Thursday, July 19, 2012

A glut in public hospital admissions causes ambulance delays, prompting a 'code orange' health alarm, according to Ambulance Victoria

VICTORIA'S ambulance service was so overwhelmed yesterday that it activated the government's emergency response plan to put doctors on notice so they could be called in to help.

A spokesman for Ambulance Victoria yesterday said high levels of winter illness had caused it to call a "code orange" between midnight and 8.30am.

The code is the second highest level of alert in the state's Health Emergency Response Plan, which was designed to manage healthcare for disasters such as bushfires and mass-casualty transport accidents.

Ambulance Victoria spokesman Danny McGennisken would not tell The Age how often the emergency plan was invoked for normal winter demand, but said it was "not unusual" to use it during peak times.

However, the ambulance union and state opposition said it was extraordinary for the service to use the plan for predictable increased demand in winter, and they questioned why the service could not bolster its own resources to respond adequately.

The move came as the service also revealed it had introduced a controversial new plan to drop less urgent patients in emergency department waiting rooms to reduce the time spent handing patients over to medical staff.

Ambulance Employees Association state secretary Steve McGhie said he had heard of the

service invoking the emergency plan only a handful of times, including during a heatwave and on one night last year when a man died after calling for an ambulance 11 times.

"This is an ambulance service in crisis," he said. "There would not have been one additional staff member put on yesterday and, if anything, they were probably below their minimum resourcing requirements because they're not filling shifts when people are off sick.

"This is day-to-day ambulance work. Winters have been going for hundreds of years and we can't plan for it?"

Mr McGhie said although the government had partly honoured its commitment to increase paramedic numbers by about 200 of the 310 promised, the service was losing about 150 a year through resignations.

Opposition health spokesman Gavin Jennings said the government was failing to meet demand with its own resources. "It's extraordinary. The plan was not meant to be used for this reason," he said.

Ambulance Victoria has also started trialling a plan for paramedics to leave less urgent patients in emergency department waiting rooms rather than staying with them until a full handover to medical staff.

The plan has infuriated Australian Medical Association state president Steve Parnis, who said he had not been notified of it.

"If a patient is deemed unwell enough that they needed to be transferred to hospital by ambulance, it would be completely unacceptable for them to be unloaded into a waiting area or any other part of the emergency department without a proper form of clinical hand-over. It would be dangerous and completely inappropriate," he said.

"A huge aspect of risk management is safe and thorough clinical handover, so if the problem is with a lack of resources, that's the thing that needs to be addressed here … cutting corners at the risk of patient safety is unacceptable."

Dr Parnis, an emergency physician, said hospitals had been under enormous pressure in recent weeks as high levels of flu had hit Victoria's ageing population.

Mr McGennisken said the trial involved paramedics having some discussion with hospital staff. "Patient safety is imperative and normal handover practices at hospitals are always followed," he said.

Health Minister David Davis did not answer questions on the issues last night. However, he said the emergency trial would help free up ambulances while he worked to deliver a $151 million election commitment to boost the ambulance service.


Twist in 'sex on the job' payout case

A public servant who fought for and won workers' compensation for an injury sustained while having sex in a motel room on a work trip could have the money taken away after the Commonwealth appealed to a full bench of the Federal Court.

In November 2007, the woman - who cannot be named - had been sent by her government employer to a country town for a departmental meeting and put up in a hotel.

The night before the meeting she suffered facial and psychological injuries when a glass light fitting came away from the wall above the bed as she was having sex with a male friend.

The Commonwealth workers compensation agency Comcare originally rejected her application for compensation - a decision upheld by the Administrative Appeals Tribunal.

But earlier this year Justice John Nicholas of the Federal Court overturned that decision, finding that the woman was entitled to compensation on the grounds that she was "in the course of her employment" when the injury occurred.

However, Comcare has now appealed this decision to a full bench of the Federal Court. Court documents show that Comcare will claim that having sex on a work trip was not an activity that was "expressly or impliedly induced or encouraged" by the woman's employe.


A Big Picture View of Problems in Australia's Maths Curriculum

Re: Ferrari J.,New maths course inadequate, The Australian, 18/7/12

Dear Professor  Wildberger

I should like to suggest for your consideration that the problems that you have identified in the proposed new national curriculum for Year 11 and 12 maths are likely to have a systemic cause which implies a need for a different curriculum development process. While this will not be immediately obvious, the cause of the problem is likely to be the biases that limit the effectiveness of ‘rational’ centralised decision making.

Your reported criticism was that "The draft national curriculum replaces core material such as algebra, geometry, and applications of calculus with a lot of advanced statistics and, for the higher strand, tertiary-level topics”. As an engineer who has done a lot of work related to the social sciences, it seems to me that the proposed national curriculum is biased towards to needs of (say) social science and medical research in which statistics play a major role, at the expense of the algebra / geometry / calculus needs of the applied sciences and engineering.

It can be noted that the national history curriculum contains a similar dysfunctional bias (see Proposed National History Curriculum: Information without Understanding?, 2010). And, as with the proposed national maths curriculum, this bias reflects a lack of concern for practical issues.
    Explanation: The national history curriculum sought to impart understanding of diverse societies, without ensuring coverage of the societies and ideas that had contributed directly to Australia’s institutions and character. Culture has practical consequences which are significant in causing history – so it is important to ensure that students gain a solid understanding of those that have led to practical success (and why this is so). The national history curriculum does not seem to do this. Though this will not be immediately obvious, the importance of ensuring understanding of what has led to success and failure in history can be seen by considering current unresolved concerns about Australia’s response to asylum seekers (see The Biggest Issue Missing from the Asylum Seeker Debate).

