This question appeared as a comment on the post ‘Alcohol and Refusing Treatment’ (3 April 2014, ) but the question warrants its own post.
Michael, I have a curly question for you. I am a very experienced paramedic, currently working in a remote capacity in remote Western Australia. On my time off I volunteer for the local state ambulance service. I have been told in no certain terms that when I work on the volunteer ambulance that my ALS skills “magically” disappear.
In the ambulance we do have ALS equipment, but I have been told I am not allowed to use it. This is my question, where do I stand if I get a patient who needs ALS support and we are remote without any close ALS support, if the patient has a poor outcome on account of no ALS intervention , where do I stand if the relatives find out that a ALS paramedic was in the back with the patient, but did not use their skills. Can I be held liable??
My colleague Ruth Townsend and I address similar issues in ‘Crossing the line – the law and ethics of going beyond the wire’ Response – Journal of Paramedics Australasia (forthcoming). Pending that paper (which I believe is in the current issue) I’ll address the issues here.
The common law concept of vicarious liability says that an employer must accept the liability for the negligence of an employee (see my earlier post, ‘Qualifications v Experience’ (21 February 2014). My correspondent tells us he is a volunteer, not an employee. There is some doubt about whether or not an organisation is vicariously liable for the negligence of a volunteer. I have no doubt they will be, but I have to concede there is debate (and see the discussion in my book, Emergency Law, (4th ed, 2014, Federation Press)). Most emergency services legislation provides that volunteers are protected and often provide that if there is any liability it is to be borne by the agency (see for example, Victoria State Emergency Service Act 2005 (Vic) s 42; Health Services Act 1997 (NSW) s 67I). In WA there is no ambulance service legislation (see my earlier post ‘Legislative compliance for WA Paramedics – what legislation?’ (12 February 2014) so there is no specific Act to look to.
In WA the Volunteers and Food and Other Donors (Protection From Liability) Act 2002 (WA) is relevant. That Act, in s 6, says ‘a volunteer does not incur civil liability for anything that the volunteer has done in good faith when doing community work.’ If the volunteer would, by the application of the ‘normal’ law be liable, then the organisation for which they are volunteering is liable (s 7). ‘Community work’ is defined in s 3 and without going through that in detail, I think it is unquestionable that volunteering for St John (WA) would constitute doing community work for a community organisation. Section 6(3) says the volunteer protection does not apply if, at the time, the volunteer:
… knew or ought reasonably to have known that at the relevant time he or she was acting — (i) outside the scope of the community work organised by the community organisation; or (ii) contrary to instructions given by the community organisation;
With all that background let us now consider the situation that involves my correspondent. Someone in remote Western Australia rings triple zero for an ambulance. They are not ringing a particular paramedic; they are ringing St John. St John despatch the ambulance with the crew that they have chosen, trained and equipped. They turn out in their St John uniform, driving a St John vehicle. They clearly represent St John. The corporate entity that is St John cannot turn out except by its staff (including volunteers) so these people are clearly not turning out for their benefit, or because they have been personally asked, but because they represent – they are – St John Ambulance.
St John ambulance owes a duty of care to its patients (Kent v Griffiths [2000] EWCA Civ 25). They have a duty to provide reasonable care taking into account all the circumstances in their operation including the reliance on volunteers and the distances that apply in WA. In this case we assume that ‘in the ambulance there is ALS equipment, but the paramedic has been told he is not allowed to use it. The patient needs ALS support and they are remote without any close ALS support. The patient has a poor outcome on account of no ALS intervention.’ Let’s put that picture in clearer focus – the patient needs care that the person in the back of the ambulance is competent to give, has the equipment necessary to give it, but choses not to. If you were that person (or their family if they die) what would you do?
Let us assume you want to sue. You have two options; sue the paramedic and/or sue the relevant ambulance service. The ambulance service owes a duty to their client and its duty is to act reasonably. They know they are providing services in remote WA and here they have a person who needs ALS support, a person on board who knows how to give it and the necessary equipment, but they don’t because the service has told them not to. Why has the service told them not to? Is it a proper risk assessment, where they have looked at potential risks, control measures and decided the most appropriate response was to prohibit this conduct. Or was it some insurance concern; that the service is saying ‘don’t treat as our insurance won’t cover you’? Whether or not they have insurance does not, however, determine whether they are legally liable.
