By Kate Deppeler, SA Ambulance Service

Adelaide/Tarntanya, Kaurna Country

'At SAAS, we have increased our paramedic presence in hospitals and in strategic healthcare system roles.'

Paramedics are problem solvers, and they use their critical life-saving skills in a number of different ways.

At SA Ambulance Service (SAAS), we have increased our paramedic presence in hospitals and in strategic healthcare system roles in a bid to improve the patient experience.

Three pieces of the puzzle are Hospital Ambulance Liaison Officers (HALOs), Hospital Relationship Managers (HRMs) and Clinical Supervisor - Dispatch Network Operations (CS-DNO).

HALOs are now in each major Adelaide metropolitan hospital emergency department, and our HRMs are in each health network’s operations centre. The CS-DNO, the 24/7 service in the SAAS Emergency Operations Centre, performs a key role for the State Health Coordination Centre.

SAAS first introduced HALOs into the Flinders Medical Centre in 2018, shortly followed by the Royal Adelaide Hospital. The role then morphed into two, with the HRMs becoming more focused on policy and hospital structure while the HALOs remained focused on specific patient paths and managing daily flow. The CS-DNO also evolved, originating as the State Duty Manager Assist and only open to Intensive Care Paramedics to becoming the role it is now, available to paramedics. The CS-DNO aims to prevent the ramp happening in the first place, minimise the impact when it does, and provide clinical support to the dispatch team.

Danny Harnas is a HALO at the Northern Adelaide Local Health Network based at Modbury Hospital, while Tracey Hughes is in the HRM role at Flinders Medical Centre at the Southern Adelaide Local Health Network (SALHN). Ruby Genborg works as a CS-DNO in the Emergency Operations Centre.

What ties these three people together is that they relish a challenge, love the strategic overview their roles have given them, and they like solving problems.

“It all comes down to patient outcomes as they navigate their way through the health system. If I can make that experience better for the patient, then that inevitability makes it better for the crew,” Danny said.

“It does alleviate a lot of the stress and tension between SAAS and the hospitals,” he said.

The pieces of the puzzle for Danny are the incoming patient and crew, the emergency department, and the decision-makers from both organisations.

Danny has had a 20-year career as a paramedic, and the ability to have a greater impact on the patient is what drives him as a HALO.

“I actually think it’s one of those positions that everyone should rotate through so they can understand the difficulties that are faced by each individual piece of the healthcare system,” he said.

Tracey, who has been with SAAS for 30 years, said the HRM role was about making those pieces of the puzzle fit together and function as a whole.

“I work in the SALHN Operations Centre as part of a team including the bed managers, nurse consultants who also review patients for alternate bed pathways, and the level-four nurse manager here,” she said.

“I work with patient flow, assist with interfacility transfers via the RFDS and road, monitor the non-emergency transfers and discharges, and also provide an awareness to the bed managers of incoming patients.”

Tracey first started working as a HALO in 2020 and is now a permanent HRM. She is excited by the development of the position and the work involved.

“I do education sessions with the staff in the hospitals and I also work on the policies, procedures and projects that bring about change in the system, helping to link it all together.

“The HRMs are also starting to manage HALOs; they’re my team working on patient flow.”

Also working at the puzzle table is the CS-DNO, a role Ruby Genborg has been in for the past 12 months.

“I’m that link between the ramp and the hospital - getting the right patient off the ramp, as well as trying to prevent the ramp happening in the first place,” she said.

“In the other part of my role, I provide medical and clinical support to the dispatchers. Where there’s multiple patients all requiring an emergency response, I help decide which job we need to go to next.”

The CS-DNO is a service staffed 24/7, performing the patient advocacy role with hospitals, and decision-makers when HALOs or HRMs aren’t available.

“I enjoy solving problems, and I enjoy that the problems I get to solve are more than just the one patient in front of me,” Ruby said.

Ruby, Tracey and Danny all reflect on how their role has changed their perspective as an on-road paramedic.

“It’s given me a higher order of thinking and a different set of skills,” Ruby said.