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

Ayesha Tanveer, Khandakar Ahmed, Assefa Teshome, Oyetunde Gbadeyan, Ziad Nehme

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…