The Service We Provide
We provide expert, timely and free to-the-patient paramedical care, and related services for the community.
To be a viable, innovative and world-class provider of free to-the-patient paramedical care, and related services
Background to the Ambulance Service
An Incorporated Society run by its own board of management, Wellington Free Ambulance is an essential service provider and is committed to providing the highest quality clinical care in emergency situations, pre-hospital care, rescue and ground transport services.
To provide this service, Wellington Free Ambulance has 107 full time staff including areas such as ambulance operations, communications, administration, management, commercial and workshop. In ambulance operations there are 73 full time Paramedics and 45 voluntary ambulance staff, all highly trained in emergency care, operating out of eight bases.
During our last financial year we assisted 39,771 patients (an average of 109 people per day). This included 14,220 emergency medical patients, 6,984 emergency accident patients, 13,060 medical transfers, and 4,438 non-transported patients.
To meet the demands of providing this service Wellington Free Ambulance operates a modern up to date fleet of ambulance vehicles capable of rapidly responding to patient needs in all situations and all parts of our region. Our highly trained ambulance paramedics’ crew front line emergency ambulance vehicles which are equipped with up to date medical equipment, able to provide vital life supporting pre-hospital care.
Complementary to the highly demanding role of emergency paramedical ambulance services Wellington Free Ambulance provides a non-emergency patient transport service between the DHB owned and contracted facilities in Wellington.
Wide Angle View of Ambulance Operations
Wellington Free Ambulance Service provides paramedical services and patient transport services to the region of greater Wellington including the Kapiti Coast, Upper Hutt, Lower Hutt, Wainuiomata and Porirua City.
Operationally we cover a population of 423,765 living in an area of 290 square kilometres (28990 hectares). We operate from eight ambulance stations including Newtown, Thorndon (also our Headquarters and Communications Centre), Lower and Upper Hutt, Porirua, Paraparaumu and two operational bases in Waikanae and Wainuiomata.
Wellington Free Ambulance is the expert service in emergency and unscheduled primary health care in the greater Wellington region also being the Capital city of New Zealand.
Our fleet department manages the 22 ambulances in the fleet. We operate Fiat Ducato for the non-emergency patient transport [NEPT] service ambulances including one vehicle equipped for wheelchair cases.
Chevrolet Van Dura and Chevrolet Silverado make up the emergency ambulance service fleet. Two four wheel drive vehicles are used for off-road rescue services. These are a mixture of petrol and diesel powered ambulances.
We run four NEPT ambulances and 13 front-line emergency ambulances each day with nine rostered at night.
There is an operational workshop located at the HQ complex in Thorndon who maintain the fleet, contributing to the ‘unit hour production’ by ensuring there are ambulances mechanically ready for each shift rostered on.
Ambulance Education and Training
Wellington Free Ambulance has a strong emphasis on in-service continuing education of our professional ambulance staff. The New Zealand College of Paramedic Sciences operates in a joint venture arrangement with Whitereia Polytechnic to deliver a three-year Bachelor of Health Sciences (Paramedic) degree. These students, who are not employees of Wellington Free Ambulance, graduate with an ambulance qualification and are ready to be employed by the sector.
In 2004 an Intern – Trainee Paramedic scheme was established to complement the degree programme in developing the future ambulance workforce. Intern Trainee Paramedics work alongside experienced and qualified ambulance paramedics while at the same time studying toward ambulance qualifications and gaining invaluable operational and clinical experience.
Wellington Free Ambulance Service employs paramedics at the following entry levels:
Patient Transport Service staff are qualified with the Pre-hospital Emergency Care, Driving and Professional Practice Course (ethics, law, handling grief and managing stress, customer service). These staff do not routinely respond to emergency calls.
Ambulance Paramedics are employed with the National Certificate in Ambulance (Patient Care and Transport), which is a qualification, based on unit standards and lodged with the National Qualifications Framework through the New Zealand Qualifications Authority. Similarly the paramedic may be a graduate of the Bachelor of Health Sciences (Paramedic) degree.
Ambulance paramedics post employment complete the advanced life support – A [ALS-A] programme to become qualified to administer intravenous infusions and cardiac arrest drugs (adrenaline, atropine, lignocaine) and run an out-of-hospital cardiac arrest scene. These staff also insert laryngeal mask airways to protect the airway in unconscious patients.
After a further period of on the job experience paramedics qualify as advanced life support – B [ALS-B] officers where they administer narcotic intravenous analgesia and naloxone in addition to their ALS-A skill set.