Let us think about that – there are two risks. One is that the ALS officer tries to administer some ALS treatment and makes a mistake (not just that there is an adverse or less than good outcome, but there is a negligent mistake that makes the situation worse). The other risk is that the ALS officer does not administer the necessary care, care that he or she is aware the patient needs, knows how to do it and has the necessary equipment. The risk of an adverse outcome must be higher by not doing something that one knows is needed rather than by doing what one is trained and equipped to do. Sure there could be liability if there is both negligence and an adverse outcome, but that is less likely than the adverse outcome of not giving the treatment.
(This all sounds familiar to the discussion on doctors and the duty of care – see ‘Doctors as ‘good Samaritans’ – do I have to stop?’ (23 March 2014) and the case of Lowns v Woods (1996) Aust Torts Reports 81-376. Remember that no-one’s been sued for attempting to help, but there has been liability for not helping.)
The injured patient may also want to sue the paramedic who also owes a duty of care to his or her patient. They knew what they patient needed, they had the necessary supplies and they didn’t do what they knew was warranted. Why not? Because their agency had told them not to. What is their primary duty? To act in their patient’s best interests or to honour the agencies direction? The paramedic may be concerned about s 6 of the Volunteers and Food and Other Donors (Protection From Liability) Act 2002 (WA) and that they are acting ‘contrary to instructions’. Now that section cannot be taken literally if it were the agency could avoid liability by instructing volunteers ‘not to be negligent’. As with the common law of vicarious liability there would have to be consideration as to what that section actually means and when it applies.
The paramedic can see the patient and may be aware of what the possible consequences of their actions are. Whilst paramedics are not required to volunteer, having done so and having responding and having the equipment at hand a court could ask was it reasonable to withhold the treatment. As quoted in many earlier posts, the test
… calls for a consideration of the magnitude of the risk and the degree of the probability of its occurrence, along with the expense, difficulty and inconvenience of taking alleviating action and any other conflicting responsibilities which the defendant may have. (Wyong Shire v Shirt (1980) 146 CLR 40, 48)
What is the risk to the patient of withholding the treatment v the risk of giving it? There is no ‘expense, difficulty and inconvenience’ in giving the treatment if the operator is trained and has the equipment. There are conflicting responsibilities in particular the responsibility to obey the services instructions but are they sufficient not to administer the treatment if that will have implications for the person’s survival or long term recovery? A court could easily conclude that a paramedic was not acting reasonably in withholding treatment from someone that needed it, and when the paramedic could administer it, just because someone told them not to.
The paramedic may want to rely on the Volunteers etc Act which says ‘a volunteer does not incur civil liability for anything that the volunteer has done in good faith’ and argue that they acted ‘in good faith’ by following the direction not to administer needed treatment that they were competent to give and where they had the necessary equipment. In my book I said this about ‘good faith’:
… in California … it was said, in relation to a ‘Good Samaritan’ statute, that to act in good faith was to act with “that state of mind denoting honesty of purpose, freedom from intention to defraud, and, generally speaking, means being faithful to one’s duty or obligation” (Lowry v Mayo Newhall Hospital 64 ALR 4th 1191 (Cal 1986), 1196). The New South Wales Court of Appeal held that acting ‘bona fides’ (that is in good faith) meant that a defendant fire fighter “… did not act from any improper motive – maliciously, from personal hostility, or spite, or dishonesty” (Vaughan v Webb (1902) 2 SR(NSW) 293). In the Australian High Court,McTiernan J, when considering a statutory immunity that applied to the New South Wales Fire Brigades, said that the concept of “good faith” referred to an act that was done “without any indirect or improper motive” (Board of Fire Commissioners v Ardouin (1961) 109 CLR 105, [1961] HCA 71,115).
In summary to act in ‘good faith’ the Good Samaritan must be acting with the motive or intention to help the person in need. The Australian Federal Court suggested however that there must be more than just honesty and no improper purpose was required, they said there must also be:
… evidence that a real attempt was made to do properly the very thing for which immunity is sought: this may involve following an established system, or set of procedures.(Mid Density Developments Pty Ltd v Rockdale Municipal Council (1993) 44 FCR 290, at 468-9.)
Acting, not in the patient’s best interests, but because of a fear of liability or, more particularly given you presumably don’t think you will be negligent, fear of lack of insurance cover, is not acting in good faith. Acting to protect your position rather than the patient is not good faith. It was to avoid that (legitimate) self interested concern that good faith type provisions were written! (Personal liability of the paramedic would be easier to establish if paramedics were members of a recognised, registered heath profession).
