Ambulance Service of New South Wales
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| Ambulance Service of NSW | |
 Excellence in Pre-hospital Care |
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| Agency overview | |
|---|---|
| Formed | 1 April 1895 |
| Jurisdiction | Government of New South Wales |
| Employees | 3,600+ |
| Agency Executive | Mr Greg Rochford, Chief Executive Officer |
| Parent agency | NSW Health |
| Website | |
| www.ambulance.nsw.gov.au | |
The Ambulance Service of New South Wales (ASNSW) is the main provider of pre-hospital emergency care and ambulance services in the state of New South Wales (NSW), Australia. It comes under the control of the NSW Government's Department of Health, and is one of the largest ambulance services in the world [1].
The Service is committed to providing high quality clinical care and health related transport services to over 6.3 million people in NSW, distributed across an area of 801,600 square kilometres [2].
The service employs more than 3,600 men and women, who work from 266 locations across the State, operating over 800 ambulance vehicles and 300 support vehicles to provide emergency, non-emergency, aeromedical, rescue and retrieval services. Around one million responses are made by the service each year.
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[edit] History
The first recognised ambulance service in New South Wales, known as the Civil Ambulance and Transport Brigade, began on 1 April 1895. The first ambulance station was a borrowed police station in Railway Square in Sydney staffed by two permanent officers. Patients were transported on hand-held stretchers and handlitters [3].
The Brigade was a dedicated community based organisation, operating the first horsedrawn ambulance in 1899 and first motor vehicle in 1912, both donated to the Brigade by the public. Radio controlled vehicles commenced operation in 1937, a rescue service in 1941, a training school in 1961 and air ambulance in 1967. Advanced life support and intensive care vehicles were introduced in 1976.
[edit] Ambulance types
ASNSW operate a variety of emergency and non emergency vehicles across the state including a number of specialised vehicles such as over-snow vehicles [4] [5].
- Emergency medical care Ambulances
In Urban areas these are Mercedes Benz 316 Sprinters whereas more Rural areas and country towns tend to use Volkswagen T5 Transporters. Hard to access areas such as bush or mountainous terrain may require specialist vehicles such as the Toyota Landcruiser Troopcarrier.
- Patient Transport Service
Typically Ford Transit vans with green & white checker emergency markings and red/blue warning lights are used by the Patient Transport Service. These vehicles do not carry the same equipment as standard emergency ambulances [6].
- Rescue Trucks
Typically custom body Hino trucks. Ambulance rescue vehicles are equipped with a vast array of equipment including motorised hydraulic tools, air tools, hand held global positioning satellite units, fibre optic search scopes, portable atmospheric testing units, lighting and breathing apparatus.
- Rapid Response Vehicles
Seven Subaru Forrester AWD vehicles and two BMW motorbikes make up the current rapid response fleet. All vehicles have distinctive signage, high visibility LED lightbar warning lights and sirens. Subaru Forresters are also equipped with an advanced satellite navigation system.
- Mega Lift Trucks (Counter Disaster Units)
These multi-purpose vehicles are used for a range of incidents including chemical, biological and radiological (CBR) incidents.
- Over Snow Vehicles
The ASNSW fleet of vehicles at Perisher Valley Ambulance Station include a Haaglund all terrain vehicle, a Kassborher oversnow vehicle, two Yamaha snowmobiles, a 4WD Quad Bike and trailer and a 4WD Mercedes.
- Special Casualty Access Team (SCAT)
SCAT use a variety of specialised 4WD type vehicles as do Supervisors and Commanders.
- Air Wing
Four Beechcraft B200 King Air pressurised twin engined turboprop aircraft, owned and operated by the Royal Flying Doctor Service of Australia, are used on Air Wing operations. There are also 13 helicopters currently operating across the State, 11 Category 1 helicopters and 2 Category 2 helicopters.
[edit] Specialist Sections
The Ambulance Service has several highly trained, specialised and equipped sections to provide medical care and response in diverse situations around the state. Some of these more specialised sections/units include the following:
[edit] Rescue operations
The Ambulance Service operates 14 primary rescue units around the State and employs over 200 rescue officers. Officers are trained for all forms of rescue including, road crash, vertical, confined space, trench, industrial, technical and domestic to name a few [7]. They learn navigation skills, four wheel driving, urban search and rescue, and chemical biological and radiological procedures. Rescue training commences with the recruitment of up to 12 officers, who are selected to undergo a rigorous five week training course. On successful completion of the course, officers are then rostered to rescue units where training continues with a minimum eight hours of structured training per month. Officers are also required to undergo a recertification program. Ambulance rescue vehicles are equipped with a vast array of equipment including motorised hydraulic tools, air tools, hand held global positioning satellite units, fibre optic search scopes, portable atmospheric testing units, lighting and breathing apparatus [8].
