This question comes from an event first aid provider in South Australia.  My correspondent is required to:

  … look at “high risk” event bookings that come into the organisation and review the relevant regulations, assisting us to determine what resources we need to supply to comply with the regulations (and more importantly the clinical needs of the competitors).

One of the major issues I have found when reviewing these is that many regulations appear poorly worded, with seemingly little understanding of the differences in clinical scope of different personnel. I have included some of the more obvious regulations for you to see what I mean.

2015 SA Conditions of Rallying

http://sarally.net.au/wp-content/uploads/2015/01/SA-Conditions-of-Rallying-2015.pdf (2.9.a Safety)

  • One or more of the following must be provided, must be incorporated in the safety plan, and must be stationed appropriately.
  1. First Aid Accredited person
  2. Medical Intervention Vehicle
  3. St John Ambulance Medical Vehicle (equipped to the highest level available in the region where the event is being held)
  4. Ambulance

Per this regulation, you can provide anything from a solitary first aider (with no mention of a vehicle) to an ambulance (I assume they mean staffed with 2 paramedics but it doesn’t say).

Pony Club Association of SA

http://www.ponyclub.asn.au/files/documents/rule-book/3eventing.pdf

 2.3 MEDICAL A doctor should be present at least during the Show Jumping and Cross Country phases. If it is impossible to obtain the services of a doctor, the minimum alternative is for a current holder of a Senior First Aid certificate to be present. Fall check list to be used by first aider in the event of a fall of rider. (form can be found at rear of this rule book) An ambulance or designated vehicle properly equipped from the doctor’s or first aid personnel’s resources must be in attendance during jumping events.

 Per this regulation a doctor is recommended – but if “impossible to obtain” then a first aider is acceptable. Almost all pony clubs are not able to/will not pay for a doctor to be present.

 Australian Speedway

http://speedwayaustralia.net.au/uploads/Australian%2BSpeedway%2BRacing%2BRules%2B%26%2BRegulations%2B-%2BSeptember%2B2015%2B%28Final%2Bin%2Bamendment%2Blines%29%2BRHYS%2BCHANGE%2BFINAL.compressed.pdf (3.3.3)

 3.3.3 At any Race Meeting or Event, the minimum requirements are (for practice sessions for Sprintcars & Speedcars, Refer to Rule 3.3.5):

(a) Regular Race Meeting standard quantity of fire extinguishers and fire crew

(b) Race Meetings and official practice sessions require:

* a minimum of two (2) first aid personnel (paramedics, ambulance service, doctor or qualified first aid personnel);

* a station wagon capable of transporting minor injury cases; and

* an appointed person equipped with an operative mobile phone and supplied with the phone number of the nearest road transport ambulance service.

(c) It is compulsory that an approved State Service road going ambulance is present at all Sprintcar & Speedcar Race Meetings and is highly desirable at all other Race Meetings.

3.3.5 For all Sprintcar and Speedcar Drivers, minimum safety requirements for practice are:

(a) a minimum of two paramedic personnel or persons with a current first aid certificate issued by St John Ambulance Australia;

(b) suitable trained, attired and equipped fire fighters;

(c) a station wagon or vehicle capable of transporting minor injury cases;

(d) an appointed person equipped with an operative mobile phone and supplied with the phone number of the nearest road transport ambulance service;

There is a large difference between the capabilities of paramedics, a doctor and first aiders.

When it comes to determining what level of medical coverage is required, I’m interested to know where a medical provider stands in the event of regulations being so non-specific or varied and determining liability in the event of an incident?

Using the 2015 Conditions of Rallying SA as an example, sending a first aider along without a vehicle is in my mind completely inadequate to deal with a high speed accident that might occur 10km from that person on a country road. But this would seemingly still meet the regulation.

I do believe that it is an important one as inadequate regulation or interpretation of them by providers may cause patients competing in various high risk events to be receiving insufficient medical coverage. Through personal experience involved in these discussions every day, club organisers often have very little knowledge of the regulations and when confronted with a choice of either paying for a health professional (doctor/paramedic) or a first aider they usually only want the cheapest option they can get away with without understanding the clinical reasons behind it. It is always somewhat of a balancing act to satisfy the customer, comply with regulation and provide a sufficient level of coverage to ensure competitor safety.

Let me first deal with some issues of language. As a lawyer, I think of a ‘regulation’ as a subordinate piece of legislation.  That is the parliament passes an ‘Act’ but the Act can’t deal with all the details so they authorise someone, the Governor, a Minister or a public official to ‘make regulations’ to fill in the gap.  There is a formal process to make a regulation and when it is made it has the force of law.

But regulation includes more than just formal laws.  According to the Oxford dictionary (online) regulation means ‘A rule or directive made and maintained by an authority’.  In this case the authority can be the Pony Club or speedway association.  What they have is a regulation but if it’s not made as subordinate legislation, it is not ‘law’ more like ‘club rules’.   I assume the regulations cited above fit that description.

What that means is the regulations don’t bind the event first aid provider, they bind the event organiser.  That is it is the organiser who has to plan (which requires actually thinking about the issues) and ensure that the requirements of the regulations as well as the needs of participants, are met.  Hopefully the prudent organiser would take advice from the event first aid provider as to the difference in skill levels and the risks involved in their event.

I would suggest the regulations are written the way they are so as not to be too prescriptive as prescription can impose obligations that can’t be met or are unnecessary or that are insufficient.  The answer here is that it’s all about risk assessment.  Who’s competing? What’s the event? Where is it?  In some cases a first aider may be sufficient or the best that can be achieved, in other cases it won’t.

The event first aid provider’s obligations must be:

  1. Do a risk assessment and form an opinion what skill level is required.
  2. Communicate with the organiser and work with them, and their own risk assessment, and come to an agreement as to the level of care to be provided.
  3. If there is a disagreement the event provider must consider whether it will cover the event considering the potential needs of patients and their own staff. If the event first aid provider thinks paramedics will be required, but the organiser only wants to pay first aiders, you have to think ‘what will be the impact on our first aid team if they face the injuries that we think are foreseeable and likely and have to try to deal with those injuries pending the arrival of the state ambulance service?’  If it is unreasonable to put first aiders into that position, then you may have to refuse to provide cover.
  4. On the other hand, you may consider that participants will be better off with some cover, rather than none, and that the social benefit of being there to allow the event to run is sufficient. That may well be true for a small event in a country town where the cost of bringing paramedics from some other town will be prohibitive.

Conclusion

In my opinion whether the level of cover meets the requirements of the event organiser’s parent body is a matter for the event organiser, not the event first aid provider.  The event first aid provider must consider whether the level of skill that the organiser wants to engage is sufficient to deal with the foreseeable risks.  If it is not, then the event organiser should advise the event organiser, and consider whether they are being allowed to operate to the professional standard that they think is appropriate.  If they are not, or if they think the risk to participants or their own staff is too great, they should consider withdrawing their services.