Same But Different - QAS

Aim

Each program is united by a core aim: to provide proactive, compassionate, and coordinated  care that improves outcomes for vulnerable individuals while reducing avoidable reliance on emergency services and hospital-based health care.

Outcomes

• QAS Mental Health Liaison Service clinicians are speaking to about 200 people each day, with 15% of these people offered interventions over the phone which do not require an ambulance attendance.
• QAS Mental Health Co-Responders are keeping around 75% of people they see at home.
• QAS Falls Co-Response Program has seen nearly 4,000 people with  47% of these people assessed without the need for transport to an Emergency Department.
• QAS’ own Social Work team is able to provide care to vulnerable people who find themselves in circumstances where they do not have the resources or resilience to be able  to cope. The small team process around 80 referrals per week.
• The QAS Complex Care Team ensure people who frequently use ambulance services to access care receive appropriate care.

Background

When a person needs an emergency response, they are frightened, overwhelmed, physically unable to cope and are experiencing a situation which they feel is beyond their control.  The act of calling for emergency help reflects both urgency and vulnerability.

When we think about an emergency response to a person who calls Triple Zero (000), we think of trauma, two paramedics, in teal, driving a van, with a stretcher and medical equipment, responding to alleviate the suffering a person is experiencing.  This traditional model of emergency ambulance care, most of the time includes a trip to the hospital to get access to assessments, treatments and health care.

Through the detailed interrogation of ambulance utilisation data, we now know a lot about who in the community we are providing emergency care for.  The highest volume of calls to emergency ambulance services are for people who have fallen and cannot get up.  The second highest calls for service are for people who are experiencing a mental health emergency.  We know that there is a small proportion of people in our community, about 0.8% of calls to Triple Zero (000), who account for almost 10% of ambulance attendances; this is 4,052 people who accounted for 84,234 incidents in 2024.

This group of people are some of the most vulnerable people in the community, with often complex medical, social and psychological needs.  They experience trauma and distress which requires alleviation and care; although this may not necessarily be purely physical or medical trauma requiring a hospital visit. The health care needs of the most common users of emergency ambulance services resulting in an emergency department visit and, in some instances, this is not necessarily the most appropriate care for a vulnerable person in crisis (1).

The QAS has acknowledged that if we are to realise the goal of timely, quality and appropriate, patient focused ambulance services to the Queensland community, that an expansion from the traditional model of emergency first response to include new and innovative response programs, are necessary to better meet the needs of communities.

Through the introduction of allied health, mental health and dedicated paramedics specialising in complex and trauma informed care, we can better understand and meet the needs of people experiencing the gamut of traumatic events with nuanced and appropriate care.  
This presentation will outline how the QAS has started on this journey to embrace and embed new models of care, an expanded and diverse workforce, the important role of stakeholder engagement and cross sector relationships have played in this journey.

Discussion

The innovative, trauma-informed care models introduced through the Mental Health Response Programs, Falls Co-Responder Program, and Complex Care Teams have demonstrated positive outcomes in addressing the needs of vulnerable individuals in the Queensland community. These models are responding to a critical gap in the healthcare system - providing proactive, holistic care to individuals whose primary interactions with the healthcare system have traditionally been in crisis settings such as ambulance services and emergency departments (EDs). The trauma-informed approach, central to each of these programs, is foundational to the success of these models, as it allows for compassionate, care that reduces the likelihood of re-traumatisation and enhances engagement.

The programs address a key issue in healthcare, the frequent use of ambulance services by vulnerable populations, including individuals living with mental health challenges, disabilities, and those at risk of falls. The mental health response programs, falls response teams have successfully diverted individuals from emergency departments by providing immediate, on-site support. This not only improves patient outcomes by ensuring that individuals receive appropriate care at the right time - but also reduces the burden on emergency services and hospital resources, thus contributing to the overall efficiency of the healthcare system.

The Falls Co-Responder Program, for example, has significantly reduced avoidable hospital admissions and re-presentations by identifying and addressing risks in the home environment. Similarly, the Mental Health Response Program has successfully diverted individuals from EDs, offering a timely mental health intervention in the community, which prevents the escalation of crises and improves the overall care experience for individuals. These programs reflect the broader aim of shifting from a reactive, emergency-based system to a proactive, community-focused model of care.

While the outcomes of these programs have been promising, there remain several challenges. One challenge is ensuring the sustainability and scalability of these models. As these programs expand, maintaining the high-quality, personalised care while also managing the increasing demand on services will require continuous investment in training, resources, and cross-sector partnerships. Additionally, cultural competency and Indigenous engagement remain key areas for growth. There is a critical need to ensure that trauma-informed practices are culturally safe and may have distinct health and social care needs.

Another challenge is the integration of services across the health, social care, and disability sectors. Although these programs are making strides in fostering multidisciplinary collaboration, there are still systemic barriers that complicate service coordination and the efficient use of resources. Establishing clearer pathways for information sharing, data access, and coordinated care and referral planning across different service providers will be essential for ensuring that vulnerable individuals receive the full continuum of care they need.

References

Pellatt RAF, Painter DR, Young JT, Kõlves K, Keijzers G, Kinner SA, Heffernan E, Crilly  J; Mental Health in Emergency Department Research Investigators. The risk of repeated self-harm and suicide after emergency department presentation with self-harm in mental health presenters: a retrospective cohort study with data linkage in Queensland, Australia.

Lancet Reg Health West Pac. 2025 Jan 16;54:101263. doi: 10.1016/j.lanwpc.2024.101263. PMID: 39896899; PMCID: PMC11786086.