The Australian Health Workforce Ministerial Council is considering options to introduce national registration for paramedics. There are many reasons why paramedics should be registered and these, along with options for registration, are discussed in a consultation paper that was released this month (see AHMAC Health Workforce Principal Committee (HWPC) consultation paper: Options for regulation of paramedics (2012).) Submissions, in response to the consultation paper need to be received by 3 September 2012.
A part of the discussion paper caught my attention and is the subject of this blog post. On page 5, under the heading 1.2 Scope of this consultation paper the paper says ‘first aid volunteers (who are not qualified as a paramedic) are not considered to be part of the paramedic workforce.’
This comment is problematic. As noted in the discussion paper, there ‘is no standard definition of ‘paramedic’ in Australia’ (p 11). In the absence of a ‘standard definition’ it is at least arguable that first aid volunteers are paramedics. The discussion paper gives various definitions of who, or what is a paramedic. These include a person who:
‘provides intensive pre-hospital health care to injured, sick, infirm and aged persons and emergency transport to medical facilities’ (p 11, citing the Australian and New Zealand (NZ) Standard Classification of Occupations (ANZSCO)).
‘a health care professional providing medical assessment, treatment and care in the out-of-hospital environment. Paramedics respond to, assess and treat patients in emergency situations, transport them to a hospital for further treatment (if necessary) or arrange alternative treatment options (p 12, citing Paramedics Australia; http://www.paramedics.org.au/paramedics/what-is-a-paramedic/).
The tasks of ambulance officers and paramedics are described by ANZSCO as including:
- attending accidents, emergencies and requests for medical assistance
- assessing health of patients, determining need for assistance, and assessing specialised needs and factors affecting patients’ conditions
- performing therapies and administering drugs according to protocol
- resuscitating and defibrillating patients and operating life-support equipment
- transporting accident victims to medical facilities
- transporting sick and disabled persons to and from medical facilities for specialised treatment and rehabilitation
- instructing community groups and essential service workers in first aid
- attending public gatherings and sporting events where accidents and other health emergencies may occur
- ensuring that ambulances are adequately maintained and stocked with medical supplies, and that equipment is in good working order, and
- preparing written reports on the state of patients’ injuries and treatment provided.
In all jurisdictions, paramedics deal with life and death and make routine clinical decisions on a daily basis, often without knowing a patient’s medical or social history. Paramedics regularly triage, assess and clinically manage unconscious, incoherent or combative patients, sometimes in multicasualty situations. (p 12).
First aid volunteers, and in particular volunteers with St John Ambulance Australia may do all those tasks with the exception, perhaps, of ‘transporting sick and disabled persons to and from medical facilities for specialised treatment and rehabilitation. If that is true, they are paramedics.
The Discussion paper adds that:
As there is currently no uniform regulation of paramedics at a national level, a paramedic’s scope of practice is determined by employers and is not consistently defined. Employers are largely responsible for setting the levels of care to be provided, the skills required to be a paramedic and the protocols, guidelines and procedures that determine paramedic practice.
That may imply that paramedics are necessarily employees but that will be problematic given the use of honorary and volunteer paramedics across Australia.
St John Ambulance Australia (in its various earlier forms) was fundamental player in the delivery of early ambulance services and it remains an authorised provider of ambulance services. In NSW it is an offence to
(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 Director-General under this Chapter,
without the consent of the Director-General… (Health Services Act 1997 (NSW) s 67E).
St John Ambulance Australia (NSW) is specifically exempt from the application of this section reinforcing their right to provide ambulance services in New South Wales.
It follows that St John Ambulance volunteers perform all or nearly all of the duties of paramedics defined by ANZSCO, should not be excluded from the definition of paramedics simply because they are volunteers and are specifically authorised to provide ambulance services. It is therefore not clear why volunteers with St John Ambulance are not paramedics.
The aim of the consultation paper is to consider issues to do with paramedic registration including who should be eligible for registration. The starting premise, that ‘first aid volunteers (who are not qualified as a paramedic) are not considered to be part of the paramedic workforce’ presupposes the answers to the critical question of ‘what does it mean to be qualified as a paramedic?’ That is a question the discussion process should be identifying and it may be that first aid volunteers by virtue of their training and experience are, or should be, qualified as a paramedic.
