Report on Government Services 2024
PART E, SECTION 11: RELEASED ON 31 JANUARY 2024
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 is 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 Western Australia and the Northern Territory, 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 2022-23, total ambulance service organisation revenue was $5.5 billion, an increase of 9.3% from 2021-22 and representing an average annual growth rate over the past five years of 6.7% (table 11.1).
Jurisdictions have different funding models to resource ambulance service organisations. Nationally in 2022-23, state and territory government grants and indirect government funding formed the greatest source of ambulance service organisation funding (80.4%), followed by transport fees (from public hospitals, private citizens and insurance) (15.4%), and subscriptions and other income (4.1%) (table 11A.1).
Size and scope
Nationally in 2022-23, for ambulance services reported in this section there were:
- 23,096 full time equivalent salaried personnel (83.0% were ambulance operatives)
- 6,052 volunteer personnel (90.2% were ambulance operatives)
- 974 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 2022-23, there were 23,837 registered paramedics in Australia (including 558 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 2022-23, there were:
- 4.2 million incidents (events that resulted in demand for ambulance services) reported to ambulance service organisations (161.7 incidents per 1,000 people)
- 5.5 million responses where an ambulance was sent to an incident (209.9 responses per 1,000 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
- 4.0 million patients assessed, treated or transported by ambulance service organisations (153.9 patients per 1,000 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 2022-23, 43.5% of the 4.2 million incidents reported to ambulance service organisations were prioritised as emergency incidents, followed by 31.4% prioritised as urgent and 25.1% 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 is complete and comparable in this report. For data that is 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 is comparable and complete
- Effectiveness – Appropriateness – Clinical
- Pain management – most recent data for all measures is comparable and complete
- Effectiveness – Quality – Safety
- Patient safety – no data reported and/or no measures yet developed
- Effectiveness – Quality – Responsiveness
- Patient satisfaction – most recent data for all measures is comparable and complete
- Effectiveness – Sustainability
- Ambulance workforce – most recent data for all measures is comparable and complete
- Expenditure per person – most recent data for all measures is either not comparable and/or not complete
- Cardiac arrest survived event rate – most recent data for all measures is 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) is 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% and 50% 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 2022-23, the time within which 90% of first responding ambulance resources arrived at the scene of an emergency in code 1 situations ranged from:
- 16.8 minutes (Australian Capital Territory) to 55.6 minutes (South Australia) in capital cities
- 16.8 minutes (Australian Capital Territory) to 50.9 minutes (South Australia) state-wide (figure 11.2).
In 2022-23, the time within which 50% of first responding ambulance resources arrived at the scene of an emergency in code 1 situations ranged from:
- 10.0 minutes (Western Australia and Australian Capital Territory) to 15.9 minutes (South Australia) in capital cities
- 10.0 minutes (Australian Capital Territory) to 15.1 minutes (South Australia) state-wide.
Supporting data on triple zero call answering times are available in table 11A.6. Nationally, in 2022-23, 93.4% of calls from triple zero emergency call services were answered by ambulance services communication staff in 10 seconds or less. This is an increase from 82.2% in 2021-22 and is the highest 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 2022-23, the proportion of patients who reported clinically meaningful pain reduction at the end of ambulance service treatment was 83.2%. All jurisdictions except South Australia reported a decrease from 2021-22 (figure 11.3).
3. Patient safety
‘Patient safety’ is an indicator of governments’ objective to deliver ambulance services that are high quality and safe.
A measure of patient safety is under development. Data is not yet available for reporting.
A patient safety incident is an event or circumstance that could have resulted, or did result, in unnecessary harm to a person receiving healthcare. Ambulance services have policies and systems in place to manage patient safety incidents.
Table 11.2 provides an overview of the incident management policies that apply to ambulance services in each state and territory. The requirements for notification, escalation and reporting can vary based on the severity of the incident.
High levels of service safety are desirable, as evidenced by low and decreasing rates of patient safety incidents. However, high or increasing rates of reported incidents might reflect more effective incident reporting mechanisms and organisational cultural change.
The feasibility and suitability of an additional measure for this indicator related to notifications about qualified ambulance officers is being investigated. Information about notifications made to Ahpra is available at: www.ahpra.gov.au/Notifications/Concerned-about-a-health-practitioner.aspx
Table 11.2 Overview of ambulance patient safety incident policy settings
|What incidents are reported, how and to whom?
NSW Health’s Incident Management Policy Directive applies to the NSW Ambulance Service. An incident is an unplanned event that results in, or has the potential for: injury, damage or loss, including near misses. A harm score (HS) from 1 to 4 applies to clinical incidents based on the patient outcome and additional treatment or resources required:
Staff must notify all clinical incidents by recording them in the NSW Health incident management system. Serious incidents are escalated and reviewed.
Safer Care Victoria’s (SCV) ‘Adverse patient safety events’ policy applies to Ambulance Victoria. Adverse patient safety events are defined as incidents that result in harm to a person receiving care. Incident Severity Ratings (ISR) are defined according to degree of impact:
Sentinel events must be notified to SCV within three days. Sentinel events are defined as adverse patient safety events resulting in serious harm or death, including all events on the Australian sentinel events list (version 2). SCV publishes the total number of health service sentinel events each year, although data are not disaggregated by ambulance sentinel events.
