M. Eburn

New law for ambulance services in Tasmania

In Ambulance, Legislation and plans on August 29, 2013 at 12:34 pm

The government has introduced into Parliament the Ambulance Service Amendment Bill 2013 (Tas). The Bill, if passed, will amend the Ambulance Service Act 1982 (Tas) in some significant ways.

1. It will introduce a new definition of ‘ambulance’. Currently an ambulance is “a motor vehicle which has been specifically equipped for the provision of first aid to, and the conveyance of, persons suffering from illness, disability, or injury and which has been approved by the Director for that purpose”. Following the passage of this Bill ‘ambulance’ will be defined to be

a vehicle –
(a) which is –
(i) specifically equipped for the provision of out of-hospital clinical care to, and the conveyance of, persons suffering from illness, disability or injury; and
(ii) operated by, or on behalf of, the Ambulance Service to provide ambulance services other than non-emergency patient transport services; or
(b) which is approved by the Commissioner to be so operated.

The reference to first aid has been change to ‘out of hospital clinical care’ to reflect the broader range of functions of ambulance services; the exclusion of vehicles used for non-emergency patient transport services means those vehicles are not ambulances.

It will be an offence to drive any vehicle marked with the word ‘ambulance’ or ‘paramedic’ or any other markings that could imply or cause others to believe that the vehicle is an ambulance or is being driven by a paramedic, unless it is an ambulance as defined in the Bill or is in fact driven by a paramedic.

2. There will be a name change from “Tasmanian Ambulance Service” to “Ambulance Tasmania” and the Chief Executive will be known as the Commissioner of Ambulance Services rather than the Director.

3. The definition of what is an ambulance service will no longer refer to first aid, but instead to ‘out of-hospital care’ once again reflecting the higher professional standing, and broader duties of today’s paramedics.

4. Significantly the Bill will introduce a definition of ‘paramedic’. A paramedic will be a person who holds an approved paramedic qualification; a person who has a qualification and relevant experience to show that they have appropriate knowledge and skill and who has been appointed to a paramedic position by the Commissioner. This provision will allow for recognition of prior learning for paramedics who have been trained by ambulance services rather than through modern degree programs, however they will only be able to call themselves paramedics if they are appointed to a paramedic position by the Commissioner. A person with a ‘prescribed’ qualification will be a paramedic whether they are working in the area of paramedicine or not. I regret to say this text is wrong – please see the updated post of 7 September.

It will be an offence for any person, other than a paramedic, to use the title ‘paramedic’ or to do anything that would imply they are a paramedic. It will also be an offence for any business that does not employ paramedics to say, or imply, that they do employ paramedics.

It will also be an offence to impersonate the Commissioner, a paramedic or an ambulance officer.

5. The Commissioner will be given specific emergency powers to be used where ambulance services are being provided. In particular, he or she will be able to:

(a) authorise the destruction of, wholly or partially, or damage to any premises, equipment, vehicle or receptacle;
(b) cause the gas or electricity supply, motor or any other source of energy to any premises, equipment, vehicle or receptacle to be shut off or disconnected;
(c) restrict access to a specified area around the site where ambulance services are being provided.

The Commissioner will be able to delegate those powers to other members of Ambulance Tasmania but whether those powers are given to every paramedic or supervising officers will be a matter for the Commissioner.

6. Ambulance officers (that is persons employed by Ambulance Tasmania to provide ambulance services) are also given emergency powers, in particular the power to “enter any land, premises or vehicle if the officer has reasonable grounds for believing that a person in or on the land, premises or vehicle requires urgent ambulance services.” They may use reasonable force to ensure safe entry for the officer and any necessary equipment, and may take with him or her, any other person that is necessary to assist the officer to achieve their purpose. For example if the ambulance officer believes that there is a person injured in premises he or she may authorise the use of force to gain entry to the premises and may call upon others, such as the State Emergency Service to assist him or her to get into the premises and to then carry the person out of the building to the ambulance.