In the discussion of the various options for registration it may be argued that the term paramedic should be reserved for advanced life support officers, with other titles such as First Aid Officer, or Emergency Medical Technician, for other levels of clinical skills. It may also be reasonable to think that a person who holds no more than a first aid certificate need not be registered, but today St John volunteers carry oxygen, defibrillators and emergency pharmaceuticals; they are not ‘mere’ first aiders any more than advance life support paramedics can be equated to the stretcher bearers of times past.
None of this may be an issue if the final result of the consultation paper is that the term ‘paramedic’ is limited to those with a three year degree in paramedicine. In that case first aid volunteers will not be paramedics and services, like St John, will be able to deploy volunteers, some of whom are first aiders, others of whom will be registered paramedics, nurses and doctors.
On the other hand, if the result of the consultation is that paramedics are necessarily employed, or meet some definition other than being ‘first aid volunteers’ then that may be problematic for St John. If that occurs, event organisers may determine that they need ‘paramedics’ to attend their event and provide health care. If, by definition, that does not include volunteers then St John may well be put behind other private ambulance providers who can claim to provide ‘paramedics’. St John ambulance may well be concerned to ensure that the ultimate result of the process is that the definition of paramedic does not exclude their well trained and professional, albeit volunteer workforce, and, more importantly, that other service providers cannot use the term paramedic in circumstances where St John cannot.
To do that the definition of paramedic should be identified by reference to an identified qualification or skill set so that St John volunteers who have the relevant qualification or can demonstrate the prescribed skills, can register as paramedics and to ensure that employees of private companies cannot use the term unless they too have the same qualifications or skill set.
19 July 2012
DISCLOSURE: Readers of this blog should note that I was a St John Ambulance volunteer from 1979 to 1988 and from 1994 to 1998. I served with the Ambulance Service of NSW as a probationary ambulance officer in 1988 and as an honorary ambulance officer in 1989 to 1990.
What this article fails to recognise or define is what constitutes a “St John Volunteer”. You refer to the NSW legislation but do not look at the complete operation if ambulance provision in relation to St John Ambulance “corporation”.
In NT and WA St John Inc is the sole provider of state/terrirory wide ambulance transport services under CONTRACT to the state and territory governents. St John Inc relies heaviily on 4 issues key to its operation:
1) Being a “bevevolent chartity or society” ad defined by the Australian Taxation Office
2) Funding in the form of donations from government, private businesses and donations
3) Volunteer labour
4) Autonomy and exclusive rights in its revenue raising enterprises (first aid training, sales, public events and commercial enterprise in providing ambulance services to public and private companies ie mining etc
In SA St John Enterprises was the sole provider of volunteer and paid staffing of ambulances for many years, however this has changed with a an operational co-enterprise with the SA state government.
It should be noted that not all regional areas especially in WA and NT do not have ambulance service response whatsoever. The townships of Nullagine and Marble Bar in WA are examples of this. St John comglomerate relies on the generosity of volunteer labour to staff ambulances – which the community has to purchase from St John Co – for coverage.
Many years ago St John Pty Limited were 2 distinct incorporated enterities – The St John Ambulance Association, the governing authority over public first aid training, provision of ambulance services and other communtiy services such as resprite care, community care, home visiiting etc. The other entity was the St John Ambulance Brigade, who were the uniformed volunteers that provide first aid services in public events, civil defence rescue, road side aid stations on highways, wartime field ambulance staffing for the military (yes, during WW1 a contingent of SJAB menbers went overseas with the AIF, a little known fact) provision of home nursing and hospital aides, unpaid uniform instructors on paid first aid courses, youth services and of course staffing ambulances in some metropolitian areas at nights and regional areas. STAB were set up along military lines with comandary, districts, corps, divisions and units complete with a military like rank and uniforms. Plus its own honours list similar to Knighthoods.
These people paid thier own money for the privilige to be apart of the St John Corportation in the faith and service of mankind.
So, in some ways, “St John volunteers” who staff ambulances under state contracting would be concidered “ambulance officers” as per various state acts. This could be transposed to the more community standard and egotistical word “paramedic”. The same word you recently highlighted as being not regonised under various acts of parliament. Now do we use this same word “paramedic” to describe a private provider or in house services such as military and mining industries one must ask?
