NSW Ambulance Patient Disposition Protocols
These protocols guide paramedics in determining the most appropriate care pathway for a patient after an assessment.
| Protocol | Description |
|---|---|
| P1: Authorised Care | For patients with an existing valid treatment directive (e.g., palliative care plan) related to their current condition who are not transported. |
| P2: Patient Refuses Recommendation | For competent patients (or their person responsible) who refuse assessment, treatment, and/or transport against paramedic advice. |
| P4: Patient Deceased | For patients who are deceased upon examination and are not transported. |
| P5: Referral Decision | For patients assessed as suitable for alternative referral options who do not require emergency ambulance transport to an ED. |
| P6: Incident in Control of Another Agency | For patients who cannot be assessed by paramedics because another agency (e.g., Police) has control of the scene. |
| P7: No Acute Health Issues Identified | For patients who have no acute health issues, normal clinical assessment, or state they are not unwell and do not require assessment. |
P1: Authorised Care
Criteria: This protocol applies when a patient has an existing diagnosed condition, a valid medical treatment directive related to that condition, and their current presentation is related to that diagnosis.
Valid Treatment Directives Include:
- NSW Ambulance Authorised Adult General Care Plan (AGCP)
- Medical Practitioner Treatment Plan (e.g., Asthma Action Plan)
- Advance Care Directive
Paramedics can follow the instructions on these plans, which may include providing specific treatments or referring the patient to their GP/Specialist. Palliative care patients with a valid plan are exempt from the generic exclusion criteria for non-transport.
P2: Patient Refuses Paramedic Recommendation
Process: This protocol is used when a patient with decision-making capacity refuses recommended assessment, treatment, or transport.
- Assess Capacity: Ensure the patient understands the situation, the risks of refusal, and can communicate their decision.
- Reconcile: Attempt to understand the patient's reasons for refusal and explain the risks clearly. Involve family or carers where appropriate.
- Document: Thoroughly document the recommendations made, the patient's refusal, and the information provided about the risks. The patient should sign the refusal on the clinical record.
- Provide Advice: Advise the patient to call '000' if their condition deteriorates or they change their mind. Provide a Referral/Advice Letter.
P5: Referral Decision
This protocol is for patients with minor illness or injury who, after a thorough assessment, are deemed suitable for an alternative care pathway instead of ED transport via ambulance.
P5 Disposition Options:
- Self-Care with Advice: For minor issues where the patient can manage their condition at home with advice from the paramedic.
- Referral to Alternative Care: Referral to a GP, community health service, or medical centre for follow-up.
- ED via Alternative Transport: For patients who need ED assessment but are stable and can safely travel by private vehicle or other means.
P5 Generic Exclusion Criteria (Non-Transport is NOT an option if any are present):
- Any red observations or un-reconciled yellow observations.
- Patient does not demonstrate competency and capacity.
- Multiple co-morbidities that are not adequately reconciled.
- Suspected to be under the influence of alcohol/drugs with signs of trauma or syncope.
- Medical practitioner requests transport to ED.
- Recent surgical procedure or hospital admission related to the presenting complaint.
Elder at Risk (EAR) Assessment
MANDATORY for all non-transported patients ≥ 65 years (or ≥ 50 for Aboriginal or Torres Strait Islander people).
An EAR assessment is POSITIVE if the patient answers "Yes" to any EAR questions, OR is identified as a "High" falls risk on the FROP-Com screen, OR has any functional/balance problems identified.
A positive EAR assessment requires paramedics to attempt to reconcile risks and determine an appropriate disposition, which may include referral to services like My Aged Care, a GP, or a physiotherapist.
Specific Referral Pathways
The availability of these services is highly dependent on the Local Health District (LHD) and time of day.
Indigenous Health Pathways
| Service | Description | Eligibility |
|---|---|---|
| Aboriginal Hospital Liaison Officer (AHLO) | Provides culturally sensitive support to Aboriginal individuals to help them navigate the health system. | Identifies as Aboriginal, requires cultural support, and meets P5 criteria. |
| Orange Aboriginal Medical Service (OAMS) | A GP service providing a wide variety of care for all ages and backgrounds in the Orange community. | Meets P5 criteria, resides in the area, and is able to attend the service. |
Aged Care Pathways
| Service Type | Description | Common Conditions Referred |
|---|---|---|
| Geriatric Outreach / Flying Squads (e.g., COGS, GRACE) | Provides timely medical and nursing care by a specialist aged care team for older people experiencing an acute decline in a Residential Aged Care Facility (RACF) or at home. | Falls without major injury, mild CCF exacerbations, acute infections (UTI, pneumonia), pain management review, decreased mobility. |
| Extended Community Care (e.g., St George ECC) | Provides sub-acute and post-acute care (physiotherapy, occupational therapy, nursing) within 48-72 hours of referral to help manage functional decline at home. | Patients >65 years with functional decline, requiring mobility assessment, ADL support, or wound care. |
Mental Health Pathways
| Service Type | Description | Key Features |
|---|---|---|
| Mental Health Line (e.g., NBMLHD) | A 24/7 telephone triage service staffed by experienced mental health clinicians who can provide advice and link patients to appropriate services. | Provides telehealth triage while paramedics are on scene to determine disposition (ED, community referral, or GP). |
| PACER / MHAPP | A co-response model where a senior mental health clinician attends the scene with Police and/or Ambulance to provide on-site triage and assessment for a mental health crisis. | Can conduct face-to-face assessments to determine the safest and most appropriate disposition, avoiding unnecessary ED presentations. |
Community Nursing and Allied Health
| Service Type | Description | Eligibility |
|---|---|---|
| Fairfield Falls Collaborative | A rapid response allied health service providing multifactorial falls assessment and prevention interventions for at-risk older people. | >65 years, resides in Fairfield LGA, identified as a "high" falls risk. |
| Diabetes in Mudgee | A GP-led project to support patients with Type 2 diabetes to optimise their self-management skills. | >16 years, diagnosed with Type 2 diabetes, patient of a participating Mudgee medical centre. |
Urgent Care Centres / Services
| Service Type | Description | Common Conditions Referred |
|---|---|---|
| Medicare Urgent Care Clinics / UCCs | Provides assessment and management for urgent but non-life-threatening conditions that would otherwise present to an ED (Triage Category 4 or 5). | Minor illnesses (fever, URTI), minor injuries (sprains, simple fractures), mild asthma/COPD exacerbations, simple wounds/burns, UTIs. |
After Hours GP / Telehealth
| Service Type | Description | Key Use Case |
|---|---|---|
| My Emergency Doctor (MED) | A 24/7 telehealth service providing ECPs with on-scene support from emergency specialists for complex decision-making, including medication prescriptions and referrals. | Used when other referral options are exhausted or unavailable, to facilitate safe management on scene. |
| National Home Doctor Service | Provides after-hours home visits from a doctor for conditions that require assessment but cannot wait until the next day for the patient's regular GP. | For patients who meet P5 criteria but need assessment outside of regular GP hours. |