Ray Bange from Paramedics Australia has brought the findings of D H Mulligan, a coroner in Western Australia to our attention.  Coroner Mulligan was conducting an inquest into the death of a young girl who overdosed on ecstasy at the 2009 “Big Day Out”.  Coroner Mulligan’s findings were handed down on 8 March 2013.

On that day the only medical services were provided by St John Ambulance volunteers.  The Coroner was impressed by their services but noted that the trained first aider who treated the young woman, was not a paramedic, doctor or nurse and did not have access to a registered health professional for assistance.  Nor had he been given specific training on recognising the symptoms of overdosing on various types of drugs.  This was not a criticism of him, but it was a criticism of St John Ambulance.

The interesting observation, for readers of this blog, was the finding that the event organisers had employed paramedics to assist staff and performers.  The Coroner said:

Whilst I have referred to these paramedics as paramedics, it is important to appreciate that there is no definition in Western Australia as to what a paramedic is or what qualifications or experience a paramedic needs to have before he or she can properly be referred to as a paramedic.

The paramedics supplied by the owners of the Big Day Out, had no powers under Schedule 8 of the Poisons Act 1964 to dispense medications and there was no guarantee that their qualifications or expertise met the standard legitimately expected by the Western Australian public, of those who use that title and who respond to emergencies in our State.

The Coroner reviewed the medical arrangements for the 2013 Big Day Out and was impressed by the higher level of care, the use of paramedics, nurses and doctors as part of the St John Ambulance response and the cooperation between the employed, even paramedics and the St John team.

The Coroner noted that under 2009 Guidelines issued by the Department of Health on the preparations for events such as the Big Day Out there was a requirement to have paramedics on scene, but he noted that there is no definition of what is a paramedic or what qualifications a paramedic may have.  He said:

In my opinion, there needs to be a State based definition as to what a paramedic is, so that organisers of events such as the Big Day Out, together with the general public, can have confidence in the abilities of those who are protecting their medical interests at large scale public events.

Coroners can make recommendations on steps they think should be taken to reduce the risk of future deaths. Coroner Mulligan recommended that

… the Director General of Health consider creating a definition of ‘paramedic’ and that he considers a form of registration that will ensure that only appropriately qualified people are entitled to use the title of paramedic and to be able to practise in Western Australia as a paramedic.

In the manuscript for the next edition of Emergency Law (Federation Press, 4th ed, forthcoming) Michael has written:

Paramedics are not registered health professionals so nowhere is it definitively said what paramedics can or cannot do or even what the word ‘paramedic’ means. In New South Wales, until December 2007, the term paramedic was reserved for level V intensive care paramedics; everyone else was called an ‘ambulance officer’. On 3 December 2007, the Ambulance Service announced that from that date forward, “our highly qualified ambulance officers will now be referred to as paramedics” (‘New uniform same excellence in care’ Ambulance Online Summer 2007-08 ).    There was no change in the law, no change in role or duties; they became paramedics simply because the ambulance service decided that they would now be called paramedics. Humpty Dumpty said ‘”When I use a word…  it means just what I choose it to mean — neither more nor less” (Lewis Carroll, The Complete Alice & The Hunting of the Snark (Jonathan Cape, 1986) 201) and in the absence of professional registration, the term ‘paramedic’ means whatever the person using it wants it to mean.

For the purposes of this discussion the term ‘paramedic’ will be used to mean anyone who claims to have special, advanced life support or first aid skills and who wishes to use the term…

It is known that the Australian Health Ministers’ Advisory Council, Health Workforce Principal Committee is considering options to regulate paramedic practice including registering paramedics under the same law as doctors and nurses (read the discussion paper, here).  Hopefully the Coroner’s recommendation will add to the argument that such registration is in the public interest (see also Michael Eburn and Jason Bendall, ‘The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics’ The Journal of Emergency Primary Health Care: Vol. 8: Iss. 4, Article 4).

Michael Eburn and Ruth Townsend

25 March 2013.