Ambulance performance in Indigo Shire has again been the worst in Victoria, prompting mayor Jenny O'Connor to call for an urgent increase in resourcing.
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A unit arrived at a "Code One" call-out within the target timeframe of 15 minutes just 28.4 per cent of the time during the October to December quarter last year.
On average it took 22 minutes for an ambulance with its lights and sirens activated to respond.
"These results are very disappointing," Cr O'Connor said.
"We understand we can't have the same level of response as one would expect in a metropolitan city, but the gap is too great between what most of Victoria expects and receives, and what the Indigo Shire is receiving.
"Even for comparable small rural shires, they have percentages of 50 and 60. "It needs to be addressed immediately; it's a critical issue for our community."
Cr O'Connor said no promises had come out of a meeting with Ambulance Victoria in December.
"They were very aware of our concerns after that meeting, and we're looking to have further discussions with Health Minister Jenny Mikakos," she said.
"We want to work constructively with Ambulance Victoria and with the Minister around appropriate resourcing and funding - for more qualified paramedics, vehicles and ambulance stations.
"We are always relying on ambulances coming in from NSW in the Western part of the shire, and sharing resources is fine, if we have the appropriate amount of services."
Ambulance Victoria's Hume Regional Director Matt Chadban said in a statement that "while response times are an important measure of the service Ambulance Victoria delivers, it's what paramedics do when they reach a patient that really counts".
"It's also important not to underestimate the invaluable role played by our highly skilled volunteers in communities such as Indigo," he said.
"Our Ambulance Community Officers and Community Emergency Response teams provide crucial lifesaving treatment in the early minutes while paramedics are on their way.
"It is a model of care that is proven and successful based on workload and demand, and operates in a number of branches in rural or remote parts of Victoria."
Cr O'Connor said the expectation in a Code One emergency was that a paramedic would respond.
"Ambulance Victoria itself has that as its standard," she said.
"I want to make it clear I'm not criticising the volunteers; this is a resourcing issue for the state government and Ambulance Victoria.
"There's potential for a shed site in Chiltern with CFA and SES, and there's potential for other sites - there needs to be planning."
The quarter two data represented a 10 per cent drop in the percentage of ambulances making the target timeframe, from 38.5 per cent for quarter 1 (July 1 to September 30 2019).
The shire has had the state's worst performance for three out of the past eight quarters, which includes only 24.5 per cent of ambulances responding within 15 minutes across the first three months of last year.
Other local government areas with consistently low results include Buloke, Loddon, West Wimmera, and in the North East, Towong.
Indigo's quarter two data was much lower than neighbouring shires of Alpine (50.7 per cent making 15 minutes) and Wodonga (87.1 per cent).
Mr Chadban said the latest quarterly performance data showed paramedics in the Hume region "responded to 4300 emergency cases in October, November and December 2019 - 332 more cases than the same period in 2018".
"Despite the significant 8.4 per cent increase in demand, the more complex patients and call-outs we are seeing, our paramedics continue to deliver best care," he said.
"We're also continuing to invest in a range of locally based initiatives for Hume residents, including installing more automated external defibrillators, developing greater awareness of the benefits of CPR training and use of the GoodSAM app, that will improve survival rates for the most critically-ill patients.
"We thank the Hume community for their support as we go about caring for local residents."
Member for Northern Victoria Tania Maxwell took up the issue of Indigo's Ambulance Victoria performance in May last year and Health Minister Jenny Mikakos met with then-mayor Bernard Gaffney in August.
After reports of a person dying in hospital after a one-hour wait for an ambulance were raised at the November council meeting, Ambulance Victoria said there was no record of the incident, and December's meeting was held.
But that confusion was "set aside" at the meeting, with Cr O'Connor commenting then more resources were needed.