Connecting Care: an integrated ambulance service and disability model of care

Adults with developmental disability, defined as a disability with onset in childhood, represent a disproportionately high proportion of frequent ambulance users in South Australia. Over 60% of frequent callers have a developmental disability, with some calling ambulance services 252–568 times annually each (SA local data), exceeding the population average of <1 call annually. South Australian rates are considerably higher than the 5-to-43-times-per-year range used in the international literature to define frequent callers. 

Adults with developmental disabilities have complex health needs and experience poorer health outcomes. Their needs often exceed the scope of primary care, resulting in frequent ambulance calls and emergency department transfers where health conditions may be missed, diagnosed late, or managed in ways that contribute to distress and trauma. This usage likely reflects the complexity of care needs in this community group, which exceeds the capacity of fragmented healthcare and disability systems, especially after transition from paediatric to adult care.

Health inequities for this community group are well documented. Adults with intellectual disability experience premature and potentially avoidable deaths at a rate of 38%, compared with 17% in the general population. Potentially preventable hospitalisations are also 4.5 times higher than for people without intellectual disability. The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability highlighted systemic failures within the Australian health system, including poor integration of services and inadequate responses to the needs of people with cognitive disability. The Commission called for new, evidence-based models of care, while the National Roadmap for Improving the Health of People with Intellectual Disability emphasised the need for reasonable adjustments to reduce distress and improve care quality. There is an urgent need for integrated, person-centred care models that better address complexity, reduce avoidable ambulance service and emergency department use, and improve health outcomes for people with disability, in particular developmental disability. 

Ambulance services are not often considered a potential interface between community- and hospital-based care. However, ambulance service staff often see that an adult with complex disability has unmet health needs that are not being met by ambulance transfers to emergency departments. To address these challenges and to use the unique position ambulance staff have in our community, we undertook a world-first pilot linking an ambulance service with an adult disability healthcare service to provide proactive, specialist care for adults with developmental disabilities. 

What did we do?

We undertook a 3-month (April-June 2026) pilot program between the SA Ambulance Service (SAAS) and the Southern Adelaide Local Health Network (SALHN) Adult Disability Care service, supported by an Allied and Scientific Health Office (ASHO) Allied Health Advanced Practice Developmental Grant. Joint community visits with SAAS and SALHN teams identified unmet healthcare needs, with interventions including: 

1. specialist disability medical assessments;
2. diagnoses previously missed, for example, autism; and
3. short-term therapeutic interventions, including occupational therapy and care coordination with NDIS and tertiary healthcare systems.

The pilot program increased clinician capacity to work intensively with individuals and their supports in a novel Advanced Practitioner role. Key facilitators were early involvement of existing supports, collection of detailed collateral and historical information, stakeholder meetings and in-context support delivered in the person’s home. Assessment and intervention considered not only the direct influences of service use but also the individual's broader health and wellbeing needs in a holistic way. This was underpinned by best-practice literature on working with people with developmental disability and Occupational Therapy practice frameworks. 

Our pilot program implemented targeted, individualised care plans and service improvements for a small cohort of adults with developmental disabilities and demonstrated early success in improving care coordination, responsiveness, and outcomes. Feedback from participants, families and staff has been universally positive. 

“No-one ever offers to help; they call to tell me what the problems are.” — Feedback from one family member participating in our pilot program.

Our initial results indicate a reduction in ambulance calls for several participants, including one who previously called 100s of times per year and now no longer calls, as his unmet health needs have been effectively addressed.

Where to now?

We are working to secure funding to continue building a clinical and research program that establishes an evidence-based model linking the SA Ambulance Service and the SALHN CARE Ability Program, informed by consumer, caregiver, and clinician experiences. 

We want to build a contemporary model of disability healthcare that provides timely, needs-based responses matched to the presenting issue, rather than relying solely on traditional medical-led pathways for every escalation in care needs. Central to this work is the recognition that people with developmental disabilities often present with complex, multifactorial health issues that span multiple body systems and clinical disciplines. This raises an important question for the future of healthcare: Should disability medicine emerge as a recognised specialty, akin to geriatric medicine or palliative medicine, with dedicated expertise, training pathways, and care models designed to address complexity that extends beyond a single organ system or diagnosis?

As with geriatrics and palliative care, disability-responsive healthcare may require care models that coordinate multidisciplinary expertise, support clinical decision-making amid diagnostic complexity, and integrate seamlessly across primary, secondary, and tertiary healthcare services. 

Collectively, we hope that our ongoing work will support scalable and sustainable approaches to disability-responsive urgent care, contribute to improved healthcare equity and service integration, and inform policy discussions about the future development of disability medicine as an emerging specialty area of practice.

Amelia Doveton is a Senior Occupational Therapist specialising in disability health care. She led the allied health component of the pilot clinical care program and is a higher degree research student at Flinders University.

Professor Kate Laver is an occupational therapist and Professor of Allied Health and Active Ageing in a joint appointment between the health service and university. She leads research which aims to optimise health, independence and quality of life in older people and people with disability.

Dr Jackie Roseleur is a health economist and health services researcher working across cancer and chronic disease. She has a particular interest in equity and economic evaluation.

Dr Sian Wanstall is a Paramedic Research Fellow with SA Ambulance Service. Her research focuses on paramedic wellbeing and patient safety, drawing on systems thinking and qualitative research. She co-leads the development of the SA Ambulance Service research program, focusing on building evidence to support safer systems of care and a sustainable paramedic workforce.

Dr Jessica Smith is a Consultant in Rehabilitation and Disability Medicine and clinician-researcher whose work focuses on improving healthcare for adults with developmental disability. She has developed innovative, integrated models of disability healthcare that challenge traditional approaches to care, improve access and coordination across services, and contribute to the emergence of disability medicine as a distinct field of clinical practice.

Associate Professor Amy Keir is a clinician-researcher and the Chief Medical Advisor for the SA Ambulance Service. Her research focuses on improving healthcare systems, and she is leading the development of an ambulance care research program in South Australia. She is a Fellow of the Royal Australasian College of Physicians and holds a PhD from Adelaide University.