So ‘where do I stand if the relatives find out that a ALS paramedic was in the back with the patient, but did not use their skills?’ I’ll try to sum it up with a table, assuming in each case there is an adverse outcome and where the treatment is given, it is given without due care and skill:
| The treatment is not given | The treatment is given | |
| The ambulance service | The ambulance service will be liable, it owes a duty to its patients and has failed to allow care to be given by a qualified person with access to the necessary equipment. Would need to be able to show that the direction was due to a legitimate risk assessment, not to try and avoid liability or remain within the terms of an insurance contract. | The ambulance service will be liable for the negligence of its volunteers. Irrespective of the Volunteers etc Act the patient would and could argue that the service is liable, in accordance with the common law, for the negligence of its agents. |
| The paramedic | The ambulance service will be liable – Volunteers and Food and Other Donors (Protection From Liability) Act 2002 (WA) s 6.
The paramedic may also be liable. He or she has taken on the care of the patient and his or her ALS skills cannot magically disappear. You cannot un-know what you know and you have access to the necessary equipment. It will be a question of what is their duty (given they are not obliged to volunteer) and whether it was reasonable to follow that direction. That in turn would be affected by the patient’s condition, how badly they needed the ALS intervention and the risk of giving the intervention v the risk of not giving it. |
May be liable if acting contrary to instructions Volunteers and Food and Other Donors (Protection From Liability) Act 2002 (WA) s 6 but that would depend on the exact terms of any instructions. |
The biggest legal risk has to be not giving the treatment (assuming that it is of critical importance). Allowing the treatment only exposes the ambulance service or the paramedic to risk if the treatment is negligently given. Vicarious liability is to ensure people injured by negligence get compensation. An employer who uses employees should not put those they injure to the further risk of looking to an employee for compensation when the employer is in a much better position to meet those expenses. All those arguments apply with equal force in this context. Without going through all the legal argument, I’ll go out on a limb and say in my opinion, absent gross misconduct, the ambulance service would be liable for its volunteers both if they give the treatment in question, and if they don’t.
So what of the paramedic? Well there could be liability if they negligently administer the ALS treatment and also if they don’t. Again the bigger risk has to be not giving treatment that you know is needed and where you have the necessary equipment at hand. Remember too, that if paramedics want to be recognised as professionals they have to act as professionals. To go back to my earlier question, a professional’s primary duty is to act in their patient’s best interests.
Would I just administer treatment using my ALS skills? I would if a person’s life depended upon it or to avoid permanent or long term disability; but short of that I would approach the service and begin negotiations to ensure that they have a system in place to recognise prior learning. If they are not prepared to do that, as a professional, one would have to rethink whether one was prepared to volunteer. You cannot simply ‘turn off’ what you know and what you can do (see also ‘Volunteer nurses and their skills’ (12 December 2012 https://emergencylaw.wordpress.com/2012/12/12/volunteer-nurses-and-their-skills/.
Australian Emergency Law 
Cheers for that .
Mike
Sent from my iPhone
Michael, it is my understanding that here in Vic, “the knowledge can be turned on and off” by the Service.
It has been well reported in Regional areas that highly trained MICA Officers are being used as Paramedics, but not MICA Paramedics due to funding.
Check this out: http://www.heraldsun.com.au/leader/north/macedon-ranges-paramedics-launch-a-petition-for-more-mica-positions/story-fnglenug-1226605617089
Am I confusing your blog with the issue in the linked report? Or are they two separate issues?
Luke, it is the same issue. To say they ‘weren’t able to practice in that capacity if they were not funded as one’ is to create the same problem. In the article you refer to it says ‘There is sufficient equipment at our stations’; that’s slightly different (but only slightly) to the case presented by my correspondent who said he had the equipment in the ambulance. If you’re at a job and need equipment you don’t have well you don’t have it; you can’t be expected to use gear you don’t have and my understanding at least from earlier discussion of the Victorian position was that the MICA paramedics were working out of ambulances that had a lower level of stocking. But if it’s there, you have the skills, you have the knowledge, you know the person needs it, you’re already in a position where you owe a duty of care then the argument ‘I didn’t do what I knew was required, in circumstances where I could have, to benefit the patient, because my employer told me not to and/or I wasn’t getting paid to do that’ isn’t going to cut it with any court. Either the paramedic’s negligent or the ambulance service is for not letting them do what they need to do in circumstances where they need to and can do it.
Now there may be good reasons not to give ALS care, perhaps whatever the treatment requires the presence of two ALS paramedics to monitor the patient whilst administering the treatment or whatever in which case, fair enough.
