Quantifying the Impact of Ambulance Ramping: A Multi-Year Analysis of Victorian Emergency Medical Services Cases

2026-09-30

AI Summary

This study addresses ambulance ramping, a critical bottleneck constraining emergency medical service efficiency whose statewide scale and underlying drivers remain poorly understood. Leveraging 2.85 million emergency dispatch records from Victoria, Australia, the research employs exploratory data analysis, time-series cross-correlation, and Pareto concentration metrics to systematically investigate this phenomenon. The work makes two primary contributions: it is the first to quantify cumulative lost operational hours due to ramping at a statewide scale, revealing that just ten hospitals account for 57.8% of total ramping losses; and it empirically establishes that arrival concurrency, rather than patient acuity, serves as the principal driver of ramping delays. These findings provide a crucial empirical foundation for developing hospital-status-aware ambulance routing strategies.

Abstract

Ambulance ramping, the delay between hospital arrival and patient handover, is a critical operational bottleneck in Emergency Medical Services (EMS), yet its systemic magnitude and dynamics remain inadequately characterised at scale. This paper quantifies the scale, trajectory, and operational correlates of ramping across an entire statewide EMS system, analysing 2,850,575 ambulance attendances in Victoria, Australia from January 2020 to March 2024 using an Exploratory Data Analysis (EDA). After systematic preprocessing, an analytical cohort of 2,026,569 Emergency Department (ED) transports across 59 hospitals with ED and 79 Local Government Areas (LGA) was examined through interval decomposition, Pareto concentration, hourly cross-correlation, hospital arrival concurrency and priority-stratified operational comparisons. Cumulative Ambulance Hours Lost (AHL) totalled 1,491,127 hours, equivalent to approximately 96 ten-hour ambulance shift lost every day of the study window. Ten of 59 hospitals account for 57.8% of lost hours from 50.9% of cases. Annual losses rose 57% to a 2022 peak while transported demand fell 3.7%, indicating deterioration in per-case handover rather than growth in demand. Handover duration varies little with patient acuity, but rises monotonically with the number of ambulances arriving at the same hospital in the preceding hour, an effect persisting within every hour of the day. Hourly demand is moderately associated with ramping two to four hours later (r = 0.365). These findings establish the empirical preconditions for hospital-state aware ambulance routing.

Problem

• Ambulance Ramping
• Emergency Medical Services
• Patient Handover
• Operational Bottleneck

Innovation

• Ambulance Ramping
• Exploratory Data Analysis
• Emergency Medical Services
• Pareto Concentration
• Hospital-state Aware Routing