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.