NSW Ambulance, previously the Ambulance Service of NSW, is an agency of NSW Health and the statutory provider of pre-hospital emergency care and ambulance services in the state of New South Wales, Australia.
Established pursuant to the Ambulance Services Act, 1976 (NSW) and operating within the Health Services Act, 1997 (NSW), the service provides clinical care and health related transport services to over 7.9 million people in New South Wales (NSW), across an area of 801,600 square kilometres (309,500sqmi).[1]
NSW Ambulance employs more than 6,100 staff including 4,952 paramedics who operate over 1,600 response vehicles from 220 locations across the state.[1] The service responds to around 1.1 million calls a year, with an average response time of 7.47 minutes to 1A emergencies (cardiac or respiratory arrests), against a target of 10 minutes.[2]
In 2018, paramedicine became a regulated profession, legally protecting the title of paramedic and establishing mandatory professional standards for practitioners.[3]Health Practitioner Regulation National Law (NSW) and the Australian Health Practitioner Regulation Agency provide minimum requirements to ensure that paramedics in Australia are competent, qualified, and able to provide safe and effective care to the public.[4][5] Other requirements include holding an accredited qualification, being fit to practice, and passing a criminal history check. [6][7][8]
History
NSW Government Railway Ambulance Corps wagon in 1890.One of the first motorised ambulances, donated to the Ambulance Corps in 1912A 1956 Holden FJ ambulance
The first recognised ambulance service in New South Wales, known as the Civil Ambulance and Transport Brigade, commenced operations on April 1, 1895. Their first ambulance station was a borrowed police station in Railway Square, Sydney, which was staffed by two permanent officers. At the time, patients were transported on hand-held stretchers and hand-litters.[9] As demand grew, so did the service and they were soon transporting over 2,000 patients a year. In 1905, they were reorganised into the Ambulance Transport Corps. In 1910, they opened their first station on the west side of the city, occupying the former parcels office at Summer Hill Railway Station.[9]
In 1912, the first motorised ambulance entered service with the Corps, followed by two ambulance trams in 1915. The service was then renamed the NSW Ambulance Transport Service Board in 1921, with further technological advances such as the installation of radios in ambulance vehicles by the mid 1930s. By 1937, the Central District ambulance fleet had grown to 15 vehicles, with many others operating in districts across the state.[9]
In 1958, the first fibreglass body ambulances entered service, marking a significant advancement in the design towards the modern ambulance.[10] In 1962, Station Officer Jim Smith (a former rigger at the Port Kembla Steelworks) became the first rescue trained ambulance officer in NSW. He received training from the existing Police Rescue Squad, and subsequently commenced operations on the service's new 'Q' (Rescue) Van.[11] In 1967, the Air Ambulance Service was established, operating a single Beechcraft Queen Air B80. Over the next ten years, this would grow to a fleet of five aircraft.[12] In 1970, the service purchased 45 new Ford F100 ambulances, which would become the face of the fleet for many years to come.[10] By the late 1970s and 1980s, Intensive Care Paramedics were introduced, allowing the service to bring unprecedented levels of pre-hospital care to patients.[9] In 1985, the Air Ambulance fleet received further upgrades with four new King Air B200C's.[12]
As the importance of pre-hospital care skyrocketed in the service, the Special Casualty Access Team (SCAT) was formed in 1986.[9] This team of elite paramedics brought intensive care to patients in the most extreme of situations, ranging from cliff falls to building collapses. SCAT Paramedics were trained in a range of skills including climbing, winching, breathing apparatus, CBRNE, caving, canyoning, USAR, bushcraft, four wheel driving and wilderness survival.[13] A major step forward for the service came in 1991, when every ambulance in NSW was equipped with a defibrillator.[14] In 2004, both immediate and long distance care were enhanced across NSW, with the purchase of new rapid response cars and new Air Ambulances (four King Air 200s).[9] The late 2000s saw vast increases to the service's specialist capabilities, with the creation of the Medical Retrieval Unit,[15] the Special Operations Team[16] and the Extended Care Program,[16] making the service one of the most advanced providers of pre-hospital care in the world.