[edit] Special Casualty Access Team (SCAT)
The Special Casualty Access Team (SCAT) was first formed in 1986, from the need for paramedic ambulance officers to be able to provide high quality pre-hospital care to patients where-ever they are [9]. The Service currently has 48 SCAT officers throughout the State. The roles of SCAT are many and varied including: support to rescue squads, specialist police units (such as the State Protection Group) and fire brigades in Hazmat; bushfires and urban search and rescue; working on helicopters; and accessing and treating patients in caves, canyons, mines, and on cliff ledges. SCAT officers are taught to be self sufficient and often ‘camp out’ with their patients when weather or operational conditions dictate a need to ‘stay put’ for a period. 'Core' SCAT skills focuses on safety and personal attributes (resilience, adaptability, teamwork & leadership) which is assessed under a range of testing conditions during an 8 week course. Special Casualty Access Team (SCAT) paramedics make up the composition of helicopter crews in the Sydney basin.
Although SCAT officers are highly trained there is a clear difference between their focus on accessing and treating patients who are then extricated by the accredited rescue unit for that area(Police, NSWFB, NSWSES, VRA). [10].
[edit] Rapid response
The use of Rapid Response Vehicles (all-wheel drive vehicles with no stretcher capacity) for ambulance operations is widely practised by ambulance services around the world [11]. Rapid Response Vehicles (RRVs) have been shown to be effective in providing early patient intervention and reducing response times.
Examples of the way in which RRVs assist in reducing response times are:
- RRVs allow a single officer to assess patients quickly and, if transport is not required, provide basic treatment at the scene, freeing up front line ambulances to respond to other emergencies.
- Early arrival on scene allows timely and effective treatment to be carried out as well as allowing the paramedic to quickly assess the situation and request the most appropriate resources, according to the patients condition and situation.
- RRVs operate across the Sydney metropolitan area. They are not attached to any particular station but instead move within certain areas, according to the demand.
[edit] Ambulance Aeromedical Division
The Air Ambulance
The Air Ambulance Service of NSW was established in 1967 with a single Beechcraft Queen Air. More Queen Airs were gradually added so that by 1978 four were operational; these aircraft were owned and operated by East-West Airlines on behalf of the Service. One aircraft was destroyed by fire at Dubbo, New South Wales in 1982 and a fifth Queen Air was added to replace it[1][2]. In 1985 a fleet modernisation programme began when the first two of four Beechcraft B200C Super King Airs were purchased to replace the Queen Airs[1]. In 2003 one of the B200Cs was written off following an accident at Coffs Harbour Airport[3]. By that time a second re-equipment programme was underway; the remaining three aircraft were replaced that year and in 2004 with four modified B200 King Airs[4]. The Air Ambulance base facility is located at Sydney's Kingsford Smith International Airport and consists of an aircraft hangar with a light maintenance facility, road ambulance bay, patient care facilities, administration and an area for aircraft parking [12].
The role of the Air Ambulance Service is to provide long distance transport while ensuring the continuation of the patient's medical and nursing care between referring and receiving hospitals. The aircraft becomes the extension of the general hospital ward, Intensive Care Unit, Coronary Care Unit, Labour Ward, Nursery etc.
Air Ambulance operates both a 24-hour emergency service and a routine service. The clinical condition of a patient determines if the transfer is on an urgent or routine basis. An urgent response is provided for patients who require immediate transport, for the clinical management of, for example, multiple trauma, labour complications, acute cardiac cases. A routine response is provided for those patients who are stable and are scheduled for the next routine or elective flight to the area or receiving hospital.
[edit] Helicopter operations
Helicopter retrieval incorporates both pre-hospital rescue and interhospital transfer services across the State. They operate from Sydney, via Bankstown Airport, and rural bases at Canberra, Orange, Tamworth, Newcastle, Wollongong and Lismore.
Helicopter fleet
The Ambulance Service of NSW, through the NSW Department of Health, has contracts with six medical rescue providers in the State of New South Wales. Each contractor is designated a region of the State and has the option of providing more than one helicopter to their region.