I think a bit more research in this article you delievered in the defination of a SJACO volunteer as the role varies from state to state (and territory).
Endnote: An interesting fact would be the examination of the Victorian ambulance strike of the 70s when St John Ambulance Brigade volunteers crossed AEA picket lines and staffed Victorian Civil Ambulance Service ambulances and in 1980s the paid ambulance officers of SJA strike in SA and the assualt of volunteers that staffed ambulances. As well as examining the Patient Stretcher Transport industry in Victoria manned by retrenched Ambulance Service staff and other persons and the Craigieburn SES volunteers that ran an unauthorised first responder service in VICSES vehicles in the 1990s (All former SJAB Rescue members from Broadmedows division)- would they be paramedics as well?
Thanks for your comments; I do understand that St John provides ambulance services in WA and the NT and clearly those officers will be included in the ultimate Paramedic registration scheme; I was talking about what I understand is now called First Aid Services. I agree with you that ‘“St John volunteers” who staff ambulances under state contracting would be concidered “ambulance officers” as per various state acts. This could be transposed to the more community standard and egotistical word “paramedic”’ You then ask ‘Now do we use this same word “paramedic” to describe a private provider or in house services such as military and mining industries one must ask?’ and that is what is being debated, certainly the intention is that army medics will be included in the registration scheme, and I imagine mining industry staff are very much seeking to use the term ‘paramedic’.
My point was twofold, the first point is given the definition of paramedics that the consultation paper refers to, those volunteers already are paramedics. If the body running the scheme has said that ‘volunteer members of first aid organisations’ are excluded then it appears, to me, that they have already judged one of the very questions that they have to answer, who, or what, is a paramedic. Hence my question ‘Are St John volunteers paramedics?’
My other point was that if St John volunteers are excluded from the scheme that may be to the detriment of St John. It wont matter if a paramedic has a 3 year degree; St John volunteers with the relevant degree will be paramedics, those without will not; but if the test is some skill level, then St John volunteers may have the relevant skills and experience but may be excluded because they are volunteer members etc and that would seem irrelevant.
Equally there is a question of why they shouldn’t be registered, St John volunteers may have a significant impact on their patients so why shouldn’t they be registered, particularly in the circumstances you mention ie where the ‘St John comglomerate relies on the generosity of volunteer labour to staff ambulances’? In the interests of patient safety they perhaps should be registered but I would expect that they would be seen as volunteers for an ambulance service, not a first aid organisation.
Now we can infer that the reason they want to exclude volunteer members of first aid organisations is so organisations like that can still work, have volunteers and not need to have them registered which would, it might be thought, impose a burden on volunteers that would discourage them. But if St John can’t call itself a ‘paramedic’ service (or ambulance service) that may put it in a disadvantage to other providers which is a shame given St John’s long history in this field.
I don’t have a view but it’s my job as a lawyer to point out that even well intentioned statements may have unintended consequences. Here they are intending, I’m sure, to put volunteers at ease by excluding them, but is that a good thing; hence my question ‘Should they be?’
Great topic Michael.
To Geoff: the term “paramedic” is becoming the worldwide standard occupational title for a registered pre-hospital health professional. I understand that it sounds American-ised and egotistical to some Australians but it is probably the most accurate term for what we do.
I would say that the registration process should be removed from the applicant’s employer. A paramedic should be expected to have a particular and defined level of training and experience. They may then practice in a volunteer or a paid capacity. Either way, their patients are then assured of the level of care being provided. Who a paramedic works for should have no bearing on their skillset; it is up to the registered practitioner to maintain their skills and knowledge.
Registration also provides for enhanced labour mobility for paramedics.
Michael you raise some really interesting points. I’ll start out by saying that I was heavily involved as a St. John Volunteer for many years before being employed by a state ambulance service as a “Paramedic” (I’ll also add that I probably wouldn’t be where I am today without my St. John background.) The key problem as you’ve stated is there is no formal accepted definition of what a Paramedic is, it is not legally defined and protected like the title Registered Nurse (Health Practitioner Regulation National Law Act 2009). So at the moment anyone is legally entitled to call themselves a Paramedic even the beauty technician providing “paramedical” skin treatments- I’m sure we would all baulk at that whether volunteer, salaried or otherwise. Whilst it may be legal, do I think this is necessarily right? No I don’t. I am sure the public would not want an individual running around calling themselves a Lawyer, and offering legal advice to someone who thinks they are getting advice from a fully qualified legal practitioner. I think the crux of the issue is that with certain titles goes an expected level of knowledge, responsibilities and indeed a level of service.
