We’ve seen countless media reports in recent days, weeks and months about the ramping of ambulances at hospital emergency departments (EDs) around Australia. Ambulance ramping occurs when paramedics are made to wait at the hospital’s entrance and are unable to transfer their patient into the emergency department within an appropriate time frame – defined as 30 minutes in South Australia. Ramping is an indicator of hospital stress.
It means patients are waiting longer to receive care in the emergency department, and patients requiring inpatient care are waiting longer to access a hospital bed. Research suggests ambulance ramping and having to wait longer for a hospital bed are associated with a greater risk of patients dying up to 30 days after their initial presentation. So why is ambulance ramping still a problem? And what can we do to fix it? Available data indicate the problem has become worse over time.
In South Australia , for example, ramping has been steadily increasing since 2017, from around 500 hours “ramped” per month to around 4,000 hours per month in 2024. This is the sum of the time ambulances spend waiting beyond 30 minutes after arriving at the hospital. In New South Wales , we calculate the numbers of patients being ramped increased from around 44,000 patients per month in early 2022 to more than 50,000 in early 2024.
The ambulance ramping bottleneck reflects an imbalance between the number of people presenting at emergency departments and the capac.