Before exercising a power of entry, an ambulance officer must, if they are not in their official ambulance uniform, produce their identification card to show that they are an ambulance officer. It is not at all clear who they are meant to show that identity card to. It makes sense if a person is refusing entry, for example if the ambulance has responded to a triple zero call and a person at the door doesn’t want to let the officer in but the officer believes that there is a person inside requiring assistance (in which case they should call the police); but if the officer is intending to enter premises, or a vehicle and there is no one there objecting, there is no one to whom the card can be produced. That section is unlikely to be problematic as presumably most ambulance officers will be wearing their official Ambulance Tasmania uniform.

7. Rescue scenes can be complex with multiple agencies attending and another agency may be in charge of the overall response, eg at a fire the Tasmania Fire Service would be the lead agency. To make the authority of the ambulance service clear, the Bill will introduce provisions that say where there are multiple agencies in attendance; the senior ambulance officer “has primary responsibility for the care and welfare of any person being provided ambulance services” and he or she may make recommendations to another agency regarding the priority of tasks that will impact upon patient care.

For example, at a rescue the officer may recommend to the rescue service that removing one person should take priority over removing another or some other task that the incident controller is considering. An agency that has received a recommendation must tell the senior ambulance officer if they are not going to comply with that recommendation and give their reasons for not doing so – so again at a rescue the senior ambulance officer may recommend that removing the patient with life threatening injuries should be the priority but the incident controller may say that even so the rescue and fire service will give priority to stabilising the vehicle and extinguishing a going fire given the threats to others. In other circumstances, given the ambulance officers recommendation, the IC may direct the fire service to focus on the rescue of the patient, rather than attending to a fire that is burning away from the accident scene and not posing an immediate threat to safety.

8. Honorary ambulance officers will now be called volunteer ambulance officers.

9. The Commissioner can authorise insignia to be adopted by Tasmania Ambulance. It will be an offence to manufacture, sell or improperly use authorised insignia or items that could reasonably be mistaken for authorised insignia.

10. The Act will introduce a scheme to licence private providers to operate non-emergency patient transport (NEPT) services (this will be similar to the schemes already operating in Victoria and South Australia). An application for a licence to operate an NEPT service is made to the Commissioner who must be satisfied that the applicant, or if the applicant is a company, the company’s CEO and directors are all fit and proper persons to hold the licence (and factors to be taken into account in deciding whether or not a person is a fit and proper person will be set out in the Act). In deciding whether to grant a licence, the Commissioner may also consider the equipment that the NEPT service will use and their operational and quality control procedures.

It will be an offence to provide an NEPT service without a licence or as part of Tasmania Ambulance.

11. The Bill contains provision for interstate cooperation allowing the Commissioner to make arrangements with ambulance services in other states and to recognise that an interstate ambulance is to be regarded as an ambulance when in Tasmania. If an interstate ambulance service is operating in Tasmania, the officers of that service will be subject to the direction and control of the most senior Ambulance Tasmania officer at the scene.

12. It will be an offence to “directly or indirectly resist, impede, obstruct or intentionally assault”, or to “use threatening, abusive or insulting language” toward, the Commissioner or any person providing ambulance services in accordance with the Act. It will be an offence to fail to comply “with a lawful requirement or direction” from the commissioner or an ambulance officer. It will also be an offence to “cause an ambulance to attend at any place by any false pretence.”

13.The Bill will provide legal protection for acts done in good faith for ambulance officers and volunteer ambulance officers, when providing ambulance services and otherwise performing functions under the Act. That protection does not extend to NEPT service providers other than Tasmania Ambulance and its employees.

14. Members who have other employment (eg volunteer ambulance officers) will have their employment protected if they have to be away from work to perform their ambulance duties.

15. There are numerous other provisions that are incidental to the above, that is changing other Acts to reflect the name change to Tasmania Ambulance and to allow for the implementation and management of the Act but they are not significant for ambulance operations.

