Stephen Gerrard was looking after his elderly father-in-law at his house in Kellyville in Sydney’s north-west, when in the middle of the day last week, he “tripped down the stairs and hit the floor pretty hard”.
“I heard a large crunching sound and then I was in excruciating pain,” the 55-year-old told SBS News.
Fortunately, he had a phone on hand, so he called triple zero.
Unfortunately, no one answered.
Finally on the third time, an operator picked up the phone.
“I gave them my details, told them I am pretty certain I’ve broken a leg,” Mr Gerrard said.
“After half an hour of no ambulance, I rang back and they said, ‘Oh, look, [the case] hasn’t even been given to an ambulance crew yet.”
It took an ambulance almost three-and-a-half hours to arrive after the first call was made.
Chris Kastelan, the president of the Australian Paramedics Association NSW (APANSW), told SBS News Mr Gerrard’s case was not unique and there are many factors behind delayed ambulance responses in New South Wales, starting “with the short staffing of paramedics”.
In Victoria, the emergency healthcare system is also buckling under significant pressure.
“A young child went into cardiac arrest at a camping ground in Victoria the other day,” Danny Hill, executive secretary of the Victorian Ambulance Union, told SBS News.
When the parents of the child dialled triple zero, “they couldn’t even get through to talk to someone on the other end of the phone”, Mr Hill said.
Luckily for the family, an off-duty paramedic just happened to be at the camping site, Mr Hill said.
“He attended to the child and saved the child’s life, but [the parents] tried to get through for about five minutes for a young child, a toddler in cardiac arrest, and couldn’t get through,” he said.
How did Australia end up here?
Australia’s healthcare system was ranked third among 11 of the world’s wealthiest countries in August 2021, according to a report by the United States-based Commonwealth Fund.
Norway and the Netherlands were ranked above Australia, and the United Kingdom, Germany, New Zealand, Sweden, France, Switzerland, Canada and the US ranked below the country.
Australia's third-place ranking represents a fall from the number-two position in the Commonwealth Fund’s previous report, which was filed in 2017.
According to the Grattan Institute's Stephen Duckett, one of the contributing factors for this fall was “, which sees paramedic crews waiting at hospital emergency departments, sometimes for lengthy periods of time, until a bed for the patient in their ambulance becomes available and they are free to respond to other emergencies.
An acute shortage of paramedics was a major issue for NSW Ambulance even before the pandemic, Mr Kastelan said.
Chris Kastelan is the president of Australian Paramedics Association (NSW). Source: Supplied/Chris Kastelan
“The last enhancement in staffing numbers we got was under an agreement in 2011 and the state has been running under those same paramedic numbers [since],” Mr Kastelan said.
In 2018, as part of the Statewide Workforce Enhancement Program, NSW Health Minister Brad Hazzard announced an extra 700 paramedics and 50 call centre staff would be employed over four years.
“But what that did was just fill existing gaps. It did not put any extra people on the ground. So [those] 700 extra paramedics were absorbed into what was already a heavily bleeding system,” Mr Kastelan said.
According to a report titled We Deserve Better, published by APANSW in September last year, the current “emergency healthcare crisis has been decades in the making”.
One in three paramedics “consistently or usually feel too fatigued to drive safely”, and one in five “report that they’re usually or consistently asked to work after saying they are fatigued”, the document, based on member surveys conducted in 2020, said.
The report found “some paramedics were working up to 21 hours with no breaks”, adding the majority of paramedics complete less than one in every three meal breaks and “they’re often forced to eat in hospital waiting zones or on the side of the road”.
The report also said “NSW has 40.8 qualified paramedics per 100,000 people” compared with Victoria which has 53, Queensland which has 69.9 and South Australia which has 53.8 paramedics per 100,000 people.
The COVID-19 pandemic and, in particular, the rapid spread of the Omicron variant have only made things more challenging.
“The service is currently facing unprecedented demand, which reached a peak on 1 January 2022 when 5,120 triple zero  calls were received in our Control Centres,” a NSW Ambulance spokesperson told SBS News in a statement.
NSW Ambulance received more than 5,000 emergency calls on 1 January. Source: AAP
“For most of the month of January NSW Ambulance’s Control Centres have received more than 4,000 triple zero calls daily,” the spokesperson added.
NSW Ambulance has taken a number of measures to cope with the demand and will continue to do more in the near future, they said.
“In response to the increased demand all available operational staff have surged and, in our Control Centres, an extra 50 call takers have been recruited,” the spokesperson said.
“Our Virtual Clinical Care Centre has also been bolstered with 32 clinical support assistants commencing duties facilitating call backs to patients experiencing longer than usual delays. More staff will come on board this month.
“Currently 60 graduate paramedics are being inducted, and another 200 graduates will begin induction in the coming weeks as we continue to surge our workforce in response to the pandemic. Sixty-five casual paramedics have been offered full-time employment.”
'We’re in big trouble'
While paramedic shortages are an issue in Victoria, too, what's making the situation worse is the state’s triple zero phone call service.
It should take the Emergency Services Telecommunications Authority (ESTA), responsible for receiving 24-hour emergency calls relating to ambulance, fire or police in Victoria, five seconds to respond to a call.
“[But] people are waiting for 20 minutes before a call taker picks up the phone,” Mr Hill said.
“[ESTA is] the gateway to all emergency services [in Victoria], so when it fails, we’re in big trouble.”
Danny Hill, executive secretary of the Victorian Ambulance Union. Source: Supplied
A rise in the number of calls for help as the pandemic enters its third year and Omicron rips through the nation is one of the factors.
But acute staffing shortages at ESTA and a failure to address them in a timely manner over the past couple of years of the pandemic has worsened the problem, Mr Hill said.
“At times, they’ll only have 10 call takers for the entire state and that’ll jump down lower if they have to take breaks or even go to the bathroom.
“We have had massive delays with ESTA and they started back in May of 2021. Those delays were around two minutes.
“And that should have been an indicator of when they start putting more people on and grow the amount of call takers.
“[But ESTA] are only just developing their responses now, when really that should have been done right at the beginning of 2020.
“[So] now we’re seeing delays of up to 20 minutes,” Mr Hill said.
SBS News contacted ESTA multiple times for comment, but did not receive a response.
“The global COVID-19 pandemic continues to have a significant and unprecedented impact on health systems, including Ambulance Victoria and hospital emergency departments,” an Ambulance Victoria spokesperson told SBS News in a statement.
“Ambulance Victoria [AV] is continuing to see a very high demand for emergency care, and this is expected to continue for a number of weeks," the statement said.
“Over the past few weeks, we have been responding to around 1,850 emergency calls every day.
“Our AV and partner agency staff are working extremely hard to manage the increasing demand while prioritising care to the sickest Victorians."
The spokesperson urged community members to "help us by saving triple zero for emergencies".