In total there are 13 helicopters currently operating across the State, 11 Category 1 helicopters and 2 Category 2 helicopters [13].
Category 1 helicopters are twin engine, single pilot and instrument guided (able to fly in cloud). They have a minimum cruise speed of 120 knots, a rescue hoist, and operate around-the-clock subject to weather. These helicopters can accommodate any type of patient, including premature babies, children and adults and have the capacity to transport two stretcher patients with medical equipment, two medical attendants, a pilot and flight crew. They are also equipped as mobile Intensive Care Units with non-invasive monitoring units, intubation and ventilation equipment including mechanical ventilators.
There are two Category 2 helicopters that are generally smaller in size and are equipped with a rescue hoist. They generally operate in daylight hours only. They are capable of accommodating one patient at a time plus a pilot, flight and medical crews.
Both categories of helicopters are equipped with on-board oxygen, suction and a comprehensive array of medical and rescue equipment. Cardiac resuscitation drugs and narcotic analgesics are routinely carried along with non-invasive blood pressure monitoring, pulse oximetry, ECG monitoring and defibrillation. Advanced monitoring and therapeutic equipment equivalent to a hospital Intensive Care Unit is frequently carried and used for critically ill patients.
The Ambulance Service and NSW Health came under fire in late 2006/early 2007 for its 'dumping' of community based rescue helicopter services Westpac Life Saver and NRMA CareFlight in favour of the Canadian owned CHC Helicopter, for the Sydney and Central West regions. Westpac Life Saver is still operating in the Hunter and Northern NSW Regions in full capacity. In Sydney Westpac Life Saver are operating as a search and rescue helicopter from its base at Malabar on the southern end of Sydney's eastern beaches and as a back up for the Ambulance Service. NRMA CareFlight has a contract with the Ambulance Service to provide medical retrieval doctors for the services based from Bankstown and Orange, and continues to provide provide the Head Injury Retrieval Trial (HIRT). HIRT is a research project undertaken jointly with Sydney University to compare clinical outcomes of patients with head injuries treated by either the specialist CareFlight doctor and team who respond to the scene in the HIRT helicopter, or the normal NSW Ambulance Service response to such calls. The main HIRT helicopter is an Agusta A109E Power, and the backup is a Kawasaki BK117. NRMA CareFlight is conducting the trial with the cooperation of the Ambulance Service of NSW. The HIRT team monitors '000' calls via an internet link and self responds based on agreed HIRT response protocols becoming airborne within 3 minutes of being given the go ahead to respond to a patient.
[edit] NSW Health Counter Disaster Unit
Established in 2003, the NSW Health & Ambulance Service Counter Disaster Unit (CDU) consists of specialised NSW Health and Ambulance Service personnel working together to co-ordinate aspects of health disaster planning and response, including responding to terrorism events [14]. The role of CDU is to ensure NSW Health is prepared to respond effectively to major health emergencies and disasters within NSW.
[edit] Rank markings/insignia
| Rank | General Manager, Operations |
General Manager, Clinical Services |
Divisional Manager |
Assistant Divisional or Unit Manager |
Operations Manager |
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| Rank | District Officer (DO) |
Seconded/ Group Officer |
Station Officer Grade 2 (SOII) |
Station Officer Grade 1 (SO) |
Paramedic (no rank) |
| Intensive Care Paramedic (ICP) Insignia |
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| Paramedic (L4) Insignia |
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| Paramedic (L3, L3c, P1) Insignia |
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| Paramedic Educator Insignia |
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| Designation | Student Paramedic (L1) |
Trainee Paramedic (L2) |
Patient Transport Officer (PTO) |
Volunteer | First Responder |
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| Designation | Senior Base Pilot |
Pilot | Doctor | Senior Flight Nurse |
Flight Nurse |
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| Designation | Senior Chaplain |
Chaplain (Jewish) |
Chaplain |
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[edit] References
- ^ a b Cookson, Bert. The Historic Civil Aircraft Register of Australia VH-AAA to VH-AZZ. 1986, Toombul, Queensland: AustairData (privately published).
- ^ State Records Authority of New South Wales page retrieved 2007-10-31.
- ^ ATSB accident report retrieved 2007-10-31.
- ^ Reid, Gordon. "Traffic" column, Australian Aviation magazine No. 191 January/February 2003, p.72. Aerospace Publications. ISSN 0813-0876.
