Tasmania’s Ambulance Ramping Fix: Is a 45-Minute Transfer Protocol the Answer?

Dave Allchin, a seasoned emergency department nurse in Launceston, Tasmania, voices a growing concern. Years spent on the front lines have instilled a sense of unease. Staff shortages, inadequate resources, and the pressure to prioritize patients are taking a toll, leading to what he describes as “moral distress.” He’s not alone.

Tasmania is attempting to tackle ambulance ramping, where ambulances queue outside hospitals, unable to offload patients. The government introduced a 60-minute transfer-of-care protocol, aiming to get ambulances back on the road faster. Now, they’re tightening the screws, reducing the timeframe to 45 minutes. The goal? To ensure paramedics can respond to emergencies without delay.
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Health Minister Bridget Archer touts a nearly 64% reduction in ambulance ramping hours this financial year. Deputy Secretary Brendan Docherty reports an 85% compliance rate with the 60-minute protocol. Numbers look good on paper.

Yet, the Australian Nursing and Midwifery Federation (ANMF) and the Australian Medical Association (AMA) raise valid points. Emily Shepherd from the ANMF notes potential inequities, suggesting hospital staff might feel pressured to prioritize ambulance offloads over patients already waiting in the emergency department. Michael Lumsden-Steel of the AMA emphatically agrees.

The core issue? A strained healthcare system. Data reveals the protocol hasn’t improved ambulance response times. Shepherd argues the focus has merely shifted the problem, creating “corridor ramping” instead of ambulance ramping. Patients are still waiting, just in different locations. This pressure, she fears, could lead to burnout and departures from the industry.
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It’s worth noting that not everyone disapproves. Some paramedics, like Simone Haigh, argue that the perception of ambulance patients receiving preferential treatment is a misconception. She believes the ramping protocol addresses a significant issue, freeing up ambulances for critical calls. “People who are ramped in the hospital, even though it’s not ideal, at least there are people there,” Haigh suggests, contrasting this with people alone experiencing medical emergencies.

The Health and Community Services Union’s Robbie Moore thinks that the 45-minute target will put more resources into emergency departments.

The debate highlights a fundamental tension: optimizing one part of the system might inadvertently create problems elsewhere. It also reveals the diverse experiences and perspectives within the healthcare workforce. Paramedics see the issue from the road, emergency department staff experience the bottleneck firsthand, and administrators grapple with system-wide metrics.

A Tasmanian health department spokesperson assures continued engagement to address concerns. But words are cheap.

The 45-minute transfer window starts December 15th, with a further reduction to 30 minutes planned for next year. It will be interesting to observe what the reality of that looks like.

The concerns from doctors and nurses groups are valid. As Allchin aptly puts it, “Unless there’s significant quality improvements that parallel with the targeted change, I don’t foresee it being of any benefit to the emergency department.”

Haigh’s assessment resonates: “To end ramping, they need to overhaul the system… The system is massively under-resourced and it’s inefficient.” This isn’t just a Tasmanian problem; it mirrors challenges faced by healthcare systems globally.

The deeper issue isn’t just ambulance turnaround times. It’s about addressing the root causes of hospital overcrowding: chronic underfunding, staffing shortages, and inefficiencies in patient flow. A mandated transfer time, without addressing these systemic issues, risks becoming a superficial fix that simply shifts the burden elsewhere. It’s like rearranging deck chairs on the Titanic.

From experience, I can say this kind of top-down mandate rarely works without buy-in and support from those on the ground. The risk is always that people will find ways to “game the system,” prioritizing speed over comprehensive care.

The question then becomes: will these changes truly improve patient outcomes and alleviate pressure on healthcare workers, or will they merely mask the symptoms of a much larger, more complex problem? The coming months will tell.

As Allchin poignantly states, “I just want to give good care to my patients; that’s why I work in emergency.” That sentiment should be the guiding principle. Real solutions require a holistic approach, one that values both efficiency and the well-being of patients and staff. Short-term fixes often lead to long-term pain.

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Keywords: Tasmania ambulance ramping, ambulance ramping, healthcare system, 45-minute transfer protocol, emergency department, staff shortages, hospital overcrowding, patient outcomes