Lives on hold: the human cost of ‘ambulance ramping’

South Australia's healthcare system is facing a persistent and escalating crisis: ambulance ramping.

Paramedics are increasingly forced to wait outside overcrowded emergency departments, unable to promptly transfer patients and return to vital community duties.

This has become more than just an inconvenience; it's a dangerous bottleneck that jeopardises patient safety and emergency response times.

What is ‘ambulance ramping’?

Delayed transfer of care, also known as “ramping”, occurs when paramedics cannot move patients into the emergency department of a hospital within the target of 30 minutes.

Alarmingly, monthly ramping hours in South Australia reached unprecedented levels in 2024, highlighting a deeply entrenched issue.

Data released under the Freedom of Information Act revealed that between March 2022 and December 2023, 91 patients triaged as priority 1 and 2 (emergency and urgent) died while waiting for ambulances delayed by ramping. Additionally, two patients died while being ramped outside Flinders Medical Centre during this same period.

Unpacking the causes

Ambulance ramping is a symptom of a healthcare system in South Australia under immense strain, driven by a range of interrelated factors:

• Surging demand: emergency departments are receiving more patients, often with complex health needs that require longer treatment times.
• Bed shortages: a lack of available inpatient beds creates a backlog, delaying patient transfers from emergency departments to hospital wards.
• Access block: when emergency department patients cannot be moved to wards, it leads to overcrowding and ambulance ramping. This is often described as an “access block”.
• Workforce shortages: chronic shortages of doctors, nurses, and allied health professionals throughout the system exacerbate [AG1] the problem.
• Inefficient patient flow: bottlenecks in admitting and discharging patients to and from hospitals contribute significantly to delays.
• Systemic inefficiencies: issues with technology and coordination can further hinder the smooth flow of patients through the health system.

The human impact

The consequences of ambulance ramping can be dire and include:

• Compromised patient safety: delays in transferring patients to the emergency department can worsen conditions and increase the risk of complications, particularly in cases where treatment is time-sensitive and there is a “window of opportunity” in which a treatment will be most effective.
• Delayed emergency response: ambulances stuck outside hospitals are unavailable for other critical emergencies in the community, potentially delaying life-saving care.
• Emergency department overcrowding: ramping contributes to congestion in emergency departments, affecting the quality of care for all patients and placing additional burden on already overstretched healthcare staff.

Ramping and medical negligence claims

Laws relating to medical negligence vary between states and territories, but generally, Australian law allows individuals to claim compensation if they have suffered physical, psychological, or financial harm as a result of negligent medical treatment.

To obtain compensation, a person must be able to prove:

1. That the treatment they received fell below a reasonable standard (negligence), and
2. That this substandard treatment caused an injury or harm that would not have otherwise occurred.

While ambulance ramping is not typically the fault of an individual doctor or nurse, it is a systemic issue for which a healthcare provider can be held legally liable if it results in avoidable harm or injury.

In emergency medicine, time is critical. Delays caused by ramping can significantly reduce the effectiveness of treatment, and in the most serious cases, can and has resulted in preventable deaths.

How Maurice Blackburn can help

Maurice Blackburn’s medical negligence team recently acted in a successful claim on behalf of a family member of a patient who died at home after waiting over an hour for an ambulance in Adelaide in April 2020.

The coroner held an inquest into the matter, alongside an inquest into the death of another Adelaide man who also died after a significant ambulance delay.

A central issue of both inquests was the unacceptable delay in the ambulance attending, and the coroner explored the systemic issues contributing to the delays, including ambulance ramping and the overall capacity of the ambulance services in South Australia.

Ambulance ramping in South Australia remains a complex challenge. Addressing the health and safety of the community depends on finding effective and lasting solutions to alleviate this pressure on the healthcare system.

If you have suffered harm or an injury due to delayed treatment caused by ambulance ramping, contact us for a confidential and free discussion. We can discuss your situation and whether you may be entitled to compensation.