The Bill has to make its way through the legislative process before it becomes law, but that is likely to happen in due course.

Michael Eburn

29 August 2013.

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  1. Hi Michael

    It is interesting there are references to protecting “ambulance” and “paramedic” in this document and I am wondering if this is the beginnings of the CAA members moving to limit some of the reasons leading to the justification for registration…….

    Secondly “ambulance officers” and “paramedics” are spoken of as if being separate titles earlier, but later in your document “ambulance officer” seems to be a universal term when referring to powers and so on. Was this done for simplification in your document, or does the legislation use “ambulance officers” intentionally in this way? I think the intentions are clear, but does only using “ambulance officer” with regards to the powers have any legal implications for “paramedics” given the legislation refers to “paramedics” and “ambulance officers” separately earlier? Or am I reading to much into it?

    • As for CAA (Council of Ambulance Authorities) members moving to limit the reasons for registration I can’t say. It may be that they were persuaded by the arguments and decided to take steps to protect the title pending registration? For those new to the debate paramedic has been an undefined term, anyone can call themselves a paramedic. One argument in favour of registration has been to define who is a paramedic and make sure only those that fit the definition can use the term. That is the effect of the Tasmanian amendments but they only apply in Tasmania. An advantage of national registration would be that a paramedic, once registered, is a paramedic in every state and territory. It is at least a first step that Tasmania is showing the lead and taking steps to limit who can call themselves a paramedic.

      As for ambulance officers and paramedics, no you’re not reading too much into it – there is a difference between paramedics and ambulance officers and it’s deliberate and significant. A paramedic will be a person who holds the prescribed qualification eg a recognised university degree. They will be able to call themselves a paramedic regardless of who they work for or what job they are doing. The legislature does not want to give them emergency powers, so there is also the Act uses the term “officer of the Ambulance Service” which “means a person appointed pursuant to section 14(2) to provide ambulance services” (Ambulance Service Act 1982 (Tas) s 3; see also s 14). So an ambulance officer (as I’ve shortened the term) is a person employed by the Tasmanian Ambulance Service (soon to become Ambulance Tasmania) to provide ambulance services (who may, or may not be, a paramedic); whereas a paramedic is someone with the appropriate qualifications who may, or may not be, an ‘officer of the Ambulance Service’ – they may work for a private provider, a mine site, allied health, who knows. It is only those employed by Tasmania Ambulance, ‘officers of the Ambulance Service’ who will have access to the emergency powers.

      Michael Eburn
      29 August 2013

  2. So correct if I’m wrong Michael, Ambulance Tasmania will recognize by name “paramedic” a Diploma vocational trained paramedic only if employed by Ambulance Tasmnia. For Private ambulance,event medical and NEPT the only way to be called a paramedic is to hold a degree?

    So old school VET pramedics have a limited life expectancy outside of Tasmania Ambulance? Who can see a rush on diploma to degree conversion programs?

    • Mike, you’re probably not wrong. To be called a paramedic you will need to have a prescribed qualification; that is lawyers jargon to mean that the relevant qualifications will be set out in the Regulations in due course. It is probable that the qualifications that will be prescribed will be the various university degrees such as the Bachelor of Paramedic Practice issued by Uni of Tasmania. Assuming that is a prescribed qualification, anyone who holds that can call themselves a paramedic. Note this is quite different to registration-if there was registration you could be ‘struck off’ for unproffessional conduct and would have obligations for ongoing skill maintenance. Under this scheme once you’ve got the degree you’re a paramedic regardless of your subsequent conduct. This scheme is certainly not about making qualifications transportable across the industry or across the country, but will go some way to ensuring that when a person is treated by someone calling themselves a paramedic, they actually have some minimum level of skill and knowledge.

