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Labor’s Recipe for Emergency Confusion

The Weatherill Labor Government’s plans to downgrade half of the emergency departments in Adelaide will create widespread confusion for people needing emergency assistance.

 “In an emergency, when minutes matter, confusion costs lives,” said Shadow Minister for Health Stephen Wade.

“It is extremely dangerous to put people in a situation where they are under pressure to try to self-diagnose.

“Currently, in an emergency South Australians need to choose between two simple options: to call an ambulance or to make their way to any emergency department.

“70% of people get to an emergency department under their own steam.

Under Labor’s Transforming Health plan if people want to make their way to an emergency department, they will face a series of challenging decisions.

Their ED destination will be dependent on their current location, the time of day and their answer to three diagnostic questions:

  • Is this a stroke emergency?
  • Is this a life-threatening emergency?
  • Is this an emergency which may see me admitted to hospital?

“One response to Labor’s plan to downgrade half of Adelaide’s emergency departments could be that South Australians will be much more likely to call an ambulance.  If that happens, the Ambulance Service will be overloaded,” said Mr Wade.

“The Weatherill Government’s promised 5% increase in the size of our ambulance fleet won’t cover the increased patient travelling distances and times, let alone an increase in ambulance calls.

“With stroke cases and life-threatening emergencies being diverted away from the downgraded Emergency Departments, the super-site EDs, especially the Royal Adelaide, are likely to overwhelmed.

The Australasian College of Emergency Medicine’s submission to the Transforming Health Proposals Paper highlighted that up to 10 times as many people have symptoms mimicking a stroke as those who are actually having one:

“Patients do not present with ‘strokes’ – they present with neurological symptoms. These symptoms may occur either due to stroke, or as a result of numerous other alternative pathologies. Stroke mimics are more common than actual strokes, and generally warrant more urgent care. Emergency physicians note that EDs will see approximately 5 – 10 stroke mimics, for every confirmed stroke. A correct diagnosis in these presentations is vital to ensure the larger hospitals are not overrun with patients, who could be appropriately managed in other (smaller) hospitals.”

A person who suspects they are having a stroke should call an ambulance straight away, however a wide range of symptoms are consistent with a stroke.

For example according to the National Stroke Foundation website, signs of strokes may include one or a combination of:

  • dizziness, loss of balance or an unexplained fall
  • headache, usually severe and abrupt onset or unexplained change in the pattern of headaches
  • difficulty speaking or understanding
  • loss of vision, sudden blurring or decreased vision in one or both eyes
  • difficulty swallowing.

These symptoms could also reflect problems related to a myriad of medical specialties including ENT, gastroenterology, neurosurgery, and ophthalmology.

Ambulance officers are highly trained to make a preliminary diagnosis but many of the sickest people who attend emergency departments do not come by ambulance. 

As the Australasian College of Emergency Medicine puts it:

There is no correlation between mode of presentation and subsequently identified pathology.