And the ambulance service is not required to have MICA paramedics on every job so they too may decide that one station has no MICA paramedics and a patient cannot complain that they did not get the MICA service. But if the person working at that station, on that night, is a MICA paramedic then he or she is indeed a MICA paramedic. To return to an earlier point, if the norm is that MICA paramedics don’t work from the station so advanced life support equipment (whatever that might be) is not there, then the MICA paramedic can’t use it and again, as an allocation of resources decision, that can’t be challenged in court; but if the gear’s there, the person’s trained etc, I just can’t get past the idea that ‘but they weren’t paying me’ is not a reasonable response to the question ‘so why didn’t you administer the treatment the patient needed?’
See also my earlier post ‘‘Just Ridiculous’? When is a MICA Paramedic a MICA Paramedic? (https://emergencylaw.wordpress.com/2013/03/28/just-ridiculous-when-is-a-mica-paramedic-a-mica-paramedic/) but in that post I said ‘First the paramedics could not be liable. They have to be negligent and they are not negligent for complying with their employers directions.’ The more I think about it the less convinced I am that that is true. I would have ‘a go’ at the paramedic – they have a duty to their patient, they know what the patient needs and they have the skills and resources to administer the care. Even then, however, I would stand by my view that ‘Even if they were negligent as employees it is there employer who must bear the liability’.
This in my mind raises three points firstly as you pointed out in your post how is someone expected to unlearn and switch off. Secondly and this goes with the first point when does an A.L.S. paramedic cease being an A.L.S. paramedic I would contend that they do not. Lastly should an ambulance service have a policy in place that goes against the very reason they exist that being to provide the best possible patient care again I contend that they should not.
What is not clear in this case is whether the A.L.S. paramedic was ever employed in a paid (career) capacity as an A.L.S. paramedic and allowed to practice at that level by this ambulance service, and then left but only to return in a voluntary capacity. If the answer to this is yes then I would say that in my mind this would complicate this A.L.S. paramedic’s position even further. I say this because this service would have a detailed history of the paramedic’s performance during his time as a paid paramedic because of continual clinical audits of their performance and mandatory continuing education and skills assessments. So I would find that compelling this A.L.S. paramedic to follow this policy as bizarre at the very least. As how can the ambulance service say on one day they are competent to perform at the level of an A.L.S. paramedic but not the next.
So where does this leave this A.L.S paramedic when they are attending to a patient I would contend that it would leave them in an unenviable position. If an A.L.S. paramedic is in an ambulance and has ready access to the equipment of an A.L.S. paramedic and is called upon to render care to a patient that requires those skills and intentionally withholds (because of service policy) those skills, and that failure brings about further harm or death occurs what would their position be then, this brings to mind a very similar question I asked back in 2011
https://emergencylaw.wordpress.com/2011/05/02/criminal-code-1913-wa-s-304/
I would say any reasonable person would expect someone who is in an ambulance and holds an A.L.S. paramedic qualification and has access to the equipment required to perform to that level would in fact perform to that level. Anything less would be an affront to quality patient care. I would say it is also an affront for an ambulance service to impose such a restrictive policy as it could be said reduce the patient’s chance of a complete recovery leading to a possibly long term reduced quality of life or indeed a tragic outcome that could have been reversed if the A.L.S. paramedic was allowed to practice to their level of competency
I agree with Dodge’s comments. Dodge raised the issue where a person, like my original correspondent, who tells us he is a ‘very experienced paramedic’ has been trained by the service for which he now volunteers. I can think of three situations:
1. Where the paramedic has no prior experience with the ambulance service. The service would need to take some steps to confirm a persons qualifications and experience but should have some process in place to recognise prior learning (RPL). In the absence of that RPL, if the paramedic knows that ALS equipment which he or she is trained and competent to use but which they are directed not to use, they would have to reconsider volunteering.
2.Where the paramedic has been trained by the ambulance service, no longer works there but has returned as a volunteer. This is Dodge’s scenario, described in his comment.
3. The third, and most bizarre scenario, is, as I understand it, what happens in Victoria where ALS paramedics volunteer to do overtime in other, non-ALS stations. Here the situation is not whether they have some record, here the person is an ambulance service employee, working for the ambulance service.
In scenarios (1) and (2) above there is a problem in that in my view failing to provide the care is not acting in ‘good faith’ so the volunteer protection legislation won’t apply. Providing the treatment is not following the services instruction so again it may not apply.
