The Paramedic Observer is reporting that a bill has been introduced to the Victorian Parliament to amend the non-emergency patient transport legislation. You can read the Observer’s full report at https://www.facebook.com/ParamedProf or on my Facebook page at https://www.facebook.com/EburnM. I won’t repeat the post in full as there is no point reinventing the wheel and Ray (the Paramedic Observer) has done a good job reporting on the Bill’s contents.
Ray does say:
The Bill updates the NEPT Act 2003 (Act) by making patient safety and quality of care a central tenet of the legislation, strengthening compliance and enforcement of the existing licensing system for NEPT service providers, and introducing licensing and regulation of the commercial first aid sector.
He also says that the Bill:
• restricts the use of the term ‘paramedic’ in business names, titles or descriptions when providing NEPT or first aid services
The restriction on the use of ‘paramedic’ has been the subject of comments on both his and my pages. A comment that captures the discussion says:
The restriction on using the term Paramedic is a joke. Who are they to dictate this? If a service/company has Paramedics then this is not misleading anyone. I’m concerned that they are making this a ‘first-aid’ for events system, and not catering to a higher clinical level offering.
Another comment, via Facebook says:
It would be good for the government to rate event medical companies capacity. With defined levels of cover. From First aider HLTAID003 (old code used to promote understanding) with tackle box (chair optional) to team medical Australia TMA who roll in a prime mover stacked with everything. The reality is resources should be tailored to risk and hazard.
I’ll look into the Bill in a bit more detail to address those issues. Before I do that it is worth referring to previous posts – see
- Regulating first aid services in Victoria (April 17, 2019);
- Report on regulating first aid forum – Melbourne (May 16, 2019); and
- Discussion paper on licensing of first aid providers in Victoria released (July 2, 2019).
The critical part of the Bill, for this discussion, is the new ‘Part 2A – Licensing first aid service operators’ that will be inserted into the Non-Emergency Patient Transport Act 2003 (Vic) or, as it will be known after the Bill is passed, the Non-Emergency Patient Transport and First Aid Services Act 2003 (Vic).
First aid is ‘aid of a medical nature provided to a person experiencing sudden illness or injury’. A ‘first aid service’ is ‘a service of offering or providing first aid in exchange for payment’. Specifically excluded from the definition of a first aid service is ‘a volunteer first aid association, including any individual who provides first aid as part of that volunteer first aid association’. A volunteer first aid association is:
a group of individuals working together for one or more community purposes that—
(a) offers or provides first aid in the course of its work; and
(b) does not charge or expect payment or financial reward for the offer or provision of first aid in any circumstances.
An organisation like St John Ambulance Australia (Vic) depends on volunteers but that does not necessarily make it a volunteer first aid association. The critical issue is not whether the members are volunteers or not but whether the organisation is offering its services on a voluntary basis that is without charge or expectation of payment. If the service charges a fee, or makes it clear that it expects a donation, that will take it outside the scope of a volunteer association.
Also excluded from the definition of a first aid service is and ‘an individual who encounters by chance a circumstance that appears to require the provision of first aid and who provides that first aid.’ This is a positive step to ensure that no-one should hesitate to provide emergency first aid where that is required for fear that they do not hold an appropriate licence. A person who has done a first aid course can still do first aid.
Use of the term paramedic
A new section 58 will say:
It is a condition of any Part 2 [Non-emergency patient transport] licence or Part 2A [first aid service] licence that the holder of the licence must not use the word “paramedic” or any related name, title or description as part of the title or description of the service.
It is an offence to provide a first aid service without a licence (s 42I(1)) but that does not apply to ‘a person or class of person whom the Governor in Council has declared to be a person or class of person to whom subsection (1) does not apply’. A provider that employs only paramedics or other registered health professionals, nurses and doctors may well argue that they are providing a paramedic, or nursing or medical service, not a first aid service and are not bound by the licensing requirement. Further the government could recommend to the Governor that regulations are made to exempt paramedics and other registered health professionals from the need to have a first aid licence. If such an argument was successful, or an exemption granted, then the prohibition in s 58 would not apply.
Tiers of service
With respect to a licence, it is to allow the licence holder to provide a ‘particular class or particular classes of first aid service’ (s 42L(2)). Nowhere in the Bill is there a definition of what the classes are or will be or even who can define the classes. Section 42V will say:
A first aid service licence is subject to any conditions—
(a) that are prescribed; and
(b) that the Secretary imposes on the licence or on the class or classes of service authorised under the licence.