Don’t get me wrong I have a tremendous amount of respect for the largest majority of St. John Volunteers you only have to look at the world class out of hospital cardiac arrest survival rates at places like the MCG to know that they can provide an outstanding level of clinical care and make a massive impact in quality of life for patients. To steal a quote from a friend and fellow volunteer “You don’t have to be paid to be professional.” That being said with the scope of practice, drugs, and interventions today’s salaried paramedics have I think there needs to be a legally protected title for ambulance professionals. Does the title have to be the “egotistical term Paramedic (as described by Geoff)?” I couldn’t give 2 hoots what it is, Ambulance Officer, EMTP, Medic whatever- however given that the Statutory Ambulance Services around Australia seem to have adopted the term Paramedic it makes sense to use that.
With the move to degree based entry to Ambulance Services largely complete it makes sense to have a degree as the minimum level of training required to register as and call yourself a Paramedic. Will that mean a person employed in a mine site or a someone not employed by an Ambulance Service can call themselves a paramedic? Yes it does. It doesn’t bother me who a person is or isn’t employed by or who they volunteer with as long as they have the appropriate level of training ie a Bachelor degree (or recognised industry equivalent), and can meet the competency standards and ongoing professional development requirements of registration as a “Paramedic” (when registration occurs that is!).
Do I agree with Volunteer Ambulance Officers calling themselves Paramedics? No I don’t this is not to say that I don’t admire them and have the utmost respect for the many un-renumerated hours they put it. Indeed communities in regional outlying areas would be far far worse off without our amazing dedicated volunteers. When I volunteered with an Ambulance Service there is NO WAY I would have wanted to be called a paramedic I feel it would have created a level of expectation that I simply couldn’t or wasn’t permitted by the guidelines to meet. The same goes for when I was a St. John Volunteer.
To sum up I think there should be a legally protected title to describe what I do for a living with the requirements for registration similar to those I described above. Should St. John Volunteers be able to use whatever this title is? Not if they don’t meet the requirements above.
As per usual you ask the pertinant question here is my take on the matter if a St John volunteer only provides first aid coverage then I would say the correct term for those volunteers could be an emergency responder as seems to be the case in both the United States and Canada. I would also like to point out that in the United States in particular as to whether they should continue to be called paramedics or use some other title.
But the overall aim of having paramedic registration if I not wrong is to have in place a framework to allow for portability of qualifications and for the proper protection of patient righs in complaint resolutions. I for one think this is long overdue, but the question concerning the term that should be used to describe volunteer ambulance officers as well as those emloyed in the mining sector, and, as Geoff also pointed out in the military. I think the military question has already been solved as they have always been termed medics.
On the question of the mining industry they have been known (in Western Australia) simply as medics or as emergency service officers. The only problem i see is as you pointed out Michael what to do about those volunteers who perform the functions of an ambulance officer in a voluntary capacity. I would also like to add one more so called spanner into the works what do you term a career paramedic who volunteers for St John ambulance as this does happen. I have been a long term volunteer ambulance officer for St John and from my perspective that is the term we should be known as. As for paramedics who volunteer for St John that would as I see it depend on whether they are performing the funtions of first aider or paramedic. But Geoff’s reply seems to be a diatribe of I.R. and unionising the debate of the main thrust of your question (and detracts from your original question)I don’t care on what has happened in the past what i care about is what is to happen in the future.
So should volunteer St John first aiders and volunteer ambulance officers be included i would say yes as the service they provide goes beyound that of voluntary rescue, in that these personnel are providing a service that is usually charged for and as such the public should be safe in the knowledge that they have in place a forum for complaint resolution and that the personnel meet the requirements for registration, and the volunteers should also be safe in the knowledge that they have the protections that registration would provide. And to alay the egos of career paramedics again the volunteer St John first aiders should simply be known as emergency responders and St John volunteer ambulance officers should be known as volunteer ambulance officer with the mining and military sectors be termed as i have already pointed out as emergency service officers and medics.