Paramedics
Paramedics form the backbone of NSW Ambulance through their dynamic application of skills and expanding role in the community.[17] They provide the bulk of frontline healthcare, responding to all types of emergencies across the state. Paramedics are highly trained in a broad variety of medical skills to assess patients’ conditions, make quick decisions, and perform life-saving procedures, often in high-pressure environments.[8] Paramedics must hold an accredited degree or be assessed to have equivalent qualifications alongside experience.[6][18][19][20]
Intensive Care Paramedics (ICP) are highly skilled and experienced paramedics, who provide advanced intensive patient care. Their extensive experience and training allows them to conduct advanced medical procedures in the field and administer specialist drugs to seriously ill or injured patients.[19]
Extended Care Paramedics (ECP) are specialist paramedics who take a ‘GP’ type approach to non emergency incidents. Their role is to ease the workload of emergency ambulance crews by dealing with non emergency incidents using specialist training and techniques. These include prescribing medication, changing catheters and resetting dislocations among many other skills.[21]
Critical Care Paramedics (CCP) are elite paramedics assigned to the Medical Retrieval Unit. As well as intensive care skills, they're trained in Special Operations, allowing them to work in hostile environments such as building collapses, floods, caves, cliffs and remote bushland. They also have the ability to perform complex medical procedures and administer highly specialist drugs in the field to patients, under the authorisation of a Critical Care Doctor.[13][22][23]
Duty Operations Managers (DOM) are senior paramedic inspectors responsible for supervising clinical operations and managing crews on shift across each ambulance zone. They provide an experienced oversight at complex medical incidents, supporting paramedics with patient management and treatment. DOMs are qualified Paramedics with additional formal qualifications in management and leadership, with a strong background of medical experience and leadership.[13]
Community First Responders (CFR) are part-time and volunteer members of other emergency services or community members trained in nationally accredited advanced medical skills, who respond to medical emergencies in conjunction with Paramedics in remote areas of the state. There are 33 CFR units in total; 11 Fire and Rescue NSW, 11 NSW State Emergency Service and 12 Rural Fire Service, with each unit generally carrying their complement of medical equipment on board existing response vehicles such as fire engines.[24]
Response priorities
NSW Ambulance prioritise cases into several priority levels based on the urgency of the case, which are categorised into:
Priority 1 – Lights and Sirens Response
1A (Highest Priority) – Patient not breathing / ineffective breathing
1B (High Priority) – Patient unconscious
1C (Priority) – Urgent response required
Priority 2 – Response without Lights and Sirens
2I – Immediate attendance required
2A – Attend within 30 minutes
2B – Attend within 60 minutes
Priority 3 – Urgent Medical Transfer (Can be upgraded to Lights and Sirens depending on situation)
The remainder of the priority levels are made up of various priority transfers.
