This from a paramedic in NSW:

I was hoping you could help me out in regards to a question I have concerning Ambulance Services within Australia (Specifically NSW) and the requirement for a Medical Director.

With Paramedics currently not being a registered profession our authority to practice is derived from our organisations. Each service has its own version of protocols/clinical practice guidelines that are authorised by the organisation. In NSW our protocols use to be approved by our Medical Director. In recent years our Medical Director has resigned and with the publication of our latest version of protocols they are signed off as being authorised by ‘Executive Director Clinical Governance’ and as being maintained by ‘Clinical Governance’. My question is, ‘Do Ambulance Services/Organisations within Australia require a Medical Director’?

I am not insinuating that there is any deficiency with the clinical care within the ASNSW, on the contrary in recent years the ASNSW has established a number of clinical advisory groups to help guide practice. Is a individual head, such as a medical director required from a legal perspective.

Before sending you this email I reviewed some legislation. The Health Services Act 1997 does not refer to medical oversight of paramedic practice; neither does the now superseded Ambulance Services Act 1990.

Your advice and guidance would be appreciated as always.

As noted the practice of paramedicine is unregulated. With respect to the Ambulance Service of NSW the Health Services Act 1997 s 67B says that it is the Director General of Health who is responsible for operating the Ambulance Service of NSW though the operation can be delegated to “a committee, board or other body” (s 67AB) so the DG doesn’t personally have to run the ambulance service. Not surprisingly, the Parliament having charged the DG with responsibility for running the service has not set out in detail how that is to be done. There is an Ambulance Service Advisory Council (s 67C) but it does not have any provision regarding a medical director.

The first answer is that there is no legal requirement for the Ambulance Service of NSW to have a single medical director.

As for private providers, in the absence of the s 67E I could buy myself an ambulance and start an ambulance company. With s 67E it is an offence to operate an ambulance service “without the consent of the Director-General and except in accordance with such conditions (if any) as the Director-General may from time to time impose.” Equally if an ambulance service wants to use scheduled drugs they need to obtain an authority from the Director General under the Poisons and Therapeutic Goods Act and its associated Regulations. Under those provisions the Director General could insist that there is a suitable level of medical supervision as a condition of the approvals.

The second answer is there is no obligation upon a private ambulance provider to have a medical director unless that is required as a condition of their approval to conduct the service and/or carry and use scheduled drugs.

Michael Eburn.