This question comes from a paramedic but I’m not sure in which state or territory.  My correspondent says:

I work for an emergency ambulance service in Australia. Our ambulances are fitted with 2x stretchers and 2x rear facing seats. On many occasions we will be transporting a patient to hospital and get asked via Comms if we can attend a second case (with a patient on board). This would often involve the driver assessing the patient, bringing them back to the ambulance and transporting 2 patients to hospital at any one time.

Also, the smaller stations that only have 1 ambulance may be dispatched to MVA’s that have multiple patients, since being the only ambulance in town we are expected to transport all or as many patients as we can (2x stretcher and potentially a seated patient).

My question is, does this impede on each individual’s confidentiality by transporting 2 different people? My assumption is that you can ask patient 1 if they consent to picking up another, however patient number 2 cannot be asked prior to your arrival. In the past I have had to transport a head injured patient and a post-ictal patient at once from difference scenes, also 2x patients from an MVA which included the driver who caused the crash with another patient injured.

There is no right to privacy in Australia – see Simpson’s Solicitors, No Privacy Tort For Australia… Yet, 21 March 2013 – but there are state and federal privacy laws. These laws relate to government agencies and how they collect, store and use private data (see Privacy and Personal Information Protection Act 1988 (NSW) and Privacy Act 1988 (Cth)).

Because I don’t know from which jurisdiction this question comes, I’ll refer to the Commonwealth Act.   The Australian Privacy Principles set out in Schedule 1 to the Act deal with:

Australian Privacy Principle 1–open and transparent management of personal information

Australian Privacy Principle 2–anonymity and pseudonymity

Australian Privacy Principle 3–collection of solicited personal information

Australian Privacy Principle 4–dealing with unsolicited personal information

Australian Privacy Principle 5–notification of the collection of personal information

Australian Privacy Principle 6–use or disclosure of personal information

Australian Privacy Principle 7–direct marketing

Australian Privacy Principle 8–cross-border disclosure of personal information

Australian Privacy Principle 9–adoption, use or disclosure of government related identifiers

Australian Privacy Principle 10–quality of personal information

Australian Privacy Principle 11–security of personal information

Australian Privacy Principle 12–access to personal information

Australian Privacy Principle 13–correction of personal information

As I say, they’re really about how an agency deals with the information it’s collected rather than the situation described here.  Here it would be a breach of the principle to take a history from Patient 1 and turn to Patient 2 and say ‘did you hear that – he reckons …’    In any event compliance with the Principles requires an agency such as the ambulance service to ‘take such steps as are reasonable in the circumstances to …’ to comply.   Where an ambulance service is faced with multiple patients and limited resources that has to be considered when determining what is ‘reasonable’.

As for confidentiality, people do have a right to expect that their treating health practitioners will keep their confidences.  For a conscious patient they can understand that their conversation may be overheard but an unconscious patient or one who for whatever reason can’t form that understanding then clearly there is an impact on their ‘confidentiality’.  Whether they like it or not Patient 2 will be in a position to learn something about Patient 1 either by overhearing the conversation or simply observing them, their injuries and the treatment being give.

Paramedics are unregistered health professionals.  New South Wales, South Australia and Queensland have a code of conduct for unregistered health professionals and there are moves to introduce a national code (see Victorian Government Health Information, Regulation of Unregistered Health Care Workers, June 19 2015; see also COAG, A National Code of Conduct for health care workers 2014).   The draft National code of conduct (at p 44) says:

Health care workers to comply with relevant privacy laws

A health care worker must comply with the relevant privacy laws that apply to clients’ health information, including the Privacy Act 1988 (Cth) and the [insert name of relevant state or territory legislation]

Commentary:

The purpose of this clause is to make clear the legal requirement that applies to all health care workers to comply with relevant state and territory privacy laws that protect the privacy and confidentiality of client information.

This clause is based on the NSW Code (Clause 14) and the South Australian Code (Clause 13)…

That does not add much, particularly if I’m right and the Privacy Acts don’t deal with the situation described in the question.

Compare this provision to the provision contained in the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia (March 2014).  It says (at [1.4]) ‘Patients also rely on their doctors to protect their confidentiality’.  This is given further weight at [3.2] where the code says:

A good doctor–patient partnership requires high standards of professional conduct. This involves: …

3.2.3 Protecting patients’ privacy and right to confidentiality, unless release of information is required by law or by public-interest considerations.

We’re not talking here about the ‘release’ of information or the ‘right to confidentiality’ but clearly the patient is not enjoying the sort of privacy they may hope for.

The risk to privacy is not however unique to the ambulance.  People in public hospitals including ED waiting areas, treatment areas where there is just a curtain between the beds and public wards all face the same dilemma.   Their conversations may be overheard and other people can observe them and their treatment.

The problem is that it may be ideal to have a separate ambulance, and a separate room for each patient but this is not feasible.  We simply cannot afford to resource our health and emergency services to that extent.  We can’t staff each ambulance station just in case there is another Kempsey bus crash in their area (this was an accident on 22 December 1989 that involved 2 coaches and claimed 35 lives and injured 41).   Because of that there will always be cases where paramedics, doctors and other health professionals have to treat multiple casualties at the same time with the impact that must have on each person’s privacy.  But that impact is unavoidable in those cases.

Discussion

To return to the question, does transporting more than one patient ‘impede on each individual’s confidentiality’ and the answer is that it must do but that does not make it unlawful or unreasonable.

Clearly if resources are available to avoid that outcome it would be better to use them but where those resources are not available everyone has to make do with what there is.

Although some paramedics may say they feel like they are operating a taxi service, the reality is that they are not.  It follows therefore that I do not think you ‘can ask patient 1 if they consent to picking up another’ or you can ask but their answer doesn’t determine the matter.   Patient 2 may require more immediate or urgent care than Patient 1.  In any event it is the ambulance service that is allocating the resources not the patient.   Patient 1 really doesn’t get a say but, having said that, the paramedics have a duty to protect patient 1 so they could and should advise the coordination centre whether they think it is appropriate to take on another patient.  For example if patient 1 is a teenager who has just been violently sexually assaulted, a paramedic would be acting appropriately to tell the communications centre that they cannot collect a patient who requires transfer for medical treatment at the same hospital due to the clinical needs of their first patient including the need to protect their privacy and deal with their no-doubt fragile state.  If you are ‘asked … if [you] can attend a second case’ then it has to be the case that sometimes the answer is ‘no’.

As for transporting two people from the same accident or worse, fight, the issue is not so much one of confidentiality as risk management.  If they are going to start, or continue an argument inside the ambulance that is a risk to both patients and paramedics.   But, again there could be a case where they have conditions requiring urgent attention and there really is no alternative.

With regard to the question of resources, it should be recalled that the risks could be addressed by having more paramedics and ambulances on the road but as suggested above, it is unrealistic to have enough to deal with every possible event – if we did many would spend much of their working day doing nothing.  But whatever is the optimum level of resourcing a person cannot sue a government on the basis that it should have allocated the resources in a different way, that is putting more money into ambulance services at the expense of some other government project (see Graham Barclay Oysters Pty Ltd v Ryan (2002) 211 CLR 540; Civil Liability Act 2002 (NSW) s 42).  It is not negligent to not be able to provide one ambulance per person even if it is axiomatic that to do so would enhance patient privacy.

Conclusion

Does transporting two patients in the one ambulance ‘impede on each individual’s confidentiality’?  The answer must be ‘yes’ but in some cases that will be the only option.  To do so creates no more legal issue than treating a patient in a public ward or other place where things may be seen or overheard.