As of early 2019, NSW Ambulance attended over two thirds of Priority 1 calls within 30 minutes.[25][26][27]
Special Operations
The Special Operations Team (SOT) are responsible for specialised ambulance operations across the state. Their role is to bring paramedic level care to patients in any kind of hostile environment including cliffs, canyons, caves, floods, bushfires, building collapses, confined spaces, hazardous materials incidents, active shooters and the remote Australian wilderness.[28][29][30][31]
SOT operate on a day-to-day basis from rapid response vehicles spread across Sydney, Wollongong and the Central Coast, located at St Ives, Bankstown, Macquarie Fields, Caringbah, Point Clare, Wollongong, Northmead and Katoomba in the Blue Mountains.[32] They additionally operate a number of specialist vehicles from their Special Operations Base at Bankstown, including 4WD Ambulances and numerous specialist support vehicles.[13][33][34]
In some rural areas of Regional NSW, SOT are trained and equipped as primary rescue units, allowing them to extricate patients in addition to their medical access role. They operate six Rescue Units, based at Wagga Wagga, Singleton, Tamworth, Bomaderry, Cowra and Rutherford, with two spare vehicles located in Sydney. These Rescue Units are equipped with a range of rescue tools including battery extrication equipment and rope rescue gear. In the winter months, the Alpine Operations Team is active, based at Perisher Valley, this specialised team of 20 paramedics provide patient access and care to the entire NSW Alpine region. The Alpine Operations Team utilises unconventional vehicles to access patients, from snowmobiles to over-snow ambulances and their paramedics are specifically trained in overnight camping, search and rescue and avalanche recovery.[31][34][35][36]
SOT is also responsible for providing the Tactical Medical Operations capability for NSW Ambulance. SOT was the first full-time Tactical Paramedic Team in Australia[37][38] working in conjunction with the NSW Police ForceTactical Operations Unit.[39][40]
The Medical Retrieval Unit (MRU) (through the Rapid Launch Trauma Centre) are responsible for the coordination and response of NSW Ambulance's Medical Retrieval Teams. Each Medical Team consists of a Doctor and a Critical Care Paramedic, who work together to bring the highest level of pre hospital clinical care to patients. Medical Teams can perform a number of complex medical procedures beyond the scope of Primary and Intensive Care Paramedics.[41]
Each Medical Team primarily operates from a specially equipped AgustaWestland AW139 helicopter. Two aircraft operate from Bankstown, with one aircraft attached to each of the other bases. A third helicopter is operated from Bankstown as a Newborn Emergency Transport Service aircraft. Each helicopter aircrew consists of a pilot and a crewman. The teams also have access to a numerous specialist vehicles for road based responses, including Ambulances and 4WD response vehicles. The helicopters are managed and maintained on a contract basis by Toll (Southern Bases) and Westpac[dubious–discuss] (Northern Bases).[44][45][46]
An additional medical team is based out of Westmead Hospital in Sydney, who are operated by the not for profit organisation CareFlight. It operates an Airbus H-145 and respond in conjunction with NSW Ambulance's other medical teams across the state.[47]
The Air Ambulance Service also conduct long distance inter hospital patient transport, ensuring the continuation high level medical care between hospitals during transit. Based at Sydney its operates five Beechcraft Super King Air aircraft.[48] Additional Fixed-Wing ambulances also operate in Dubbo and Broken Hill as part of a contract with Royal Flying Doctor Service.[49] In January 2024, two Pilatus PC-24 operated by Pel-Air commenced operating.[50][51]
The primary response vehicle of NSW Ambulance is the Mercedes-Benz Sprinter. Run by both General Duties and Intensive Care crews, Sprinters make up the large majority of the ambulance fleet across the state. A number of rural areas previously used Volkswagen Transporters, but these have now been replaced. Some rural stations also operate Toyota Landcruiser Troopcarriers which are configured for patient transport and are used to access patients in difficult and remote terrain. The Troopcarrier 4WD vehicles have an after market side access door on the left hand side for paramedic access into the treatment cabin.[13][52]
Multi Purpose Vehicles (MPVs)
MPVs are large custom built Mercedes Sprinters, which are equipped to deal with large complex bariatric patients. The rear patient transport area of the vehicle is significantly larger than a standard emergency ambulance, and is also equipped with specialist casualty loading and patient management gear, such as mechanical lifting equipment. As well as bariatric patients, the vehicles are also highly beneficial for patients undergoing hospital transfers who require specialist equipment such as life support machines to travel with them in the ambulance.[53]