      The alternative route requires a qualification that is not in the list (and remember the list of qualifications does not yet exist) and have such experience as to satisfy the Commissioner that he or she has the necessary skills and knowledge, and has been appointed to a position that the Commissioner has determined is a “paramedic position”. The paramedic position does not have to be with Ambulance Tasmania, a private provider could convince the Commissioner to designate a position within their service as a paramedic position. Regardless of where it is, leave that position and you cease to be a paramedic.

      So are you correct? Probably, I imagine that VET qualifications will not be in the list of prescribed qualifications, and one can imagine that the Commissioner will only certify positions in Ambulance Tasmania as paramedic positions, but that is not inevitable. VET qualifications may be listed as a prescribed qualification, and the Commissioner could certify positions within NEPT and event medical services as paramedic positions. Whether that does happen, or not, will be seen if and when the Bill is passed into law.

      Michael Eburn

    • Further to my earlier reply, and my post of 7 September, actually the only way to be recognized as a paramedic is to be employed by Ambulance Tasmania until regulations are passed that may expand that definition.

  3. How do all these changes affect people in the line of mechanical repairs etc and also Museum/Historical societies/groups? (see last para in Sec.1) Hopefully the Commissioner will have the power to grant exemption to this part.

    • They are interesting questions. The new s 39(1) will say it is an offence to ‘drive’ a vehicle marked ambulance or otherwise implying it’s an ambulance, unless it is an ambulance and to be an ambulance it must be approved. That could be a problem for historical motor vehicle enthusiasts. No one might think an antique ambulance is being or capable of being used as an ambulance today, but if it has the word ‘ambulance’ on it, the Commissioner’s approval would be required, which one would imagine would be granted to bona fide collectors, museums etc.

      The new s 39(2) will be more problematic. It says that it is on offence to drive a vehicle marked withe word ‘paramedic’ or otherwise implying the vehicle is operated by a paramedic unless it is in fact “is staffed and operated by a paramedic” so where does that leave a mechanic driving the vehicle for the purpose of taking it to a place for repair or mechanical inspection? On the face of it that would be an offence and there’s no place for the Commissioner to somehow approve that. Presumably none of the enforcement agencies (eg the Commissioner or the police) would take action. If they did I would argue, that the vehicle is usually operated by a paramedic when being used in its normal course and that is what the section is intended to cover – when it was being driven by a mechanic, and not used ‘as’ an ambulance that was merely incidental to its use by a paramedic. Whether a magistrate would accept that argument remains to be seen.

      Michael Eburn.

  4. I wonder what effect this legislation will have on the operations of St. John Ambulance in Tasmania who would carry out a similar function under the control of their own Commissioner. Is there an exemption under the Act as exists in other States (NSW, for example), or will they need to seek permission from the AT Commissioner to continue their present activities? The new legislation would seem to put SJAA (Tasmania) in a difficult position.

    Your thoughts?

    • Good question, George. It is an offence to provide an ambulance service in Tasmania without the approval of the director (Ambulance Service Act 1982 (Tas) s 37). That section, which will not be changed by the Bill (except to substitute the word “Commissioner” for “Director”) does not however apply to St John Ambulance (s 37(3)) so they will continue to be able to do the work they have been doing; but can they have the word ‘ambulance’ on their vehicles?

      The new s 39 will say:

      Unless authorised by the Commissioner a person must not drive, operate or have charge of, or allow another person to drive, operate or have charge of, a vehicle, other than an ambulance, that is –
      (a) marked with the word “ambulance”; or
      (b) otherwise marked or altered, or bears any inscription –
      so as to imply, or lead to the belief, that the vehicle is an ambulance capable of providing ambulance services.

      A St John ambulance vehicle will be marked with the word ambulance which can only be lawful if it is in fact an “ambulance capable of providing ambulance services” (which is odd because of course the vehicle can’t supply any service, you would think it should say capable of being used in the provision of ambulance services, but let’s not get distracted by that).