At the risk of sounding like I’m bashing volunteers, I am not sure that the content of this paper should even be considered in the Paramedic Registration debate.
I find it both interesting and frustrating that the focus of this article seems to be based largely on the definition of a “job” in relation to what a paramedic should be, rather than the focus of a Paramedic as a Health Care Professional.
While a lack of regulation of the industry and specifically, the title of Paramedic, has led to the situation that is found now – there are so many reasons why this Registration model needs to be done correctly the first time.
My personal opinion is that the ability to provide a holistic health care model, with the best interest of the patient at the forefront of any treatment and referral regime is what Paramedics need to be building on.
The model of providing a treatment regime based on a book of treatments prescribed by a Doctor, in an environment largely dictated by Medical Dominance is one which needs to be consigned to the shredder.
At the current time, this is the only model that can be employed, and has been, in large part – brought about by the necessity to have quality controls in place to ensure best practice, in the absence of a broader, overarching regulatory mechanism.
Over time however, the ability of the individual to increase their level of clinical skillsets or interventions, underpinned by a comprehensive knowledge base – has emerged as the minimum standard expected from a paramedic entering the workforce, be it public or private sector.
with such broadening options for paramedics across sectors other than just that of the traditional frontline emergency response systems provided to the broader community under State Government based systems (including subcontractors ie: WA, NT) – there is much more scope to provide a larger range of care.
Considerations of specific qualifications such as ALS, Intensive Care, Community Care, Extended Care Practitioner, Retrieval Paramedic etc are roles which are emerging for the now, but what of the future? Industrial Paramedics have been mentioned in responses to this paper, and my own opinion is that this is a model which needs to be explored more wholly, given the ability of this role to cover so many varying levels of intervention ie: remote area, Primary Health Care, Emergency Medical AND Trauma Response, Rehabilitation….the list goes on, but it comes back to one specific driving or motivating factor – dollars.
In this day and age, it would be cost prohibitive to employ a doctor to work in a remote area 24/7, and it could be argued, a waste of skills. The ability to provide an appropriately educated, trained and maintained paramedic at circa 1/3 of the cost makes much more business sense, not to mention the recruitment and retention issues that are overcome by broadening the ability to employ across a more suitable employment pool.
As someone who has had a background with St John, Public Sector Ambulance, and a Private Sector Paramedic Provider, I can understand why there will be so much angst in the debate of “who” should come under the jurisdiction of an AHPRA based registration model.
One thing that my 3 hats has taught me in my short 13 year career however, is that a St John Volunteer, who has an “advanced first aid, oxygen, Analgesic Gases and Defibrillation” certificate, is not a Health Care Professional.
I’m not sure you understood my point. The paramedic consultation process has to determine who it is that fits the definition of a ‘paramedic’ as there is, currently, no binding definition. If you adopt the definition given by the Australian and New Zealand (NZ) Standard Classification of Occupations (ANZSCO) then arguably St John volunteers are paramedics. That definition is very much based on what paramedics do, rather than what qualifications they hold.
It’s true that paramedic practice is changing and that is fundamental to the debate on registration. Paramedics are no longer restricted to the employees of state based ambulance services. They are practising in a wide range of areas, but we’re still not sure who it is that fits the definition of a ‘paramedic’.
To define the term, to know who we are talking about, then a definition is going to have to be adopted and I anticipate that will come if registration is accepted. If what I’ve said, above, is correct, then on one view at least, St John volunteers are paramedics (hence my question) but that leads to the second question, ‘should they be?’ On one view they should be regarded as paramedics as they are out there, providing care to people who may not be able to distinguish them from their local ambulance service (and in the NT and WA they are part of the same organisation drawing a distinction still between the ambulance service and first aid services) so patients should get the same protection and quality assurance. On the other view, the one you’ve expressed, the first aid volunteer is ‘not a health care professional’ and should not be included in the system.
That is the issue that I sought to raise, so I’m not sure why you think ‘the content of this paper should even be considered in the Paramedic Registration debate’. I think it’s essential, in the paramedic registration debate, to define what we mean by ‘paramedic’.
