The Australian Institute of Health and Welfare (AIHW) reports that, in 2020-21, there were 8.8 million presentations to Australian public hospital emergency departments (EDs). About a quarter (2.3 million) of those cases arrived by ambulance. 

But that no longer means they were seen quickly. Nowadays, ambulances queue up outside hospitals and paramedics wait in corridors with their patients until there’s space available in the ED – meaning they’re not able to answer other 000 calls

Such ambulance ramping is a sign of a health system under immense strain. So, how bad is it? Why is it happening? And what can be done to improve the situation? 

Ambulance ramping in Australia: How bad is it? 

Ambulance ramping is now a dire problem across Australia. 

The Australian Medical Association (AMA) reports that every state and territory is failing to meet its performance targets for the time it takes to transfer patients from an ambulance to the Emergency Department. Longitudinal data demonstrates that the time it takes to transfer a patient from the ambulance to the care of the hospital emergency department has been overall increasing year on year. 

The Guardian reports that in the last quarter of 2021: 

  • 38% of Queensland ambulances waited more than 30 minutes to hand patients over to emergency department staff (rising to 46% in south-east Queensland in December 2021)
  • 37.3% of Western Australian ambulances were ramped for more than 30 minutes
  • 33.3% of Victorian ambulances were ramped for more than 40 minutes.   

It’s an appalling situation for patients. One 84-year-old Perth woman who had been a nurse and a senior healthcare manager before retirement reports that in March 2021 when she needed emergency care: 

  • The ambulance took 3 hours to arrive
  • Her preferred private hospital wouldn’t admit her so she was taken to the nearest public one
  • She waited, in the care of paramedics, in a corridor on a stretcher for 9 hours before admission to the ED – near a woman with a neck of femur fracture who wasn’t seen for 3 hours
  • Once admitted to the ED, it took 2 hours for a doctor to see her and another 2 hours for a specialist to come. She was then discharged 4 hours later. 

Ambulance ramping can also have adverse clinical outcomes, with a Victorian study finding that it increases the risk of patients with chest pain dying within 30 days and is associated with preventable deaths. A UK report by the Association of Ambulance Chief Executives found that 80% of patients who experienced ambulance ramping of 60 minutes or more potentially experienced some level of harm and nearly 10% experienced severe harm. 

Why does ambulance ramping happen? 

Ambulance ramping is a complex problem but it’s worth highlighting two key contributors to it. 

The first is an over-capacity hospital system that simply has no space for new patients until the existing ones are discharged. 

The second is the underfunded primary and community care system. Understaffed aged care homes call 000 because they can’t care for a patient with high needs. Patients with chronic conditions who can’t get a timely appointment with their GP call 000 because they need help to manage asthma attacks or epilepsy seizures. 

As Danny Hill, secretary of the Victorian Ambulance Union comments, ‘These patients need care, just not emergency ambulance care. They call triple zero when the care they need is not available.’

A 5-point plan to ease ambulance ramping

  • Consider the whole system

Systemic reform is needed to address ambulance ramping. It’s not simply a matter of hiring more paramedics or ED doctors but of improving processes across the continuum of care. 

The UK is also battling similar issues. Ambulances can take over an hour to arrive, even for stroke and epilepsy patients. In July 2022, at Northern Lincolnshire and Goole NHS Trust, 532 people waited more than 12 hours in the Accident and Emergency Department for a ward bed, after a decision to admit was taken. 

In the UK, Leeds Teaching Hospitals NHS Trust has worked to improve patient flow into and out of the hospital. That’s reduced ambulance ramping delays over 30 minutes to just 4.9% of paramedic attendances, compared to a national average of 21%. Just 0.16% of delays exceed 60 minutes compared to a national average of 8.5%. 

Key aspects of this model include: 

  • A strong working relationship with the Yorkshire Ambulance Service
  • Data sharing with key partners
  • A zero-tolerance approach to ambulance handover delays, which is owned by staff across the ED and recognised by colleagues across the hospital from frontline staff to the CEO
  • Tackling challenges relating to patient flow into and out of the hospital
  • A dedicated ambulance team staffed by 2 nurses at all times – one nurse checks with the ambulance crew and takes responsibility for the patient while the second conducts assessments and observations and allocates where the patient will go
  • An escalation process to quickly pull in staff to create space for incoming patients
  • Ensuring patients who don’t require admission to a ward are discharged in a timely manner and with appropriate care in place. 

This model has informed the Victorian government’s $162m plan for system-wide solutions to counter paramedic wait times.

  • Reduce patients going in 

In 2020-21, 47% of presentations to emergency departments were classified as either semi-urgent or non-urgent, according to the AIHW. That’s just over 4 million emergency department presentations that could have been addressed by doctors and nurses outside a hospital.

Better pathways to non-emergency care in the community can help some patients avoid an ED presentation. 

The new Labor government has promised to create 50 Medicare Urgent Care Clinics that would enable people with an urgent but not life-threatening need to see a bulk billing doctor without going to an ED. Such clinics may treat some broken bones, wounds, minor burns, and other illnesses.

While Australia has a shortage of doctors and nurses, we have a surplus of graduating paramedics – a ready-made workforce of registered healthcare professionals who could provide valuable support to urgent care clinics. 

  • Consider an Analytical Command Centre

University Hospitals of Morecambe Bay NHS Foundation Trust runs an award-winning Analytical Command Centre at Royal Lancaster Infirmary, modelled on the air traffic control systems used at airports. 

Powered by Qlik, this gives frontline care workers instant access to vital information on ambulance status, demand surges, current beds available, and patients ready for discharge.  

  • Use Hospital in the Home

Given the capacity issues faced by Australian hospitals, it’s vital that they only treat patients who cannot receive care anywhere else. 

Expanding your Hospital in the Home (HitH) service is one way to free up ward beds for patients languishing in the ED. 

HitH enables stable patients to receive IV antibiotics, immunotherapy, chemotherapy, antivirals, anticoagulants and other treatments at home, supported by a dedicated nursing team. It’s a viable treatment model for patients with cancer, MS, rheumatoid arthritis, cellulitis and a number of other conditions.  

  • Create capacity

Some solutions – such as Medicare Urgent Care Clinics, an Analytical Command Centre or an expanded ED – may require the creation of additional capacity. 

That doesn’t have to mean commissioning an extensive building program that takes years to achieve its aims. 

Mobile and modular infrastructure offers a relatively fast way to create additional capacity tailored to the particular needs of each organisation. 


Ambulance ramping is a key issue facing the Australian healthcare system. Patients experiencing a medical emergency need to know they can count on an ambulance coming quickly to their aid and a hospital admitting them promptly. 

That will take systemic reform, more funding, and a willingness to try new models of care. It will also require the right infrastructure to sustain and support this new direction. 

If you would like to learn more about how mobile and modular facilities could help your organisation, please contact Q-bital Healthcare Solutions.