ECPs operate a fleet of Hyundai iLoads and Toyota HiAces which are fitted out with an extensive range of extended care equipment. These vehicles are unable to transport patients, instead they provide extensive specialised treatment to patients on-scene, minimising the number of patient transports to hospital with their significant range of equipment.[21][52]
Paramedic Immediate Care Units (PICUs)
PICUs provide rapid response to emergencies across Metropolitan NSW, utilising a range of Holden Captivas, and Kia Sorentos. Staffed with a mix of GD and IC Paramedics, they're able to provide immediate lifesaving care to patients in the busy areas of Sydney and Newcastle. NSW Ambulance also operate three Motorcycles, staffed by IC Paramedics, which are able to negotiate the tight and congested areas of Sydney's inner city.[52]
DOMs operate a range of response vehicles, predominantly SUVs and Utilities, which allow them to respond rapidly to incidents and provide immediate on site expertise and oversight. Each vehicle carries an array of medical equipment similar to a PICU, allowing them to perform patient care when required (such as arriving on scene at an incident before an ambulance crew or assisting with multiple patients). The wide fleet of vehicles used by DOMs includes Holden Captivas, Holden Colorados, Holden Trailblazers, Toyota Prados, Isuzu MU-Xs, Isuzu D-Maxs and Kia Sorentos.[52]
Over snow vehicles
Perisher Valley Ambulance Station operate a fleet of over-snow vehicles, including a Hägglunds all-terrain vehicle, a Kässbohrer Geländefahrzeug over-snow vehicle, two Yamaha snowmobiles, a 4WD quad bike and trailer and a 4WD Mercedes Sprinter, which allow paramedics to access the alpine areas of the Snowy Mountains.[13]
SOT operate custom built Toyota Hilux utilities as their primary response vehicles, which are fitted out with an equipment pod that allow them to carry specialist equipment such as cordage (rope), harnessing equipment and breathing apparatus. Each vehicle is also fitted out with an array of medical equipment, often featuring the same general duties kits found in emergency ambulances, allowing them to provide treatment to patients. SOT also operate Holden Colorados and Toyota Landcruisers for special operations work such as major incident deployments, which are often double crewed.[13]
They also operate a number of specialist support vehicles from the Special Operations HQ at Bankstown including;
– Forward Control Vehicle (Mercedes Sprinter fitted out as a mobile forward command post)
– Rescue Support Vehicle (Mercedes Sprinter fitted out with rescue and extrication gear, often used for training)
– Logistics Support Vehicle (Hino Truck used to carry bulk equipment and medical supplies)
– Major Incident Support Units (Two Mercedes Sprinters with custom bodies fitted out to carry major incident support equipment)
Each of the six SOT Rescue Units is also assigned a Hino Rescue Truck. Each rescue is equipped with a wide array of rescue and extrication equipment such as forcible entry gear, battery cutting tools and rope rescue gear among other equipment. Each truck also carries a complement of medical equipment similar to SOT Response Vehicles. A seventh Hino Rescue is kept in Sydney as a spare, in addition to the Mercedes support vehicle.[13][52]
A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.
An ambulance is a medically-equipped vehicle used to transport patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medical emergencies by emergency medical services (EMS), and can rapidly transport paramedics and other first responders, carry equipment for administering emergency care, and transport patients to hospital or other definitive care. Most ambulances use a design based on vans or pickup trucks, though others take the form of motorcycles, buses, hearses, aircraft and boats.
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
A Paramedic in Australia is a health care professional who holds a minimum of a Bachelor's Degree in Paramedicine and is registered with the Paramedicine Board of Australia via the Australian Health Practitioners Regulation Agency (AHPRA) As of December 2021, there are over 22,500 registered paramedics in Australia, of which approximately 70% (15,750) work for a jurisdictional service, and of which 47% of which are female. Paramedics in Australia may undergo further training and complete a Master's Degree to specialise in either Intensive Care or Primary Care medicine.
The Scottish Ambulance Service is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government.
York Region Paramedic Services provides legislated land ambulance services and paramedic care for the local municipalities within York Region. Paramedic Services is a division of the Region's Paramedic and Seniors Service Branch. Prior to 2000, ambulance services were provided by 2 private operators, York County Hospital, Nobleton Volunteer Ambulance and Ontario's Ministry of Health. The patchwork of service also had York Region dispatched by 3 different Ministry of Health Communication Centres. Georgian CACC now dispatches the whole region on the Ontario Government leased Bell Mobility Fleetnet VHF trunked radio system. There are approximately 480 full-time paramedics serving the region. Paramedic Operations are based in East Gwillimbury, Ontario.