As I mentioned in my previous reply if St John Ambulance volunteers are providing a service and let’s call it first aid for hire then in my honest opinion that goes beyond the term voluntary rescue and (and in W.A. and the N.T. providing remote ambulance services) should be part of the registration process.
I do not think they should be broadly termed Paramedics, my sugestion is term these volunteers as they do in say Canada where they are emergency responders which is the bottom tear of the E.M.S. system. But again if an organisation provides a user pay system, then the people providing that service should be registered.
I am a highly experienced and well qualified registered nurse. I am also a divisional Nursing Officer for a St John branch in QLD. Nationally, St John does train to paramedic level, in some states, we run the ambulance service. In Queensland, we are currently introducing the certificate IV ambulance officer course and are looking at bringing the Diploma in paramedicine from WA branch.
We would never however advertise someone as a paramedic without them being credentialed as such.
However, having recently started the skills mapping to be recognised as a paramedic based on my experience and skills, it is evident to me that St John Advanced Responders (AR’s) and Ambulance Officers (AO – cert.IV) hold most of the same skill set as paramedics are required to, and therefore the question stands that should these people be allowed to be credentialled as paramedics? If we can prove we have the same knowledge and skills, and provide any additional training required to meet and maintain this skill set, then shouldn’t we be allowed recognition for this in the form of being able to register as paramedics?
St John Australia is an evolving 21st century emergency and pre hospital care provider. Our volunteers practice in line with our ethos “In the service of humanity”, and deserve formal recognition at federal level for the knowledge and skills we posses in order to fulfil our service to the community.
Thanks for that input and you’ve identified the problem nicely; the discussion paper on paramedic registration says ‘first aid volunteers (who are not qualified as a paramedic) are not considered to be part of the paramedic workforce.’ At the recent forum I attended I asked why would they exclude volunteers, to which the response was ‘but are they qualified as paramedics’ but we don’t know if they are qualified as paramedics because, at this stage of the discussion, we don’t know what paramedic means; that has to be defined. As you say ‘We would never however advertise someone as a paramedic without them being credentialed as such’ but at this stage there is no indication or set of credentials to say who is ‘credentialed as such’. If the concept of ‘paramedic’is defined by a skill set, and you’ve told us that ‘that St John Advanced Responders (AR’s) and Ambulance Officers (AO – cert.IV) hold most of the same skill set as paramedics are required to’ then they are, or perhaps should be, considered as part of the paramedic workforce and registered as such – whether that is the case or not is something that the consultation process needs to address. My concern was that by excluding people who they identify as volunteer first aiders, even before the consultation process began, the process may inadvertently rule out a group of people that should be ruled in, and do so without the appropriate discussion. If, at the end of the process, a paramedic is defined as someone with a three year degree, not an ‘AO – cert IV’ then St John volunteers wont be paramedics although there will be paramedics who volunteer for St John (just as there are doctors and nurses who volunteer). It is my view however, and you’ve clearly shown why it is important, that the discussion needs to be had. It is not axiomatic or self evident that ‘first aid volunteers’ (given the range of training and skills that they may have) are not, by virtue of their volunteering, qualified as paramedics or shouldn’t be counted as such. That is the discussion that needs to occur so the qualifications and skill sets that are appropriately included, or excluded, from the registration process can be identified.
I have been following the debate for many years now. I also wonder why Australia is, once again, reinventing the wheel. I work overseas and all these issues have been sorted years ago. Paid or unpaid has no bearing on skills. When i work for free in some countries along with doctors, do we drop our title?, no. Not that we use it. Ego seems to be driving this along with big, big dollars. Lets not forget a lot of ambulance services make huge dollars and are private. Look up what a not for profit group does with its profits. Look at the cars the directors drive and the houses. I am off track… Ok, there is an international standard already. EMT-B, EMT-I and EMT-P to name a subset. These are skill and training based. Basic, intermediate and paramedic. National registration, exems and skill demonstration. From what i have seen, the real story behind the scenes is about money and protection of contracts. fact!
I have heard it said many times.
Yes there is protection of patients etc. and rightly so.
Come on Australia, just get an off the shelf product from overseas and stop playing.
Don’t believe its really about money, Do some company searches.
There are so much evidence i have to support my case and conversations.