      An ambulance service is going to be defined as: “services relating to the work of rendering out-of-hospital clinical care to, and the conveyance of, persons suffering from illness or injury”. Given St John are allowed to provide an ambulance service and even though it says “and the conveyance of…” not “or the conveyance of …” we can infer that St John operational vehicles are ‘capable of [being used in] providing ambulance services”. But the vehicle has to be “an ambulance capable of providing ambulance services” not “a vehicle” that is so capable.

      An ambulance will be defined as:

      a vehicle (a) which is (i) specifically equipped for the provision of out-of-hospital clinical care to, and the conveyance of, persons suffering from illness, disability or injury; and (ii) operated by or on behalf of, the Ambulance Service to provide ambulance services other than non-emergency patient transport services; or (b) which is approved by the Commissioner to be so operated”

      The Ambulance Service is (or will be) Ambulance Tasmania. To be an ambulance it has to meet both (a)(i) and (ii) or (b). A St John ambulance vehicle may meet (a)(i) but is not operated by or on behalf of Ambulance Tasmania, so it will need to meet (b) ie it needs to be approved by the Commissioner.

      One could argue that s 37 by implication allows St John to have ambulance on their vehicles as they are entitled to provide an ambulance service and it is part of their corporate name; but a strict reading of the Bill says, in my view, that although St John can and will be able to continue to provide ambulance services, they will need approval from the Commissioner of Ambulance Tasmania to have the word ‘ambulance’ on their vehicles.

      Michael Eburn

  5. Hello Michael,

    I’m still a little confused and do not see the authorisation of a private Paramedic ambulance service under the proposed new Act. The proposed Act as read above defines a Paramedic through appropriate qualifications and that has been ‘appointed to a paramedic position by the Commissioner’. This surely cannot take place unless that Paramedic is working for Ambulance Tasmania and therefore excludes the use of private Paramedic services. In your reply to Peter on 29 Aug you say “They will be able to call themselves a paramedic regardless of who they work for or what job they are doing.” I cannot see that in the wording of the proposed Act.

    I am a strong advocate of protecting the title of Paramedic and am hopeful of a national registration scheme in the future. It certainly helped in the regulation of standards and provision of services in the UK. I feel that the smallest mistake in legislation, that on the face of things is big a step in the right direction, could actually restrict Paramedics in their options for employment and deny competition for covering commercial events.

    Regards

    David

    • David

      As my post of 7 September shows, I was a ‘little confused’ too. There is no authorisation of private paramedic services in the new Bill, though there is provision for non-emergency patient transport services. You’re correct that on 29 August I said “They will be able to call themselves a paramedic regardless of who they work for or what job they are doing” and that was an error on my part. To call yourself a paramedic, you need to be employed by Ambulance Tasmania.

      It would appear that this is a step to protect the title, but certainly to save it for Ambulance Tasmania though there is provision to allow for expansion to people in a ‘prescribed class’ (eg employees of organisation x) or with ‘prescribed qualifications, so they are leaving their options open.

      I apologise for my earlier error.

      Michael Eburn

  6. I’m curious about the new offence for a person to ‘directly or indirectly resist, impede, obstruct or intentionally assault… a person who is providing ambulance services, or is otherwise performing a function or exercising a power, under this Act;or… an authorised officer, or a paramedic, who is performing a function, or exercising a power, under this Act’ in new s39B(1). Where does this leave a person’s right to refuse medical treatment?

    (Terrific blog, by the way.)

    • The new offence will have not impact upon a persons’ right to refuse treatment. A paramedic’s powers or functions do not extend to assaulting people (which is what providing treatment in the absence of consent or other lawful authority amounts to). Ambulance officers don’t do their job for their benefit, they do it for the patient’s benefit. Any suggestion that ‘refusing’ treatment amounted to resisting, impeding or obstructing an officer would only be true if they had to provide care for reasons other than the person’s own benefit. In short an officer exercising a function or power is doing so in accordance with the law which includes the law of assault and consent. This new offence will make no difference to that.

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