It would appear that the definition of the class or classes of service will be a matter for the secretary to determine as part of setting licence conditions.
The Review of the Non-Emergency Patient Transport Act 2003 and Regulation and Licencing of First Aid providers: Discussion Paper (June 2019) at p. 25 suggested:
… a three tier licencing system for first aid providers. Suggested terminology for the tiers is:…
Basic Care would be for those providers who only use over-the-counter medications and provide basic first aid…
Intermediate Care would be for more complex first aid provision. The purpose of Intermediate Care includes the stabilisation of patients until emergency ambulance arrives to transport the patient to hospital, or for a friend or family member to drive them to the nearest emergency department. At times, schedule 4 medicines will be appropriate for this purpose…
Advanced Care would cover complex and emergency first aid provision. Administration of schedule 8 medicines is an issue to be considered for the Advanced Care tier…
It could be that the secretary will define the class of first aid services to exclude paramedic and other professional services but that seems unlikely. If one is going to use schedule 8 medication and provide complex first aid, that is likely to involve medical and paramedical practitioners.
It follows that there is both an argument that a service provided entirely by registered health professionals is not a first aid service and there are provisions to specifically exempt such a service from the licensing requirement. It would appear however that such an interpretation was not intended to be applied and the purpose of the scheme is to licence all ‘aid of a medical nature provided to a person experiencing sudden illness or injury’ regardless of the qualifications of the person providing it so whether they hold a first aid certificate or a degree in medicine or paramedicine, if they are going to offer a medical service at an event, they need a licence so it is unlikely the secretary or governor will move to exempt registered health professionals from the scheme, even though they could.
The discussion paper says (at p. 33):
It has been proposed to the department that the use of the term “paramedic” in a company name should be prohibited. This approach would mirror the Ambulance Services Act 1986 that prohibits the use of the words “ambulance service” on vehicles and in company names. It would also help to remove patient confusion or misunderstanding about when a paramedic is actually attending to them. It would be reasonable for a member of the public to assume that if a company name includes the word “Paramedic” and the vehicle has that name written on its side that they will be attended by a paramedic. Such misunderstandings are unhelpful and potentially undermine paramedic practice.
To return to s 58 it does say that it is an offence to use ‘the word “paramedic” or any related name, title or description as part of the title or description of the service’ (emphasis added). It does not say paramedics cannot be identified as paramedics. It means the service cannot be Emergency Event Paramedic Service. But it does not mean that Emergency Event Pty Ltd (a fictitious company name not meant to refer to any actual event first aid provider) cannot tell potential customers that they can provide paramedics or that the paramedics cannot have the word ‘paramedic’ on their jackets. It’s more complex to have the word ‘paramedic’ on the vehicle (see Use of the term ‘paramedic’ on an ambulance without a paramedic crew – Victoria (September 28, 2020)) and a first aid service provider (and an NEPT provider) certainly cannot have the word ‘ambulance’ on their vehicle (Ambulance Service Act 1986 (Vic) s 39(1)).
Discussion comment 1
The limit on the use of the word paramedic is in the title or description of the service. It is true that the legislation is aimed at creating ‘a ‘first-aid’ for events system’ but the proposed tiers do include or anticipate ‘a higher clinical level offering’. A licensed first aid service cannot be described as either a ‘paramedic’ or an ‘ambulance’ service, but it can be staffed by paramedics who are identified as paramedics. Different providers will be able to distinguish themselves by reference to the class of first aid services they can provide (once those classes are defined).
Discussion comment 2
As noted above the discussion paper anticipated three tiers of service. The Act provides for a class or classes of first aid services permitted under licence. An Act is a directive from the legislative arm of government (the parliament) to the executive arm of government (the Minister, the Department and in this case the secretary) giving broad powers but not setting out the details. The fact that the ‘class or classes’ of first aid services is not defined in the Act is not unusual. It would appear they will be defined by the Secretary as part of the process of issuing licences rather than being set out in a regulation.
It does mean we cannot know exactly how the system will be develop but we can see from earlier papers that it is intended that the ‘government [will] rate event medical companies capacity’ and that will include:
…defined levels of cover. From First aider HLTAID003 (old code used to promote understanding) with tackle box (chair optional) [basic care] to team medical Australia TMA who roll in a prime mover stacked with everything [advanced care].
Requiring event organisers and first aid service providers to ensure ‘resources …[are] tailored to risk and hazard’ was the intention behind the discussion paper. How the secretary will give effect to that stated intention once the Act has passed remains to be seen.