I suspect this correspondent wants to start a business. He or she says
I know you have discussed various legislation and regulation that covers Private Ambulance Services, but these tend to imply a transportation service. My question relates to a Private Paramedic Service that does not transport…..
An example would be Expedition Medicine.
Groups that undertake expeditions in to remote or difficult areas might want to employ the services of a trained Paramedic who can provide emergency pre-hospital care. This wouldn’t necessarily include transport, it would most likely involve life saving procedures and/or invasive procedures such as IV access for fluid therapy and of course appropriate drugs.
Repatriation would most likely be left to the appropriate government agency, for example a state ambulance service, but in remote areas this may be delayed.
My question is how can this operate? Is there legislative provision, in any state, for such a service to be set up by a private company or individual. How can authority be gained to administer medical procedures or drugs that a Paramedic would normally be trained in, without the usual authority that is gained by employment through an ambulance service?
Putting aside, for one minute, the use of drugs.
If you are in WA or the NT go for it. There is no legislation.
If you are in South Australia, you cannot operate an ambulance service without a license (Health Care Act 2008 (SA) s 60). But an ambulance service, in that State, is ‘service of transporting by the use of an ambulance a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment’. If my correspondent does not intend to transport persons the he or she is not providing an ambulance service and s 60 is not applicable.
In SA a person cannot be described as a ‘paramedic’ unless the person holds the prescribed qualifications (Health Practitioner Regulation National Law (South Australia) Act 2010 (SA) Sch 2, cl 120A and Health Practitioner Regulation National Law (South Australia) Regulations 2010 (SA) r 11A).
In Queensland ‘A person … is not to directly or indirectly imply that the person provides or participates in providing ambulance transport without the approval of the Minister and except in accordance with such conditions (if any) as the Minister may impose’ (Ambulance Service Act 1991 (Qld) s 43). My correspondent is not intending to provide ambulance transport so there would be no offence contrary to s 43.
In Victoria it is an offence to claim to have any relationship with or be part of Ambulance Victoria or to use the word ‘ambulance’ or ‘ambulance service’ (Ambulance Services Act 1986 (Vic) s 39). It would be easy for my correspondent to avoid using ‘Ambulance’ in any business title and ensure that there is no suggested link with Ambulance Victoria.
In New South Wales the Health Services Act 1997 (NSW) s 67E says:
(1) A person must not:
(a) directly or indirectly provide or take part in the provision of transport for sick or injured persons for fee or reward, or
(b) conduct for fee or reward any operations similar to the operations carried on by the Health Secretary under this Chapter,
without the consent of the Health Secretary and except in accordance with such conditions (if any) as the Health Secretary may from time to time impose.
My correspondent is not proposing to provide ambulance transport so s 67E(1)(a) does not apply but it is arguable that s 67E(1)(b) does as the Ambulance Service of NSW will provide on site emergency medical care if requested and paid to do so.
In any event a person cannot use the title ‘paramedic’ in New South Wales unless he or she holds the prescribed qualifications or is an authorized employee of NSW Ambulance (Health Services Act 1997 (NSW) s 67ZDA; see also What are the prescribed qualifications for a paramedic in NSW? (January 20, 2016).
In Tasmania, the Ambulance Service Act 1982 (Tas) s 37 says:
A person shall not provide ambulance services similar to the services provided by the Commissioner under this Act without the written consent of the Commissioner and except in accordance with such conditions (if any) as the Commissioner may from time to time impose in relation to the provision of ambulance services by that person.
Ambulance Services are ‘the work of rendering out-of-hospital clinical care to, and the conveyance of, persons suffering from illness or injury’ and it certainly sounds like that is what my correspondent intends to do.
It is an offence to use the title ‘paramedic’ in Tasmania unless a person is an employee of Ambulance Tasmania and holds the appropriate qualification or is otherwise approved under the regulations (Ambulance Service Act 1982 (Tas) s 3AB).
In the ACT it is unlawful to provide ambulance services without permission (Emergencies Act 2004 (ACT) s 63). Ambulance services are ‘the provision of medical treatment and pre-hospital patient care, and includes the transport of a patient by ambulance or medical rescue aircraft’ (s 60). The use of the word ‘includes’ shows that transport is not an essential part of ambulance services, that is transport is part of ambulance services, they are ‘included’ in the definition. Even so the provision of pre-hospital patient care without transport is sufficient to meet the definition.
Conclusion so far
- You can operate as a private emergency health care provider:
- In WA and NT;
- In Queensland and South Australia provided you are not providing ‘transport’;
- In Victoria provided you do not use the word ‘ambulance’ or claim any affiliation with Ambulance Victoria;
- In NSW provided you are not providing services ‘similar to the operations carried on by the Health Secretary’ that is by New South Wales Ambulance.
- You cannot provide ambulance services, without permission, in Tasmania or the ACT.
- You cannot use the title ‘paramedic’ unless you hold the prescribed qualifications in South Australia, Tasmania and New South Wales.
As I’ve noted earlier paramedicine is a largely unregulated field and there is no law to stop a person providing ‘life saving procedures and/or invasive procedures such as IV access for fluid therapy…’ provided they know what they are doing. The key issue is drugs. It is unlawful in every state to use, carry or administer scheduled drugs. The key drugs in emergency medicine may be listed in schedules 2, 3, 4 or 8 of the Poisons standard.
Each jurisdiction has a process to allow authorities to be granted to relevant people or organisations to allow them to use scheduled drugs in accordance with their training (see for example, Poisons and Therapeutic Goods Regulation 2008 (NSW) Appendix C).
So if my correspondent wants to use ‘appropriate drugs’ he or she would need to contact the relevant Health Department and determine what they require in terms of training, clinical control and security and apply for the relevant authority to possess and administer the drugs that were ‘appropriate’.
Think how much easier it would be if paramedics were registered? As part of their registration they could have the authority to carry ‘appropriate drugs’ so anyone who wanted to provide this sort of service need only employ a ‘registered paramedic’ and it would be clear what drugs they could use and carry.
It would be clear to any client what service they could provide as they could call themselves a ‘paramedic’ and the client would know that only registered paramedics could use that title (unlike the situation now in WA, NT, Victoria, Queensland and the ACT where anyone can call themselves ‘a paramedic’ or Tasmania where only employees of the Ambulance Service can use the title).
As my correspondent has noted; many of these issues have been raised previously. See for example:
- Use of artificial airway by a sports volunteer March 14, 2016
- Carrying scheduled drugs interstate January 28, 2016
- Alternative ambulance providers in WA January 24, 2016
- What are the prescribed qualifications for a paramedic in NSW? January 20, 2016
- “Stereosonic 2015: Paramedic company gags staff from talking to police after woman dies” December 1, 2015
- The use of scheduled drugs by volunteer Ambulance Officers in Tasmania. November 16, 2015
- Carrying and using Methoxyflurane and other scheduled drugs in NSW October 3, 2015
- Protecting the title of paramedic in NSW June 3, 2015
- Victorian state registration of paramedics November 4, 2014
- Protecting the title of Paramedic (South Australia) October 2, 2014
- What is a paramedic’s ‘authority to practice’? August 19, 2014
- St John (NSW) and Schedule 2 drugs April 1, 2014
- Legislative compliance for WA Paramedics – what legislation? February 12, 2014
- Ambulance Service Amendment Act 2013 (Tas) January 24, 2014