A ‘reportable event’ in the provision of ambulance services is defined in section 36A of the Ambulance Service Act 1991 (ASA) to mean:
The Queensland Ambulance Service (QAS) is obligated to comply with the Health Ombudsman Act 2013 (Qld), which requires employers of health practitioners to notify the Health Ombudsman of certain events. Further, the QAS also notifies the State Coroner of deaths that meet the definition of ‘reportable deaths’, defined under the Coroners Act 2008 (Qld).
The QAS is currently rewriting the clinical incident management systems as part of the draft Patient Safety Strategy. A Pilot of these initiatives is planned for Metro South and Metro North regions. Currently, the QAS defines a clinical incident as ‘an event or circumstance that could have resulted, or did result, in unintended harm to a patient during the course of clinical care is considered a clinical incident’. Clinical incidents are then assigned a Severity Assessment Code (SAC), being one of the following:
WA Department of Health’s Clinical Incident Management Policy and associated guidelines apply to St John Ambulance WA, as part of its contract. Health services must ensure they maintain systems and processes that provide a consistent approach to clinical incident management, including managing data quality.
A clinical incident is as an event or circumstance that could have or did lead to unintended or unnecessary physical or psychological harm to a patient. Clinical incidents are those events or circumstances where the harm is attributed to health care provision (or lack thereof) rather than the patient’s underlying condition or illness.
The WA health system Severity Assessment Codes (SACs) include three categories of clinical incidents:
When a clinical incident or near miss has occurred, staff must notify the incident in the approved clinical incident management system by the end of the workday and allocate a SAC rating within 48 hours of notification. Health services are required to report SAC 1 clinical incidents to the Department of Health.
SA Health’s Patient Incident Management and Open Disclosure Policy Directive applies to the SA Ambulance Service.
A patient incident is defined as any event or circumstance which could have (near miss) or did lead to unintended or unnecessary psychological or physical harm that occurs during an episode of health care to a person or patient. The Incident Severity Rating (ISR) is a numerical score applied to patient incidents that considers the direct outcome and follow up treatment required following an incident:
Services must record all patient related incidents, including near misses, in SA Health’s Safety Learning System.
All patient safety events are required to be reported, categorised and managed through the Department of Health Safety Reporting and Learning System (SRLS), which is oversighted internally by an Ambulance Tasmania management and review committee. The SRLS is subject to required commencement of management and completion KPIs.
Version 2 of the Australian sentinel events list applies to all health services in Tasmania, including
ACT Ambulance Service (ACTAS) manages adverse and near miss events using its own policy and procedure. Patient safety incidents are categorised according to the following Severity Assessment Code (SAC) scale:
ACTAS is not required to notify patient safety incidents or sentinel events to the ACT Government.
Version 2 of the Australian sentinel events list applies to all health services in the NT, including St John Ambulance NT. The NT Health annual report includes the number of sentinel events in NT health services, although data are not disaggregated by ambulance sentinel events.
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 2022-23, the majority of respondents (97.0%) 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 2022-23 who reported a quicker than expected phone answer time (64.0%) and ambulance arrival time (60.0%) increased from 2021-22 (table 11.3). The proportions of respondents who indicated a slower than expected phone answer time (5.0%) and ambulance arrival time (13.0%) both decreased from 2021-22 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 2022-23, the proportion of the ambulance workforce aged under 50 years was 78.6% (figure 11.4 and table 11A.9). This is a decrease from 2021-22 when the proportion was 79.1%, however it is the equal second highest proportion over the past 10 years (with 2013-14) (figure 11.4 and table 11A.9).
Supporting data on student enrolments in accredited paramedic training courses are available in table 11A.10. Enrolments peaked in 2019 with 342.3 enrolments nationally per million people, while there were 292.4 enrolments per million in 2022-23.
Nationally in 2022-23, the attrition rate was 4.4%, an increase from 4.1% in 2021-22 and the highest rate in the 10 years reported (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 $210 per person in 2022-23, an increase of 6.3% 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 2022-23, 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 45.8% nationally
- the cardiac arrest survival rate for non-paramedic witnessed cardiac arrests where resuscitation was attempted was 23.5%
- the VF/VT cardiac arrest survival rate for non-paramedic witnessed cardiac arrests was 45.0% (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.
Human resources refers to any person delivering a service, or managing the delivery of this service, including:
Initial assistance can come from two locations:
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).
User cost of capital
The opportunity cost of funds tied up in the capital used to deliver services. Calculated as 8% of the current value of non‑current physical assets (including land, plant and equipment).
Australian Health Practitioner Regulation Agency (AHPRA) Paramedicine Board of Australia, 2022, Registration, https://www.paramedicineboard.gov.au/Registration.aspx (accessed 7 October 2022).
Note: An errata was released for section 11 Ambulance services above on 5 February 2024.
The following change has been made to section 11:
- Data table 11A.3 was amended to include corrected data for the total number of registered paramedics in South Australia and Australia for 2022-23.