DOWN UNDER – Queensland Ambulance Service

Queensland is Australia’s “Sunshine State”. It is known for its relaxed lifestyle and year around sun. And looking after it quietly in background is a modern rescue service. The Australian state of Queensland is about five times the size of Germany, but with a population of around five million, it has just one sixteenth as many inhabitants. Most Queenslanders live in the region around the capital Brisbane. The Queensland Ambulance Service (QAS), a department of the state health authority, Queensland Health, is responsible for the ambulance service in Australia’s second largest state. QAS’s tasks include both emergency rescue and patient transport as well as inter-hospital transfers and the management of major emergencies and disasters.

The beginnings of the Queensland Ambulance Service dates back to September 12, 1892. On that day, the City Ambulance Transport Brigade (CATB) was formed in Brisbane. By 1902, Queensland had lost its status as a British colony and had became a state of its own. The Brisbane Ambulance Brigade was subsequently imitated in a number of other communities, with the CATB becoming the Queensland Ambulance Transport Brigade (QATB). Each midsize centre in the state received its own QATB committee, which  directed the skills of the local rescue service It was not until July 1, 1991 that the QATB was converted into a government administered service, creating the Queensland  Ambulance Service as it exists today.

Queensland Ambulance Transport Brigade officers posing in front of their Head Office in Wharf Street Brisbane 1901.

The Queensland Ambulance Service (QAS) operate in North and South Queensland. The areas include eight geographic regions, which in turn are made up of 17 districts. In  addition to around 4,100 full-time employees, QAS can also rely on volunteers. They  support the Queensland Ambulance Service in a variety of ways, not just as a first  responders during an emergency. 

Local Ambulance Committees have been formed at around 150 locations throughout Queensland. 1,300 volunteers work in their ranks, forming the link between the rescue service and the local community. These volunteers raise awareness in the community that make the rescue service’s work easier, support broad-based training, for example in the form of the CPR awareness program, and take care of the financing of additional equipment or materials for first aid.

A volunteer paramedic explaining the ambulance to some children.

The Queensland Ambulance Service aims to ensure high standards of emergency treatment, patient care and the transport of the sick and injured. The on-site rescue workers – paramedics – are largely responsible for fulfilling this goal. As a rule, they have undergone training in “Advanced” or “Critical Care” measures. All paramedics in  Queensland belong to what is known as the ‘Registered Health Professions’ group. Members of these professions are listed under the National Registration and Accreditation Scheme. This means that only people who are registered with the Paramedicine Board of Australia can legally call themselves and work as ‘Paramedics’.

With this central accreditation, which can be verified by anyone on the Internet, the state wants to ensure that they have only appropriately qualified rescue workers. The Clinical Practice Manual (CPM) was created to provide paramedics with up-to-date, consistent standards of clinical practice. It contains systematically developed statements based on the best available scientific evidence. Its content is subject to constant updates and  adjustments, as well as being reviewed at least every three years.

QAS management encourages all emergency services to participate in updating the CPM. The hurdle for this is deliberately low: completing an online form on the QAS portal is sufficient. In terms of content, this can involve the introduction of new guidelines, the review of existing procedures or protocols for drug therapies, for example. All submissions then go through a multi-stage review, where experts look at the suggestions and decide on their implementation.

In the years to come, Queensland is expected to experience significant social and demographic changes. By 2026, the state’s population is likely to increase by a third to about 6.3 million people. Of these, 1.1 million people will be over the age of 65, an 83 percent increase from 2011. These expected changes will also have consequences for the rescue service.

The Queensland Ambulance Service is preparing for this as part of its “QAS Strategy 2016 - 2021”. In recent years, the QAS has professionalized its employees as part of its strategy implementation. Almost all of the rescue workers now employed are university  graduates. Additionally, their knowledge and skills have constantly increased, as the range of measures they carry out and the medications they use has expanded  significantly over the past ten years.  The QAS assumes that this trend will continue.

Notably there are now more women than men among the new QAS rescue workers. It is important to the Queensland Ambulance Service that its workforce continues to reflect the diversity of the population. It believes that an inclusive and diverse workforce brings many benefits, including an improved corporate culture, greater innovation and more
community engagement. The “QAS Strategy 2016 - 2021” contains performance targets that they would like to have achieved by the end of the five years. Among these, is that 50 percent of Code 1 calls (emergencies) are dealt with within 8.2 minutes and 90 percent of
these calls within 16.5 minutes. Another goal is that 90 percent of Triple Zero calls – 000 is the national emergency number – are answered within ten seconds. Each year, QAS receives over 1.1 million emergency calls.

For a long time now, QAS has paid particular attention to the high-quality care of emergency patients in relation to cardiac events. Heart attack remains the leading cause of sudden death in Queensland. QAS believes that a strong rescue chain improves the chances of survival and recovery for people who experience heart attacks, strokes and other emergencies. Therefore, the general goal for QAS is to further support and improve the rescue chain.

In detail, one of the aims is to improve the survival rate to hospital admission as well as to hospital discharge after a cardiac arrest, each by ten percent. The number of cases in which a person in cardiac arrest is resuscitated by a layperson before the arrival of the emergency services is to be increased by 70 percent. And the percentage of patients who report chest pain and who have a 12-lead ECG taken after paramedics arrive is expected to rise to over 95 percent. Since 2014, corpuls has been doing its part to ensure that these goals can be achieved. In 2013, the Queensland Ambulance Service wanted to update its aging ECG/Defibrillator units and published an international tender.

corpuls won with its corpuls3 and was awarded the contract. In doing so, QAS was the first Australian rescue organization to buy the German product corpuls. Today, around 1,300 corpuls3 and 40 corpuls cpr are in use in the QAS. The implementation of these goals is scientifically supported by the “QAS Cardiac Arrest Outcomes Program”. It began work in 1999 and includes the Cardiac Arrest Database (CADB). The most important data sources include the digital Ambulance Report Form, the Computer Aided Dispatch, the Death and Cardiac Arrest Report Form, ECG recordings, corpuls.mission and data collected during the hospital stay. The CADB can be used to derive key data such as the reaction times of the emergency services, the frequency of cardiopulmonary resuscitation by first responders, the suspected cause of cardiac arrest and information on patient outcomes. With the help of this study, the performance of the QAS Paramedics can be looked at and starting points for continuous improvements can be made.