Scenario (3) doesn’t have that problem as the paramedic is an employee not a volunteer. As an employee the employer will be liable for any negligence. Further vicarious liability extends even if a person does an authorised act in an unauthorised way. It would depend on how one defined an ‘authorised’ act; here the person is being employed as an ambulance officer, they are employed and trained by the service, so their authorised act is to treat the patient, to provide first aid and emergency care. That’s what they are doing even if in an unauthorised way. I suspect the ambulance service would be liable if there was some negligence in the way the treatment is given; and would certainly be liable if ‘a patient that requires those skills and [the paramedic] intentionally withholds (because of service policy) those skills, and that failure brings about further harm or death occurs.’
I fail to see why an ambulance service would want to restrict patient care. Even if the station does not normally have ALS paramedics if, on this shift, there is an ALS paramedic that is surely a bonus. Like Dodge I fail to see why an ambulance service would want to have a policy that denied the best available care for patients.
This would all be much easier to resolve if paramedics were registered health professionals. Then the qualifications and authority is carried with them. Agencies that accept volunteers into their ranks would know what they could do and paramedics would be in a much stronger position to say that they must provide the treatment that the patient requires and that is within their scope of practice.
I’m curious to know what the stance is on this now that Paramedics are a professional registered body. Your statement of “This would all be much easier to resolve if paramedics were registered health professionals. Then the qualifications and authority is carried with them. Agencies that accept volunteers into their ranks would know what they could do and paramedics would be in a much stronger position to say that they must provide the treatment that the patient requires and that is within their scope of practice.”
My understanding is that Scope of Practice is still determined only by your employer and not by preexisting qualifications. For example Paramedics who have changed states are told they are unable to utilise any skills, protocols, pharmacology by their new employer. Nurses/Doctors/OS trained paramedics who are “RPL” are only fast tracked through to “Qualified Paramedic” (with all the restrictions that come with non-medical trainees or interns including limited medication administration rights, no authority to cannulate, no ECG’s etc…)
The question that comes up all the time is why can’t some of these be done under supervision? Much like a lot of health Departments, you often have those who are “independently qualified” to perform X skill but others come under “requires supervision” meaning they can do the skill but need to have supervision. That’s how doctors, nurses and many other health employees learn. They don’t have to be enrolled in a certain course to undertake it as it’s something they should learn as part of their job and so they get exposed to opportunities, some go on to study and obtain their formal qualification and some say no it’s not for me. Same could be argued for Paramedics. A trainee is working towards a qualified paramedic position. If you’ve gone through Uni it’s fine you have a full scope of a Qualified Paramedic under supervision, but if you’re going through vocational you’re told this is your scope and you are not allowed to step outside of it even if its supervised. Paramedic students on placements are “allowed” to perform under the scope of a Qualified Paramedic so I fail to understand how that does not apply either to trainees and Interns, or even to Qualified Paramedics working with higher skilled Paramedics. What defines the ability to perform skills under supervision vs an independent scope of practice and when it can be applied?
It was always explained to me when I first started working for Health, that “Scope of Practice” was about what you were authorised to do at your level with a degree of autonomy, and then there were other people in the role you’re in (whether training or not) and you are afforded the opportunity to learn on the job, get exposure to skills etc and be supervised in performing those skills as you personally have no authority to do it independently. Not being told it’s out of your scope for the next 24 months, then we’ll teach you and give you authority. Or, even though you do it in your secondary job (still under in health), you are not authorised to use that skill in this job even if it will save someones life as it’s out of your scope. In particular in my personal circumstances, I am employed as a RN in NSW Health and as a Paramedic in NSW Ambulance which now falls under NSW Health. One day I am employed as a RN I am authorised to do certain skills and give certain medications in accordance with NSW Health policies and standing orders (I work regionally/rurally so the Rural Emergency Guidelines are utilised), then, on the days I work as a Paramedic, I am told that I am not allowed to use the skills I have authorised to me under NSW Health (such as IO’s full cardiac arrest medications etc…). Now that National Registration applies to Paramedics, I am worried about where the liability lies. If in the rare and hopefully remaining hypothetical scenario where a patient requires an intervention I am trained under another department of NSW Health to do, but I’m working for this department today where they also have the equipment but no access to ICP or hospitals who could do the intervention. If I do it, I’ve been told direct from my employer that I’d lose my job (which would mean my house, impact on my family) and with Registration this is allegedly a “something they can report” so then I potentially lose not just one but both of my registrations. Or I do nothing, do not act outside my scope and hope like hell that the patient does not have an adverse outcome, and if they do, that they do not sue me. I feel that I would be negligent in some way.