Hamilton Paramedic Service is the designated service provider for emergency medical services (ambulance) in the City of Hamilton, Ontario.
Ottawa Paramedic Service is a uniformed municipal public safety agency providing emergency and non-emergency paramedic care to residents and visitors of city of Ottawa, Ontario. It is the sole, licensed, statutory provider and is operated directly by the city. The Service is an independent third service provider. This means that it is part of the Emergency and Protective Services department of the city but functions as an independent and separate agency from other services. The Ottawa Paramedic Service operates in compliance with legislation and licensing standards overseen by the government of Ontario. It also provides routine, non-emergency transports and emergency paramedic coverage for special events. It is the only service provider permitted to service medical emergency calls in the City of Ottawa.
The East of England Ambulance Service NHS Trust (EEAST) is an NHS trust responsible for providing National Health Service (NHS) ambulance services in the counties of Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk, in the East of England region. These consist of approximately 6.2million people across an area of 7,500 square miles (19,000 km2).
The West Midlands Ambulance Service University NHS Foundation Trust (WMAS UNHSFT) is responsible for providing NHS ambulance services within the West Midlands region of England. It is one of ten ambulance trusts providing England with emergency medical services, and is part of the National Health Service.
Winnipeg Fire Paramedic Service (WFPS) provides fire and EMS services to the City of Winnipeg, Manitoba. It operates from 27 fire stations, and 3 administration offices across the city.
Australian mobile intensive care ambulances (MICA) are well-equipped ambulances staffed by highly trained paramedics dispatched to emergency situations where patients require a higher level of care than a regular ambulance can provide.
SA Ambulance Service (SAAS) is a State Government agency under SA Health, that provides emergency ambulance transport, clinical care and non emergency patient transport services to over 1.5 million people, distributed across an area of 1,043,514 square kilometres in South Australia, Australia.
St John Ambulance New South Wales is a charitable organisation dedicated to helping people in sickness, distress, suffering or danger. It provides first aid training and event and community health care services. It is part of an international organisation that consists of eight Priories that form the Order of St John. The organisation is sometimes incorrectly referred to "St John's Ambulance" or "St Johns Ambulance" (plural/possessive) instead of "St John Ambulance" (singular).
Emergency Medical Responders (EMRs) are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. Specifically used, an emergency medical responder is an EMS certification level used to describe a level of EMS provider below that of an emergency medical technician and paramedic. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties.
Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.
State Medical Rescue in Poland is a system of free public emergency healthcare established by Ustawa o Państwowym Ratownictwie Medycznym, including ambulance service and Emergency Departments (EDs). While in Polish public hospitals and clinics NFZ common public insurance is required, PRM medical services in ambulances and EDs are completely free for everyone. Since 2018 emergency ambulances that operates in PRM, that is Polish 112 and 999 emergency numbers, are operated by public entities only.
The Queensland Ambulance Service (QAS) is the state emergency ambulance and patient transport provider in Queensland, Australia. QAS is part of the Queensland Government under the Queensland Health portfolio and is one of the largest ambulance services in the world.
Ambulance Victoria (AV), a Victorian agency of the Department of Health, is the statutory provider of pre-hospital emergency care and ambulance services in Victoria. Ambulance Victoria was formed on 1 July 2008 with the merger of the Metropolitan Ambulance Service (MAS), Rural Ambulance Victoria (RAV), and the Alexandra District Ambulance Service (ADAS). Ambulance Victoria has undergone significant reform since 2008.
Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of urgent medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation and rescue operations.
References
1 2 "About us". NSW Ambulance. Government of New South Wales. 2022. Retrieved 30 June 2022.
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