A small number of staff will go on to qualify as Intensive Care Paramedics who administer a range of resuscitation drugs and perform a range of patient care resuscitation skills including transcutaneous pacing, endotracheal intubation, chest decompression, cricothyroidotomy, continuous positive airway pressure (CPAP), capnography, intra-osseous infusion, thrombolysis and twelve-lead electrocardiogram. This qualification is at a post-graduate diploma level.
All paramedical staff are assessed each year through an in-service continuing medical education programme and clinical skill revalidation. This verifies the individual paramedic’s ‘right to practice’ issued by the employer.
Wellington Free Ambulance is contracted by both the Ministry of Health to provide paramedic services and transport for medical emergencies in the community and non-emergency inter-hospital transfers and the Accident Compensation Corporation to provide emergency and some non-emergency ambulance transport for their claimants.
Air ambulance services in Wellington are provided by the Life Flight Trust with Wellington Free Ambulance Intensive Care Paramedics providing the medical aircrew for helicopter emergency responses.
Our Ministry of Health contract requires an ambulance to be located at an emergency within 8 minutes 50% of the time from when the Emergency Ambulance Communications Centre has enough information to despatch an ambulance in urban areas. Within 19 minutes 50% of the time in rural areas. The difference between urban and rural is a town population of 15,000 or less being classified as rural. Majority of the Wellington Free Ambulance response area is considered urban.
Volunteer Ambulance Officers
One of the more significant issues facing Wellington Free Ambulance as a modern ambulance service provider is the degree of half (single) crewed emergency ambulances responding to everyday emergencies in the community. One of the ways of addressing this issue is to have trained and qualified volunteer ambulance paramedics working alongside of their paid colleagues. Wellington Free Ambulance values the significant contribution volunteers provide to fully crew ambulances responding to emergencies.
While never working alone, volunteer ambulance paramedics undergo the same basic training as their fulltime colleagues commencing with the ambulance service. Volunteer personnel commit to at least one twelve-hour shift per week.
Ambulance paramedics are not currently registered health care professionals. Therefore it is imperative to the leadership and paramedics in the Service that clinical governance and clinical standards within the Wellington Free Ambulance Service are as high as possible.
A Clinical Advisory Group (CAG) provides the clinical governance to the organisation. This group consists of the Service’s part-time Medical Director who is also an Emergency Physician, ambulance managers and Intensive Care Paramedic peers. Meeting each two months the group look at clinical issues including clinical complaints, skill competence, application of clinical care guidelines and professional standards.
Any new clinical treatment provided by ambulance paramedics in Wellington must first be supported by research and/or empirical evidence-based medicine and sanctioned by the CAG and our Medical Director. Hospital specialists will be consulted before any new treatment is initiated to ensure the ambulance service is part of the continuum of primary health care and to ensure resourcing implications are considered.
Clinical Practice Guidelines
In 2005 Wellington Free Ambulance was the first ambulance operator in New Zealand to move away from patient care procedures to clinical practice guidelines. This enables professional staff to apply their knowledge and education in delivering the best clinical pathway for their patient rather than uncritically following preset procedures.
This is critical in some situations, such as when cardiac patients suffering an inferior acute myocardial infarction that would not benefit from oral nitrates and might benefit more from a fluid challenge. Following diagnosis using a twelve lead ECG in conjunction with the history gathered and assessment of the vital signs and other clinical indicators, the paramedic is able to make an informed clinical decision as to what clinical guideline is best for their individual patient’s ongoing care on the way to hospital.
Funding the Ambulance Service
It costs $9 million to run the Wellington Free Ambulance. Approximately 70% of the operational budget is met by Government contracts. The balance, around $3 million, is raised from sponsorship, Local Authority grants, trusts, donations, public appeals and the Service’s own resources. In addition, through its commercial division, Wellington Free Ambulance has a joint venture arrangement with Healthcare New Zealand to market medical alarms (Freedom Alarms) and sells first aid training and first aid kits to generate income.
For the past five years fundraising records have been set, indicating the high regard the public has for Wellington Free Ambulance and its services. Last year’s (2004) general appeal raised $403,000, which is greater than many national fundraising appeals. The remainder of our funding is from the contracts with the Crown through Ministry of Health and Accident Compensation Corporation.
Donated funds both assist Wellington Free Ambulance to meet the operating deficit each year and sponsor our capital equipment purchases. Many service groups assist us each year in raising funds for equipment from ambulances to all the lifesaving gear that is carried in them. Bequests are also used for replacing ambulances and buildings.
Emergency Ambulance Communications Centre
Wellington Free Ambulance maintains a position of leadership in the area of communications through investment in leading edge technology (for example GPS automatic vehicle locating), matched by highly trained communication staff.