Should i mention that a grandfather clause was issued some years ago for St Johns W.A. Ask if the degree in Edith Cowan University is a recognised degree…no. Is the masters degree recognised…NO same for some other universities. (I have this all in writing)
As for me, i change slides depending which service i am working for, paramedic, combat medic and ambulance officer. EMT-P overseas.
It should be said, all members on the comittees should declare their financial involvement.
Please excuse spelling, i am fighting a phone here.
Michael, I love your book on emergency law and your articles over the internet. As always, you are switched on to the subjects. I would love to provide more information here, however, i would need a lawyer to defend it. I am happy to stick with my international quals from the U.S.
I have not read all the responses however there are 2 simple points to untangle.
1. The Skill and Practise of Paramedical Skills and therefore the Title should not be restricted by employment by a certain body. This would be a restriction of Trade. It is not so in nearly every Western Country.
2. Is a ‘Paramedic’ employed by a State Ambulance no longer a Paramedic if he is a St Johns Volunteer in his time off.
If Registration of Title is to exist it must also come with Freedom of Employment.
Thanks, Ian, for your comment. An essential argument for paramedic registration is that it will allow Freedomof Employment as employer will know what ‘paramedic’ means and health agencies can Licence paramedics as they do nurses and doctors so your right to administer drugs won’t depend on your employers certification but is something you’ll carry with you.
My question, posed in this post, is about whether paramedics need to be ’employed’ at all. The discussion paper puts volunteers outside the discussion, my point being that’s premature. Deciding who is a ‘paramedic’ is an essential part of the discussion.
Once you have registration, a registered paramedic will be a register paramedic, just as a nurse is a nurse and a doctor a doctor whether they are at work or not. That does not mean you have to be apply to ap
Ly the full range of clinical skills in any situation. If you’re not at work you won’t have ‘the gear’ but ou will have your knowledge. So a paramedic who’se employed buy a State ambulance officer is a paramedic when volunteering for St John or when at the movies with his or her kids, just as they are now.
A very stimulating debate indeed.
As one who wears many hats, including volunteering for St John, I can not stress enough how important it is that St John volunteers are included in any registration efforts. They train to use equipment and medicine that is potentially dangerous in the hands of someone who is not as well trained or knowledgeable in its use. Having said that, should they be paramedics? No. The equipment they use is designed to be quickly trained on and have little room for error and the medications selected for St John volunteers tend to have a wide therapeutic index. This is all for a reason.
Whilst it is commendable the amount of knowledge a first aider needs to have in order to use said equipment and drugs, and even a little bit of why, that knowledge does not measure in any way to the level of a health care professional as far as exactly how those drugs work, or what that piece of equipment is really doing. A first aider operates to a set of protocols for this reason. Paramedics (I’m using state ambulance authority paramedics for the sake of this example) utilise guidelines however, with a firmer grasp on exactly what is happening and how we can apply that to other conditions, ailments or situations to improve outcomes.
Eg, I would expect a first aider to know that GTN opens up the blood vessels and that it is given to angina patients. What I wouldn’t expect them to know but I would expect a paramedic to have some understanding of is Frank-Starling’s law of heart contractility, the effect of GTN on venous blood pooling and the subsequent O2 demand reduction secondary to reduced preload, and the mechanics of this. This would allow a paramedic to utilise GTN in a number of extra scenarios other than just the patient with known angina. This shows a clear extension of the paramedic skillset over what St John has to offer.
Yes, on paper and through job definitions, St John first aiders do the same as paramedics but with first aiders we lower the goal posts, shorten the field, provide a lighter ball, etc. We essentially expect less knowledge, less skill, less responsiveness to diversity but we accept this for what it is because it still significantly improves patient outcomes. So in summary, no, I do not believe St John first aiders are paramedics.
As I said though, I do believe there is a need for regulation of this level of skill set, and at the risk of sounding hypocritical because at this stage of the discussion, I do not believe we should be discussing exclusion criteria before we have established any inclusion criteria but I have personally witnessed organisations whom can’t even operate (or at least claim to) at a first aid level without being exceedingly dangerous. I will enjoy seeing these groups tidied up by regulation and recourse for belligerently poor practice.