In both these cases the problem is arguably that reform proposals have been developed (and in one case already implemented) on the basis of a particular point of view, and this has not taken account of other considerations that are outside the expertise and experience of the persons involved. In relation to this, it is further noted that:
    There are limits to human rationality that are recognised in management, public administration and economic literature. For example, the inability of central planners to acquire the information required to make appropriate decisions is economists’ primary justification for a market economy;

    The application of reforms to governments and universities which involved an autocratic implementation of particular ideologies has led to severe problems (eg see Toward Good Government in Queensland , 1995 and A Case for Restoring Universities, 2010). In the Queensland Government case (which was replicated in various ways Australia wide - see Decay of Australian Public Administration, 2002) attempts to ‘reform’ government across-the-board on the basis of particular (but narrow) understandings of what was required led to the elimination of much of the knowledge and skills which was vital for practical success in government operations - but which the ‘reformers’ did not appreciate. Crisis prone government administration across Australia over the past couple of decades is the consequence. A general account of the problems facing government in Australia is in Australia's Governance Crisis and the Need for Nation Building (2003+). This emphasises the need for institutional reforms for which one important focus involves enabling complex issues that are beyond simple ‘rational’ prescriptions by potential reformers to be better managed.

A better approach to developing curriculum (as with the other concerns above) would involve a shift away from centralised attempts to make ‘decisions’ towards centralised efforts to identify the issues requiring change while encouraging proposed responses to emerge from existing practitioners. This would ensure that new curriculum would build on existing strengths while taking into account new requirements, rather than being biased towards the central decision maker’s perception of the new requirements while potentially eliminating existing strengths that are not centrally understood.


G20 summit helps seal Queensland's place in political sun

The G20 leaders summit to be held in Brisbane in 2014 will be the biggest political meeting ever held in this country. The G20 represents two-thirds of the world's population and 90 per cent of its gross domestic product. The right to host the meeting sparked a State of Origin war between Queensland and NSW, which, as usual, Queensland won.

The only other time the G20 met in Australia was the meeting of central bankers and finance ministers in Melbourne in 2006. It was a very successful meeting, but it generated awful television coverage for the city. A self-styled "Stop G20" movement surrounded the venue and tried to prevent delegates getting in and out.

Aid groups attacked the forum as being indifferent to, or conniving in, global poverty. The celebrity aid activist Bono gatecrashed the event to hold forth on how the leaders were failing the world. And the Victorian police allowed demonstrators to smash property - even police property - as part of a rampage through city streets. The pictures of Melbourne beamed around the world looked just like the scenes we are now seeing from riots in Athens or Madrid.

I should make it clear that frontline police did a magnificent job and were appalled by the violence and disruption. Their commanders were keen to take a tougher line, but this was the time when Christine Nixon was the commissioner of Victorian Police. Sensitive policing meant giving young anarchists a free hand and picking them up after they had caused their vandalism and damage.

When it was all over, Nixon saw no fault with her policing methods. She said the mayhem showed it was not "appropriate" to hold such events in major cities. In other words, ministers and leaders who obey the law should stay away from Melbourne because protesters and demonstrators do not. After that experience there was no chance Melbourne would host another important international event like that again - at least not while the G20 and that theory of policing were fresh in the memory.

Sydney and Brisbane see the value in staging large international political and diplomatic events. If New York can host the United Nations, if Washington can host the International Monetary Fund, if London, Toronto and Pittsburgh can host the G20, why shouldn't Sydney and Brisbane put themselves on the international map? Brisbane will be the centre of the world for a weekend in November 2014. It will come of age as an international city.

In 1956 Melbourne put itself on the international map by hosting the Olympics. It reflected ambition and confidence. In 2000 Sydney, which by then was a lot more brassy and confident than Melbourne, hosted the Olympics. And with the G20 summit the centre of gravity will move north again.

This is in keeping with the direction of economic opportunity and the population growth that is following it. Queensland is profiting from a mining boom just as Victoria did in the 19th century. It does not see itself as a provincial backwater. Nor will the global media as they report the deliberations of world leaders in 2014.

Sydney and Melbourne will have to get used to growing political clout coming out of Brisbane. Queensland now has 30 seats in the House of Representatives compared with 37 for Victoria and 48 for NSW. On current polling there could be as many as 29 Queensland Liberal National members elected to the lower house at the next election. They could be the largest state bloc in the Coalition party room. With more members, they will claim more seats in the cabinet. One reason the next Coalition government will be different from the last will be the enormous sway held by the Queenslanders.

The landslide victory of Campbell Newman in the state election has given the Queensland LNP enormous confidence. Newman sees himself as the "can-do" Premier. He is not afraid of controversial decisions. He wants to change the state. He is intent on turning Queensland around and making it an economic powerhouse.

Over the past 18 months, Coalition governments have been elected in each of the three eastern states. It will be natural for people to compare them. If Queensland becomes the pacesetter on reform, it will put a lot of competitive pressure on the other states to lift the tempo of their efforts.

Melbourne's lord mayor, Robert Doyle, said the city did not want to host the G20 summit. If so, Melbourne took the attitude of Hobart and Adelaide.

But Sydney still has ambition. As does Brisbane. Which is now gaining on its once more fancied rivals.


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