Triple Zero ambulance calls in Western Australia. Can secondary triage referral direct non-traumatic back pain direct to primary and allied healthcare services to reduce emergency system demand?
Dan Rose1 1St John Wa, Belmont, Western Australia, Australia
Abstract
Ambulance systems are increasingly accessed for non-emergency, low acuity complaints. In 2022, approximately 50000 triple zero calls to St John Ambulance WA were classified as low priority through primary triage. Over 30000 received secondary triage. 6000 (12%) were diverted away from primary ambulance attendance by the in-house secondary triage team (STT) to a variety of outcomes. STT is multi-disciplinary, consisting of General Practitioners, Registered Nurses and Registered Paramedics.
We sought to understand factors surrounding 000 calls for non-traumatic back pain, reasons for ambulance, transport decisions and ATS scores.
Non-priority musculoskeletal complaints potentially yield benefit. Over 13000 cases of non-traumatic back pain were sent an ambulance despite secondary triage. Most commonly, the reason cited for inability to discharge over the phone was a reluctance to mobilise, pain and expectations of imaging. A significant number of these patients were transported to hospital and categorised as ATS P3 by the crew, suggesting concerning features were not discovered on physical assessment. The most common reason cited to paramedics at the scene for transport echoed the STT experience. Paramedics cited a lack of convenient access to pathways as a reason for accommodating the transport. The most common analgesia administered during transport by Paramedics was Fentanyl.
We propose that secondary triage clinicians are well placed to identify a select cohort of these patients in the community who may be safely screened and appropriately referred away from ED direct to primary and/or allied health services for assessment and management but require system buy-in, expert guidance and engagement.
Biography
Dan has a background in Paramedicine, both Critical and Urgent/Primary Care. His principle role in St John is clinical system design and management