As for inclusions of paramedic, I’d like to remind of the many hats I wear and then start by saying this; One of the things that has never ceased to amaze me about paramedic practice is how quickly self confidence develops. This is because paramedics operate outside the rest of the health system. Team work does not exist beyond the pond of ambulance work (excepting for jurisdictions that occasionally utilise medical retrieval teams) and this causes a paramedic to become self dependent, self confident… self righteous.
I hate to say it but the negative byproduct of rapid self confidence can be and often is arrogance. Paramedics today are massive fish in puddles. There is a single goal, and that is to get a patient to hospital alive. If the patient has an ankle injury, and they arrive to hospital alive, well now the paramedic is an expert in ankles. I pause here to recognise that at this point it is potentially sounding a bit offensive but bare with me to the bedrock of my point. Now, these things are not on purpose, they’re usually subconscious developments over time. I fell into the same trap. But when we become this self confident we forget that there is more to learn and more to know. But knowing what you don’t know is in itself an exercise in retrospectivity. And by definition, prejudice is bias based on lack of understanding.
So it is alarming to many, at the thought of opening their pond to new ponds and new fish. Deep down we all to some extent think “If you weren’t trained with us you can’t possibly be as good.”
Embrace the unknown. Take on the challenge of becoming moderately sized fish in a lake. It is a massive world of health, knowledge and learning out there if we accept that there are other ways to become a paramedic. Paramedics can not pride themselves on their diversity of practice and at the same time take offense to the concept of diversity in experience, education and paths to the title ‘paramedic.’
If a St John volunteer with 12 years of experience dealing with emergency patients at the MCG, Royal Shows or other major events does a paramedic degree then why the heck shouldn’t they have the title? They might not be as good as you are at it but instead of holding that over them, teach them something. They could learn a lot from you and vice versa I’m sure. We shouldn’t be punishing the person who is doing their best with what they have to become the best that they can be. We should be punishing the person who takes the half arsed approach to some cash or self satisfaction and doesn’t mind putting lives at risk through belligerent and continuously dangerous practice.
Let’s just not be so paranoid as to the security of our own little ponds (and they are tiny, trust me) to start with exclusion criteria. We all know people we would rather not see gain the title paramedic but that thinking prevents us from making smart, impartial decisions on what is best for the industry. Remember, if you want to continue being a group of civil ambulance technicians, regardless of what you call yourselves or how often you change the title on your velcro chest patch then keep the status quo. Forget a register, forget professional registration.
But if you want a true register of the health professional then you need to be ready to open your doors to people you don’t know and didn’t expect to be there. People who know more about research than you but less about the paediatric patient. People who know more about winch operations than you but less about COAD management. More about a the Steyr Aug assault rifle or foreign diplomacy or who can speak multiple languages or who know the nutritional needs of schoolage children in the congo but wouldn’t know a hare traction splint from a press to talk button or who thinks a Category Bravo is a job bloody well done.
Lets be a little more excited and a little less hostile. We are trying to forge a nation first. Lets do it right, and do it for the right reasons.
I tend to agree with brad. I’m not as eloquent with my words but at the end of the day it’s about the best treatment for the patient. It seems to be something lost in the argument. You know your anatomy and physiology, your pharmacology and have an authority to practice at a particular level, then what’s the issue? Why dose it mater if its a state authorisation, St. John’s or any number of health dept authorised private providers. Patent care is really the only mandate. Having said all that, I have seen some pretty shoddy personalities in the events and mining industry over the years who love titles. And I’ll include some state service employees in this statement. Registration is not the begin all or end all but at least is a start as I have seen great bull artists slip through the cracks over the years. Are St. John’s volunteers paramedics? Well if they are then any tradie with a first aid certificate is also a paramedic. So in my mind if you work within the confines of a first aid certificate wether senior, applied, remote, advanced or any other first aid title. You are a first aider. It’s really that simple. If you have earned a certIV in ambulance/paramedic, diploma, adv dip or deg in paramedic science then you are a paramedic of obviously varying levels and authority. It’s really that simple. Forget the ego it’s about the patient, and its the duties within the codes of conduct and in every paramedic text that every paramedic is duty bound that if patient care is being compromised that he/she must step in and hold that person compromising to task. Regulation seems like the answer but there are mechanisms already available, only courage to act is lacking in my humble opinion.