health services in SA, including SA Ambulance Service.
The SA Ambulance Service must report incidents within 24 hours or as soon as practicable to the SA Health Safety Learning System (SLS), assigning an Incident Severity Rating (ICR) 1 rating if they or a manager suspect that it is a sentinel event. Sentinel events are categorised as ICR 1 clinical incidents.
The Safety and Quality Unit of SA Health oversees the sentinel event reporting program. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/safety+and+quality/safety+and+quality
Version 2 of the Australian sentinel events list applies to all health services in Tasmania, including Ambulance Tasmania.
Ambulance Tasmania must provide a brief to the Tasmanian Department of Health within 2 business days of any sentinel event being reported in its safety event reporting system.
The Tasmanian Department of Health Clinical Quality Regulation and Accreditation (CQRA) unit oversees the sentinel event reporting process. https://www.health.tas.gov.au
There is no definition of sentinel events applicable to the ACT Ambulance Service, including version 2 of the Australian sentinel events list.
The ACT Ambulance Service is not required to notify ACT Health of any incidents otherwise identified as sentinel events. The legislative and administrative arrangements for the ACT Ambulance Service are different when compared to other jurisdictions. Unlike other jurisdictions, the ACT's Ambulance Service is not part of the Health Services but rather, sits within the ACT Emergency Services Agency under the Justice & Community Safety Directorate.
As such, Version 2 of the Australian sentinel events list is not applicable to the ACT Ambulance Service. Whilst there is no legislative requirement for the ACT Ambulance Service to report sentinel events, the ACT Ambulance Service has established pathways to address the issues of sentinel events.
No agency collects data on sentinel events from the ACT Ambulance Service. https://esa.act.gov.au
Version 2 of the Australian sentinel events list applies to all health services in the NT, including St John Ambulance NT.
There are no legislative requirements in the NT. St John Ambulance NT reports sentinel events to the Northern Territory Government under a service delivery contract.
NT Health oversees the sentinel event reporting program. The NT Health annual report includes the number of sentinel events in NT health services, although data are not disaggregated by ambulance sentinel events. https://health.nt.gov.au/homepage
Source: State and Territory governments (unpublished).
4. Patient satisfaction
‘Patient satisfaction’ is an indicator of governments’ objective to provide emergency medical care, pre-hospital and out-of-hospital care, and transport services that are responsive to patients’ needs.
‘Patient satisfaction’ is defined as the quality of ambulance services, as perceived by the patient. It is measured as patient experience of aspects of response and treatment that are key factors in patient outcomes.
Patients are defined as people who were transported under an emergency event classified as code 1 (an emergency event requiring one or more immediate ambulance responses under lights and sirens where the incident is potentially life threatening) or code 2 (urgent incidents requiring an undelayed response by one or more ambulances without warning devices, with arrival desirable within 30 minutes).
The following measures of patient experience of ambulance services are reported:
- proportion of patients who reported that the length of time they waited to be connected to an ambulance service call taker was much quicker or a little quicker than they thought it would be
- proportion of patients who reported that the length of time they waited for an ambulance was much quicker or a little quicker than they thought it would be
- proportion of patients who reported that the level of care provided to them by paramedics was very good or good
- proportion of patients whose level of trust and confidence in paramedics and their ability to provide quality care and treatment was very high or high
- proportion of patients who were very satisfied or satisfied with the ambulance services they received.
High or increasing proportions for these measures are desirable as they indicate improved responsiveness to patient needs.
Nationally in 2021-22, the majority of respondents (96.0 per cent) reported they were satisfied or very satisfied with ambulance services received in the previous 12 months (table 11.3).
Nationally, the proportions of respondents in 2021-22 who reported a quicker than expected wait time for call connection (63.0 per cent) and ambulance arrival (58.0 per cent) increased by one percentage point from 2020-21 (table 11.3). The proportions of respondents who indicated a slower than expected wait time for call connection (8.0 per cent) and ambulance arrival (14.0 per cent) have risen to their highest levels over the six years of reported data (table 11A.8).
5. Workforce sustainability
Workforce sustainability’ is an indicator of governments’ objective to provide emergency medical care, pre-hospital and out-of-hospital care, and transport services that are sustainable.
Health workforce sustainability concerns the capacity of the health workforce to meet current and projected demand.
‘Workforce sustainability’ is defined by two measures:
- ‘workforce by age group’ – the proportion of the operational salaried workforce in 10-year age groups (under 30, 30–39, 40–49, 50–59 and 60 and over)
- ‘operational workforce attrition’ – the proportion of full time equivalent salaried staff who exited the organisation. This includes staff in operational positions where paramedic qualifications are either essential or desirable to the role.
A low or decreasing proportion of the workforce in younger age groups and/or a high or increasing proportion of the workforce in older age groups suggest potential workforce sustainability problems as older age workers enter retirement. High and increasing levels of staff attrition also suggest potential workforce sustainability problems.
The workforce by age group and staff attrition measures should be considered together. Each provides a different perspective on the changing profile of the ambulance workforce. These data should also be considered in conjunction with data on the:
- number of students enrolled in accredited paramedic training courses (table 11A.10)
- availability of paramedics and response locations, which show that for some jurisdictions, there can be a large proportion of volunteers or volunteer ambulance locations (tables 11A.2 and 11A.4).
