Following my post ‘What’s an ambulance’ (May 28, 2017) I was asked ‘what’s an ambulance service’. My initial response was to quote the article I wrote with Dr Jason Bendall- ‘The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics’ (2010) 8(4) Australasian Journal of Paramedicine Article 4 (see the comments at the end of the ‘What’s an ambulance‘ post).
I’m now asked:
Who licences the ambulance service in ACT, or elsewhere for that matter? What are the criteria and standards? My question is related to the upcoming national registration of paramedics and continuing Paramedicine course accreditation. If paramedics and universities need to be registered or accredited (which I support), wouldn’t it be logical to ask that those providing ambulance or paramedic services also be required to meet some sort of standard and be accredited in some way. There are many paramedic service providers in Australia. This requirement has been established in England where a number of ambulance trusts have been put on a watch-list for failing in some areas of the standards.
There is indeed an argument that not only should paramedics be registered, but that those entities that provide ambulance services, however defined, should also be subject to some sort of accreditation for example accreditation by the Australian Council on Health Care Standards.
At the moment there is no legal obligation for that sort of accreditation or even licensing for many services that might be described as ambulance services. This is particularly true for ‘event health providers’ that is people who provide emergency medical services, ranging from basic first aid to advanced paramedic care, at public and private events such as sporting and entertainment venues.
State and territory ambulance services
The state/territory Ambulance services in all jurisdictions, other than the Northern Territory and Western Australia, are created by statute. They are not ‘licensed’ by anyone but are managed by the relevant department which, in some states, is the Health Department in others the department charged with managing emergency services.
Most state ambulance legislation provides for quality assurance mechanisms to be applied to the state ambulance services.
Non-government ambulance services
Who ‘licences’ private ambulance services depends upon which state or territory you are in.
With respect to the use of scheduled drugs, it is the health department in each state or territory that has to grant relevant authorities to allow paramedics to use and carry scheduled drugs, but that is not the same as licensing ambulance providers.
Western Australia and the Northern Territory
In these jurisdictions, there is no ambulance legislation so no-one licences ambulance services in those jurisdictions.
Australian Capital Territory
In the ACT (Emergencies Act 2004 (ACT) s 63):
(1) A person commits an offence if—
(a) the person is not approved by the Minister under this part to provide emergency, ambulance, firefighting or rescue services; and
(b) the person provides emergency, ambulance, firefighting or rescue services.
Note the ‘comma’ between ‘emergency’ and ‘ambulance’ that is the section does not say it is an offence to provide ‘emergency ambulance’ services, rather it is an offence to provide ‘emergency’ services (akin to the State Emergency Service) and ‘ambulance’ services (akin to ACT Ambulance).
The term ‘ambulance services’ means ‘the provision of medical treatment and pre-hospital patient care, and includes the transport of a patient by ambulance or medical rescue aircraft’ (Emergencies Act 2004 (ACT) Dictionary).
It follows that the Minister is the relevant licensing authority. To their credit, the ACT publishes all the relevant authorities and you can see who has been authorised and the conditions of any authorisation on the ACT Legislation Register (http://www.legislation.act.gov.au/) – see the various Emergencies (Service Provider) Approvals listed under ‘notifiable instruments’.
New South Wales
As noted in the earlier post, 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.
Now the licensing authority is the Health Secretary. As also noted in an earlier post (see Changes to ambulance legislation in NSW – about time too! (August 24, 2015)) this will change with the commencement of the Health Services Amendment (Ambulance Services) Act 2015. When that act commences, approval will only be required to provide emergency ambulance services. Non-emergency patient transport will not require a licence so anyone will be able to start an NEPT service. The department will only get involved if someone complains about the service.
The Ambulance Service Act 1991 (Qld) s 43 says:
A person, other than the chief executive or the commissioner, 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.
In that state, the licensing authority is ‘the Minister’ (no doubt delegated to the relevant Department) but is only required where the service is providing ‘ambulance transport’.
The Health Care Act 2008 (SA) says:
(1) A person must not provide emergency ambulance services unless—
(a) the services are carried out by SAAS; or
(b) the services are provided by a person or a person of a class, or in circumstances, prescribed by regulation; or
(c) the services are provided under an exemption granted by the Minister under this Part.
An ‘emergency ambulance service’ is (s 3):
an ambulance service that—
(a) responds to requests for medical assistance (whether made by 000 emergency telephone calls or other means) for persons who may have injuries or illnesses requiring immediate medical attention in order to maintain life or to alleviate suffering; and
(b) is set up to provide medical attention to save or maintain a person’s life or alleviate suffering while transporting the person to a hospital;
An event first aid provider may respond to requests for medical assistance as set out in (a) above, but if they are not transporting the patient to hospital, they are not providing an ‘emergency ambulance service’ and don’t need the Minister’s approval.
A person must not provide ‘non-emergency ambulance services’ unless the person holds a restricted ambulance service licence or has an exemption from the Minister (s 58). Again, the Act and its regulations deal with the standards to be met by a licensed NEPT provider.
Non-emergency ambulance services are any ambulance services other than an emergency ambulance services. Ambulance services means ‘means the 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’ (s 3). The critical part of the definition is that it involves transport to hospital by ambulance (and an ambulance is ‘a vehicle that is equipped to provide medical treatment or to monitor a person’s health and that is staffed by persons who are trained to provide medical attention during transportation’). An emergency health care provider does not need approval if they are not transporting the patient to hospital, or even if they do transport the patient, they do so in a non-modified or standard vehicle (see Police v Zammitt  SASC 37).
Ambulance services in Tasmania means ‘means services relating to the work of rendering out-of-hospital clinical care to, and the conveyance of, persons suffering from illness or injury’ (Ambulance Service Act 1982 (Tas) s 3): Section 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.
Further (s 37A):
A person must not provide non-emergency patient transport services unless the person –
(a) holds an NEPT licence; or
(b) is providing the service as part of the Ambulance Service.
NEPT licences are issued by the Secretary of the Department, so to the extent there is a licensing scheme the authority is the Secretary for NEPT providers. Again, the Act sets out the various requirements that must be met by NEPT licence holders. The Commissioner of Ambulance Tasmania is the ‘licensing’ authority for other ambulance services but only to the extent that the service provided is ‘similar’ to the service provided by Ambulance Tasmania.
In Victoria, the term ‘ambulance service’ means ‘means an ambulance service created under section 23 or listed in Schedule 1’ (Ambulance Service Act 1986 (Vic) s 3). It is an offence to use the term ‘ambulance service’ or ‘ambulance’ without the approval of the Secretary of the Department. That means a person or company who provides ‘ambulance services’ but doesn’t use the term ‘ambulance’ is not breaching that regulation. It follows that an ‘Event First Aid Provider’ does not need to be licensed or regulated.
Non-emergency patient transport providers are indeed licensed and regulated by the Secretary under the Non-Emergency Patient Transport Act 2003 (Vic). That Act and its regulations provide details of standards to be met by a licensed NEPT provider.
There is no simple answer to ‘who licences the ambulance services in Australia?’ Statutory ambulance services in every jurisdiction other than WA and the NT aren’t ‘licensed’ they’re created by statute and run by the government. The passage of the relevant statute is, if you like, the licence or authority to act.
For non-state providers the degree of ‘licensing’ varies. For NEPT providers in Tasmania, South Australia and Victoria there is a well developed licensing scheme. For other providers of ambulance services the degree of regulation and therefore the need for a licence varies from none in WA and the NT to not much in Victoria to quite extensive and perhaps more importantly, transparent in the ACT.