title: The ethics of ambulance ramping.
abstract: Ramping is the practice of requiring paramedics to continue to care for patients rather than hand over clinical responsibility to the ED. It arose as an alternative to admitting patients to EDs that are deemed to be already operating at or beyond capacity. This paper analyses the ethics of ramping. Ramping has been embraced by some ED practitioners and policymakers as a solution to the problem of ED patients suffering increased risks of harm as a result of waiting times within ED. However, this perspective fails to adequately consider the implications, especially the opportunity cost of requiring paramedics to remain at the hospital rather than make themselves available for other patients. From this perspective, ramping negatively impacts the wider provision of emergency medical services, with potentially serious consequences for people's health. Advocates of ramping must consider people in the community who require a medical emergency response.
authors.affiliation: Paramedic Emergency Care, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perry
authors.affiliation: School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Drew
authors.initials: D
authors.lastname: Carter
mesh_terms: D000488:Allied Health Personnel / Q000523:psychology / Q000639:trends*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004992:Ethics, Medical; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D009726:Nurses / Q000523:psychology / Q000600:supply & distribution / Q000639:trends; D062209:Patient Handoff / Q000592:standards* / Q000639:trends; D010820:Physicians / Q000523:psychology / Q000600:supply & distribution / Q000639:trends
keywords: ambulance; emergency department; ethics; paramedic; ramping