These measures are not a substitute for a full workforce analysis that allows for migration, trends in full-time work and expected demand increases. They can, however, indicate that further attention should be given to workforce sustainability.
Nationally in 2021-22, the proportion of the ambulance workforce aged under 50 years was 79.1 per cent, the highest it has been since 2012-13 (figure 11.4 and table 11A.9). This is an increase from 2020-21 where the proportion was 76.9 per cent, the equal second lowest proportion over the past 10 years (figure 11.4 and table 11A.9).
Supporting data on student enrolments in accredited paramedic training courses are available in table 11A.10. Following a peak in 2019 of 341.9 enrolments nationally per million people, 2020 reported the lowest rate over the nine years of available data (261.8 enrolments per million people). The 2021 rate increased to 300.6 enrolments per million people.
Nationally in 2021-22, the attrition rate was 4.1 per cent, an increase from 2.9 per cent in 2020-21 and the highest rate since 2012-13 (4.3 per cent) (figure 11.5 and 11A.9).
6. Expenditure per person
'Expenditure per person’ is a proxy indicator of governments’ objective to provide emergency medical care, pre-hospital and out-of-hospital care, and transport services in an efficient manner.
'Expenditure per person’ is defined as total ambulance service organisation expenditure per person in the population.
All else being equal, lower expenditure per person represents greater efficiency. However, efficiency data should be interpreted with caution.
- High or increasing expenditure per person may reflect deteriorating efficiency. Alternatively, it may reflect changes in: aspects of the service (such as improved response); resourcing for first aid and community safety; or the characteristics of events requiring an ambulance service response, such as more serious medical presentations requiring complex clinical interventions.
- Differences in geographic size, terrain, climate, and population dispersal may affect costs of infrastructure and numbers of service delivery locations per person.
Nationally, total expenditure on ambulance service organisations was $190 per person in 2021-22, an increase of 8.8 per cent from the previous year (figure 11.6).
7. Cardiac arrest survival rate
‘Cardiac arrest survival rate’ is an indicator of governments’ objective to provide emergency medical care, pre-hospital and out-of-hospital care, and transport services that reduce the adverse effects of emergency events on the community.
‘Cardiac arrest survival rate’ is defined as the proportion of adult patients (aged 16 years and over) who were in out‑of‑hospital cardiac arrest and returned to spontaneous circulation (that is, the patient had a pulse) on arrival at hospital.
Three measures are reported:
- Paramedic witnessed adult cardiac arrests where resuscitation was attempted by ambulance or emergency medical services personnel.
- Non-paramedic witnessed adult cardiac arrests where non-paramedic resuscitation was attempted.
- Non-paramedic witnessed adult Ventricular Fibrillation or Ventricular Tachycardia cardiac arrests where non-ambulance resuscitation was attempted.
Ventricular Fibrillation (VF) is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. Ventricular Tachycardia (VT) is a type of regular and fast heart beat that arises from improper electrical activity in the ventricles of the heart.
Cardiac arrests that are treated immediately by a paramedic have a better likelihood of survival due to immediate and rapid intervention. Patients who suffer a VF or VT cardiac arrest are more likely to have better outcomes compared with other causes of cardiac arrest as these conditions are primarily correctable through defibrillation.
This indicator measures survival rates to hospital, not survival rates in or post-hospital. A high or increasing cardiac arrest survived event rate is desirable.
Nationally in 2021-22, the survival rates for patients in VF or VT cardiac arrest or paramedic witnessed cardiac arrest were higher than for non-paramedic witnessed cardiac arrest where resuscitation was attempted:
- the cardiac arrest survival rate for paramedic witnessed cardiac arrests was 49.5 per cent nationally
- the cardiac arrest survival rate for non-paramedic witnessed cardiac arrests where resuscitation was attempted was 21.4 per cent
- the VF/VT cardiac arrest survival rate for non-paramedic witnessed cardiac arrests was 43.8 per cent (figure 11.7).
Estimated resident population (ERP)
The official Australian Bureau of Statistics estimate of the Australian population. The ERP is derived from the 5-yearly Census counts and is updated quarterly between censuses. It is based on the usual residence of the person.
Excludes the user cost of capital for land, payroll tax and interest on borrowings.
User cost of capital
The opportunity cost of funds tied up in the capital used to deliver services. Calculated as 8 per cent of the current value of non‑current physical assets (including land, plant and equipment).
Human resources refers to any person delivering a service, or managing the delivery of this service, including:
Revenue received directly or indirectly by ambulance service organisations on an accrual accounting basis, including:
Subscriptions and other income (subscriptions and benefit funds received from the community; donations, industry contributions and fundraising received; other income).
Australian Health Practitioner Regulation Agency (AHPRA) Paramedicine Board of Australia, 2022, Registration, https://www.paramedicineboard.gov.au/Registration.aspx (accessed 7 October 2022).
Impact of COVID-19 on data for the Ambulance services section
COVID-19 may affect data in this Report in a number of ways. This includes in respect of actual performance (that is, the impact of COVID-19 on service delivery from 2020 to 2022 which is reflected in the data results), and the collection and processing of data (that is, the ability of data providers to undertake data collection and process results for inclusion in the Report).
A PDF of Part E Health can be downloaded from the Part E sector overview page.