AHPRA’s response to my quest for clarification was:
“Treating patients or clients in emergencies requires practitioners to consider a range of issues, in addition to the provision of best care. Good practice involves offering assistance in an emergency that takes account of the practitioner’s own safety, skills, the availability of other options and the impact on any other patients or clients under the practitioner’s care, and continuing to provide that assistance until services are no longer required.”
It refers me to the Professional Capabilities for Registered Paramedics which states “follow the Paramedical Code of Conduct”,
The Code of Conduct states: “Practitioners have a responsibility to recognise and work within the limits of their competence and scope of practice. Scopes of practice vary according to different roles; for example, practitioners, researchers and managers will all have quite different competence and scopes of practice. To illustrate, in relation to working within their scope of practice, practitioners may need to consider whether they have the appropriate qualifications and experience to provide advice on over the counter and scheduled medicines, herbal remedies, vitamin supplements, etc. ”
I hope I am never in that situation but it’s certainly something I feel will be questioned more and more, especially with graduate paramedics receiving more advanced training in University and only doing very short courses with Ambulance.
I’d be interested to hear your thoughts on this, based on reading this blog and now with National Registration in place whether things have changed in terms of Scope for paramedics.
Thank you
That’s a very long comment so I’m not going to try and address every point but in summary:
1. There are two concepts in scope of practice. One is what your employer says you can do, the other is what a registered health professional determines is in their scope. As professionals it is up to practitioners to understand their limitations so accept somethings are out of scope because they know they don’t have the skills, but also to undertake CPD and other training to expand their scope – see Scope of practice – previous posts explained (January 21, 2017).
2. The Paramedicine Board and the Nurses Board are not concerned with industrial matters (did you follow your employer’s instructions) but risk to patients. If you are a nurse and have relevant skills, then you have those skills regardless of what uniform you are wearing. What is the bigger risk to patient safety- not using the skills you have when equipment is to hand to save your patient’s life because today you are in a different uniform? Or using those skills even if for some perverse reason your employer has said ‘we’d rather the patient died’? You may be afraid you’ll be subject of a professional complaint as a paramedic because you used your nurse skills, but I think the risk is much, much higher that you’ll be subject of a complaint and rightly criticised by the Nurses Board for not acting when you could.
3. For further discussion on this and similar questions – see in Dual registered paramedics (November 27, 2018); Dual qualifications (October 18, 2018); Holding dual registration – EEN and paramedic (April 25, 2017) and all the posts here: https://emergencylaw.wordpress.com/?s=volunteer+scope+of+practice.
From a professional standpoint, one should really be asking about the validity of the skills in question. The writer may have a qualification, the real question that didnt appear to be addressed is whether that endorsement is actually valid and if so who has it been validated by and when ( the state authority or a private remote provider that doesnt have a relationship with the state authority). I have a truck drives licence, when did i last drive a truck and how well did I do?
If and when something goes amiss, these are the questions that will be asked, and i dont believe that hiding behind volunteerism will cut it.
A bit negaitve i know but that is why clinical goverance structures exist.
Jazz Mann, what you say is true but remember the person who originally posed the question said ‘I am a very experienced paramedic, currently working…’ In my concluding comments I said ‘I would approach the service and begin negotiations to ensure that they have a system in place to recognise prior learning.’ Certainly an organisation just can’t take someone’s word that they are competent particularly now when what is taught in paramedic courses, and who can call themselves a paramedic are all unregulated. It would be much easier if a person was a ‘registered’ paramedic as that would necessarily identify their core competencies. This is also the basis of Dodge’s comments that the situation was sillier if the service had in fact trained the paramedic who was now returning as a volunteer or, as I mentioned, the situation in Victoria where I understand it, Victoria Ambulance are restricting the practices of their own employees. So I agree that the question of ‘validity of skills’ is relevant, and if the original question had said ‘I was a paramedic 10 years ago and now want to volunteer…’ the answer would have focussed on that issue.
I don’t think anyone was ‘hiding behind volunteerism’ and the starting point of the question was that my correspondent has current ALS skills.
Just wanted to clear up a few questions. I am the author of this question. I use to work for the ambulance service in question as an ALS paramedic . I left the service to take a position running a remote clinic. I volunteer on my days off to keep my skills fresh in relation to 000 calls.