By Dr Juan Ascencio-Lane, the Tasmanian Chair of the Australasian College for Emergency Medicine.

A code yellow, on paper, is due to an internal emergency that affects service delivery in a hospital. What it means, in real life, is that the hospital and interconnected health system are overwhelmed. There are far too many sick and injured people, and there are not enough trained staff and beds to cope with demand.
As usual, there was an urgent ring-around, pleading for staff to come and help.
As usual, staff cancelled their long-awaited holidays, scrambled for places to put the kids they were looking forward to spending time with, cancelled get-togethers with friends, and they showed up to help.
As usual, staff across the entire hospital and emergency services system were resilient, selfless and resourceful.
I know this, because I saw it, and I see it every week.
I see paramedics working over-time, and getting called back to work, without rest. I see them care for patients on the ramp, when the hospital is too full, for up to 16 hours, and I see them looking after groups of patients, to let the ambulances get back onto the road to collect more sick and injured people.
I see hospital inpatient teams forced to care for patients in the waiting room, instead of in a private space, whilst still showing complete compassion and professionalism.
I see nurses and doctors cry, then wipe their faces and push through to give the best they can.
These are the people that keep this health system afloat, doing things that no one wants to do. No one wants to play bed Tetris to try and manage all the sick patients. No one wants to tell a mother with her sick baby that it could be hours before we find you a bed.
No one wants to watch elderly patients, who are so confused and disorientated from being stuck in the ED for days and days, due to a lack of spaces in care or hospital, that they must be sedated.
And, importantly, Tasmanians don’t want to be that disorientated elderly person, or that mother with the sick baby, who are forced to suffer long waits due to a lack of capacity in the healthcare system. And they should never have to be. Because they deserve, and need, better than this.
And that is why healthcare workers – who do the work they do because they are dedicated to caring for others – continue to push past their own needs to care for patients.

But healthcare staff are breaking. We can no longer rely on the empathy of staff to keep this under-resourced system going. I know that Tasmanians don’t want to receive healthcare on the broken backs of healthcare workers.
Because while I see staff going to great lengths to provide care, I also see, across the sector, talented healthcare workers walking away. I see them leaving their field, in a steady stream, unable to cope with the way our health system is failing our patients – and our staff.
ACEM has long called for investment, policy and action that addresses the consequences of access block in our health system. However, every time a small step forward occurs, there is a painful reminder that we are, at best, scrambling to keep pace.
So, who needs to take responsibility for this? The answer is: all of us. There are no gains to be made by pointing fingers. This is no one’s fault, but it is everybody’s responsibility to fix. We are struggling now across the state because of poor decisions made over 10 years ago. The Tasmanian Department of Health is engaged, but struggling as we go from one crisis to the next. They continuously have to stop the haemorrhage, rather than having the time to fix the root cause.
While we appreciate the previous measures our leaders have put forward to address the issues in Tasmanian healthcare, our current challenges require a greater level of ambition, leadership, and collaboration across the health system, and all levels of government, than we’ve previously seen.
We know this won’t be easy. But it is possible. We have the medical and health leadership. We have the will. We have the ideas. We just need resources, and the political support.
Recent improvements to the management of Tasmanian mental health showed that politicians of all stripes, at federal and state level, can produce collaborative and thoughtful solutions for complex healthcare situations. By bringing together policy makers and medical and healthcare stakeholders, across specialties, we can revolutionise our system through achievable and suitable solutions.
To the people of Tasmania, if you require treatment over this busy period, know that the healthcare workers of this state will work tirelessly to try to provide safe care to you. But please understand that people seeking care for non-immediately life-threatening conditions will likely experience long waits. Please be patient, and kind, and please investigate alternative options for care.
As ACEM President Dr Clare Skinner said, “Right now in emergency departments, we are doing our very best to treat people with serious injury or illness as quickly and safely as possible. With limited staff and resources, we are prioritising saving lives.”
I hope that the next festive period, I see something different. I hope I see solutions being implemented, across the healthcare system. I hope I see all Tasmanians able to access the healthcare system they deserve, when and where they need it – and I hope that I see staff being supported properly to provide safe care. I hope.


ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards.

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