Having entered a joint venture with St John New Zealand, Wellington will soon become one of the three modern Emergency Ambulance Communication Centres in New Zealand providing communication services to Wellington Free Ambulance, Wairarapa DHB Ambulance Service, St John Central Region and Taranaki DHB Ambulance Service. Known as the Ambulance Communications Project full implementation is scheduled for September 2006.
See further information on New Zealand Ambulance Services Communications Centre Review, Click Here.
Wellington Free Ambulance has introduced quality systems to ensure it provides the best possible care for its patients through organisational excellence and quality management initiatives. An electronic system for disseminating policies and procedures has been established. Wellington Free Ambulance is ISO 9002 certified and is subject to regular quality audits. In 2001 Wellington Free Ambulance received ACC Tertiary Status recognition (one of only three organisations in Wellington) recognising excellence in health and safety polices and procedures. A safe workplace action team (SWAT) operates to ensure hazards are identified then reduced, minimized or isolated for the safety of all our staff and patients’ using our services. We are ensuring that the organisation promotes the good health and safety of our staff by the systems and practices we operate.
Medical audit is also a process we use to ensure we are providing best practice ambulance care. Each time our staff complete a patient report form a duplicate copy is reviewed by peers and in some cases our Medical Director. This ensures we are continually learning in a blame free collegially supported environment. These duplicate patient report forms are then secured with an off-site secure document storage facility to protect patient confidentiality.
While attendance at community events is not the core business of Wellington Free Ambulance, we do hold a contract with the Westpac Regional Stadium Trust to provide paramedical services to all events held at the stadium. This ensures professional paramedic services on site with rapid response to medical emergencies within the stadium.
We also provide specialist motor sport paramedical coverage to the Upper Hutt Speedway.
Wellington Free Ambulance staff work in conjunction with St John Central Region Event Services to provide event coverage to event in the greater Wellington area. While we do not have first aid personnel, event organizers can approach Wellington Free Ambulance for a quote to provide paramedical services on a cost recovery basis. We are a not-for-profit service provider.
Zooming into the Future
Wellington Free Ambulance has established a number of action and business plans aimed at modernization and continuing to improve the level of services delivered to our patients’. The plans include the following:
Connecting all ambulance stations electronically to enhance staff communication.
Investigate electronic patient report form to enhance data capture and analyze patient outcomes.
Improve community access to early defibrillation in cardiac arrest by closer working relationship with the Fire Service.
Separate the non-emergency ambulance transport from emergency ambulance transport so emergency ambulances are waiting for calls rather than calls waiting for ambulances.
Improving the relationship with primary healthcare providers so Wellington Free Ambulance is seen as the portal to emergency and unscheduled health care.
Assisting with the implementation of the Ambulance Communications Project in New Zealand.
Continue our key stakeholder engagement through development of relationships and communication links.
Investigate opportunities to register ambulance paramedics as health care professionals
Developing the concept of Practitioners in Emergency Care on the Kapiti Coast.
Aim to have an emergency ambulance at 75% of life threatening emergencies within 8 minutes.
Explore the gaps between the ambulance standard and current operational practice
Continued development of our system status management deployment processes to ensure emergency ambulances are appropriately deployed.
In facing the challenges of the future Wellington Free Ambulance is working within a regional picture that has seen:
Rising demand for emergency ambulances reflected in a 6% increase in ‘111’ activity.
Rising patient expectations as people expect a world-class ambulance service tailored to meet their individual needs.
Rising staff and patient expectations as Wellington Free Ambulance strive to provide full crewing of emergency ambulances.
Rising constraints on capacity to respond to emergencies and finances, which necessitates us to operate more efficiently and effectively not simply doing more and more of what we have always done in the past.
Wellington Free Ambulance leadership and staff have been shaping the way paramedical ambulance services have been delivered free to the patient for Wellingtonians since 1927. The aim of the emergency ambulance service is to remain free to the patient through contracts with the Crown, income generating activities and the charitable funds donated by the public we serve.
Sometimes people might not be totally satisfied with our service.
How to register your concern about the service you received.
The management of Wellington Free Ambulance welcomes expressions of concern from the users of the ambulance service, as this is a way of learning and improving the service we provide our patients.
To register a concern that will be fully investigated write, stating dates, times, situation and the reasons for your concern to the:
General Manager Ambulance Services
Wellington Free Ambulance Service
P.O. Box 601
Wellington Free Ambulance welcomes comments from satisfied customers and patients, and the opportunity to share your story in our regular Pulse newsletter. To register your satisfaction you can either write to the General Manager Ambulance Services or phone our reception on (04) 499-9909.