As I often do, last night I tweeted facts about ramping in Victoria, as posted on the Code Red Facebook campaign page. That night, among the many crews ramped at hospitals across the state, ten were ramped at the Northern.

I’ve written about the problem of ramping before. One of the things I didn’t say last November was that ramping significantly contributes to overtime and missed breaks – paramedics can’t leave their patients just because their shift is over, even if it will be another two hours before the hospital they’re ramped at can take the patient; though they’re paid for this time, the shift extensions contribute to fatigue (which increases risks of error and accidents, as well as long term health effects and increased rate of burn out), and intrude on personal time.

Ramping is only part of the problem facing Victoria’s paramedics, who are currently in EBA negotiations with the state government – though they’re the best trained paramedics in the country, with world-beating rescue times for cardiac patients, our paramedics are the nation’s worst paid. There are virtually no return-to-work programs for paramedics injured on the job, despite suggestion from their union that placing these professionals in emergency departments (where they wouldn’t have to lift stretchers, negotiate stairs, bend to the ground and other limiting actions) would both allow the industry to retain experienced staff while also freeing ramped crews. And there are inadequate support services for the men and women who witness horrendous injuries and are subject to the highest rate of occupational violence in Victoria – a combination that sees not only a high turn over rate and distressing levels of substance abuse, but a suicide rate six times the state average.

For Victoria’s paramedics – just as was the case for Victoria’s public sector nurses and midwives – this really is a campaign that’s about fair compensation but much more than just the money.

The reason why there’s an emphasis on ramping is that it’s the aspect of service provision that most affects the public, it’s visible, and it’s undeniable. It’s the single biggest reason for delays, and some of the examples posted by paramedics are truly astonishing – like the night a category 1 call (which merits urgent attendance) in Tarneit was responded to by a crew from Prahran – because there were no available crews in the west or north of Melbourne.

There have already been cases were delays appear to have affected patient outcomes, and it seems inevitable that people will die. The Victorian government, though talking about commitment to health care, has failed to move with any swiftness, and the only way to put prssure on Premier Napthine and Health Minister Davis is through public attention – paramedics cannot reduce services, as we did.

Which is why I tweet about ramping – because the more the public understand about why this is important, what it means, and how we are all potentially affected,t he more able they are to support our paramedics. And make no mistake – this is an issue that can affect anyone who lives or visits Victoria, because you never know when the patient on that stretcher may be you or someone you love.

Which brings me back to Monday.

As I tweet, ten ambulance crews are ramped at the Northern hospital alone – we have a crisis, Premier Napthine: please help! #SpringSt

In response to my tweet, someone I didn’t know replied “they are… walk outside and have a look behind the temp fencing… new ED bays. #springst

We then proceeded to have a very frustrating discussion, where he insisted that the problem was “purely capacity” of emergency departments, and where I was informed that “general [inpatient units] can swing for maternity or surgical etc… ED bays are specialised” (and later “highly specialised”).

I agree that emergency medicine is a specialty – I certainly couldn’t practice with the same level of proficiency there as I do on my specialist medical ward. The focus of ED is assessment, initial treatment, and flow – to outpatients, home, or specialist wards. Staff there deal with every conceivable condition, from splinters to myocardial infarction, from fractured toes to major traumas. They never know what’s coming thorough the door next, their patients are often drug and/or alcohol affected, they don’t conveniently arrive with a medical, psychiatric and social history attached, and both the patients and their accompanying entourage of friends and family are often emotionally volatile.

I find the statement that inpatient units are not equally specialised both insulting and ill-informed. When I pointed out that my position was informed by almost a quarter of a century working at a tertiary hospital (including some time in one of the state’s busiest emergency departments, albeit some time ago), I was informed that his position “is informed by a decade of health conferences, design, user, construction meetings while building them..”

There’s a limit to how productive a discussion one can have on Twitter, particularly when it’s being approached from very different perspectives. We ended with his reiterating that some hospitals are having ED capacity added, and me tweeting “I appreciate that. My point is that ramping, and ambo issues in general, are about more than bed/ED capacity”

And then I had a little rant of Facebook. It was well received there, so I’m reproducing a slightly expurgated version here.

Ambulance ramping is, indeed, a multifactorial problem. When I tweeted that there were ten ambulances ramped at the Northern, it was part of a number of tweets, over a number of weeks, about ramping across the state.

How awesome the Northern’s extending its ED. That doesn’t invalidate my points, that:
a) more nurses in ED would reduce ramping
b) the Vic govt declined that, as it would be a nursing budget cost but a paramedic productivity gain
c) we have too few paramedics
d) Vic paramedics are very highly educated, and appallingly paid
e) they have inadequate supports, almost no return-to-work systems, and woefully inadequate safety measures
f) your decade “attending health conferences, design, user, construction meetings while building them” is awesome, but doesn’t outweigh twenty-four years working on the damn floor, including ED
g) especially when you tweet that in-patient units aren’t specialised, and give the examples of them bring able to take surgical patients and MATERNITY!
h) then say ED is more specialised

If you think any area of nursing’s not specialised, it’s because you don’t know what you’re talking about – from mid to aged care, ICU to palliative care, plastics to orthopaedics, for the best outcome you want nurses, midwives, doctors, surgeons, pharmacists and allied health staff who know more about that area that anything else.

A renal-experienced pharmacist would have prevented an accidental overdose of one of our patients – prescribed by a doctor who didn’t know the condition or protocols, and missed by busy nurses, this is just one example of how specialised experience makes a difference.

Finally – I don’t know nothing ’bout birthin’ no babies – don’t tell me maternity’s not a specialty! Sure, we can care for patients in specialties other than our own, but we’re more likely to miss things. You wouldn’t see a paediatrician about a detached retina – don’t think a nurse is a nurse is a nurse!

I know this has turned into a rant about nursing, for which I won’t apologise, because it’s important and something too many people (including those who should know better) fail to recognise. But I will conclude where I began, with paramedics.

Please show your support of our over-worked, highly educated, life-saving paramedics: visit the AEA Facebook page, follow their parent union, @UnitedVoiceVic on Twitter, and please – sign their petition, and circulate it!