I have been contacted by a person involved in organising outdoor music festivals in Victoria who has asked a number of questions regarding legal issues.  Some of them are too complex and too specific to answer here, but the issues of general interest I’ll comment on.  I’m told:

I work with a number of outdoor music festivals in Victoria and we constantly need to keep up-to-date with legislation and decipher the many requests and demands that various “authorities” place on us.  The latest one involves Ambulance Victoria and has posed two main questions:

1)            Essentially my question is, what is actually considered an emergency, and can a planned and expected event such as a music festival be considered an Emergency (even before it has started) and therefore be subject to emergency provisions such as the Victorian State Health Emergency Response Plan (SHERP)?

2)            My second question relates to health practitioner qualifications and scope of practice. I have noticed a number of articles you have written about this, but mostly the specifics have related to states other than Victoria.  I don’t necessarily expect you to provide me a detailed explanation, but perhaps at least you could point me in the direction of where it is all specified –

a)            Paramedics – what exactly can they do and what can’t they do (if they are not working for AV)?

b)            Nurses – what can they do? and do they need to be registered in Victoria to do these things? or are they just a over-qualified first-aider if they are not working in a hospital?

c)            If they are working under the direction of a registered Medical Practitioner (a doctor) does it change what they can do, particularly in regard to drugs administration?

so many more questions, but that would be getting greedy! I would be greatly appreciative if you are able to respond to the questions above!

Emergency is defined in the Emergency Management Act 1986 (Vic) s 4 as

… an emergency due to the actual or imminent occurrence of an event which in any way endangers or threatens to endanger the safety or health of any person in Victoria or which destroys or damages, or threatens to destroy or damage, any property in Victoria or endangers or threatens to endanger the environment or an element of the environment in Victoria including, without limiting the generality of the foregoing-

(a)       an earthquake, flood, wind-storm or other natural event; and

(b)       a fire; and

(c)        an explosion; and

(d)       a road accident or any other accident; and

(e)       a plague or an epidemic or contamination; and

(f)        a warlike act or act of terrorism, whether directed at Victoria or a part of Victoria or at any other State or Territory of the Commonwealth; and

(g)       a hi-jack, siege or riot; and

(h)       a disruption to an essential service;

As my correspondent has noted, it is problematic using the word ‘emergency’ in a definition of ‘emergency’ but we shall ignore that logical problem.

The Act requires the Minister to prepare the state emergency response plan (s 10).  Sub-plans are made to fit and compliment that state plan, an example of a sub-plan is the State health emergency response plan (SHERP, 2009).  That plan says (at p1):

SHERP adopts an ‘all-hazards’ approach. The principles outlined in this plan will apply in any emergency including mass gatherings and public events and from small complex incidents to major ones requiring a coordination and management framework, such as:

• mass casualty incidents

• complex trauma emergencies

• chemical, biological or radiological incidents

• food and drinking water contamination involving health impacts

• human illness epidemic

• natural disasters

• essential services disruption.

My correspondent has said ‘However I am not sure festival of 12,000 people classifies as a “mass gathering”.   I would think a gather of 12,000 is, beyond doubt, a mass gathering, but a mass gathering is not, automatically an emergency.   The SHERP, and the State plan, all indicate how the state and its agencies will respond to an emergency.  A mass gathering becomes a health emergency if the services of the state are required eg if something causes a mass casualty event, or there is an outbreak of illness in the crowd etc.  If that happens, and the emergency services are called, then it becomes a health emergency and the emergency plan would come into effect.

The Emergency Management Act clearly anticipates that an emergency may exist, and if necessary a state of disaster may be ‘declared’ before an event impacts so if there was a fire burning in South Australia that was expected to burn into Victoria and cause significant damage, the emergency plan may be activated before the event.  If there was a mass gathering, say an unplanned protest, where it was perceived that there would be a real risk of mass casualties, the SHERP could and should be implemented before the casualties arrive, so an event could be considered an emergency even before it occurs.  But to be an emergency it has to ‘endanger or threaten to endanger the safety or health of any person’ and the authorities may well be satisfied that a carefully planned and managed event does not meet that threshold.

In short a music festival is not an emergency but the managers, and the health services, need to plan on how they will deal with an emergency should one arise.

With respect to health professionals, we now have national registration so doctors and nurses once registered can practice, and be subject to professional discipline in any state or territory (see Health Practitioner Regulation National Law (Victoria) Act 2009 (Vic)).   It follows that doctors and nurses don’t need to be registered in Victoria, they just need to be registered.  Paramedics are not yet part of a registered health profession.

So, where it is all specified

a)            Paramedics – what exactly can they do and what can’t they do (if they are not working for AV)?

No-where is it specified what paramedics can and can’t do or even what the word ‘paramedic’ means.   In criminal law, the law says what you cannot do but if there is no law saying you cannot do something, then you can do it.  The most important law, for both nurses and paramedics, are the drug laws.  In Victoria the relevant Act is the Drugs, Poisons and Controlled Substances Act 1981 (Vic).  Under that Act and its associated regulations, an ‘operational  staff member’ of an ambulance service may be in possession of the Schedule 4 and Schedule 8 drugs listed in the permit issued to the ambulance service.  An operational staff member is:

 a person who is employed or engaged (whether on a paid or voluntary basis) by an ambulance service-

(a)  as an ambulance paramedic or an intensive care paramedic; or

(b)  in any other capacity to provide medical or other assistance to patients in an emergency;

Paramedic is not defined by the Act so it is really up to Ambulance Victoria to decide who is called a ‘paramedic’.  (Note that in NSW, the term paramedic was reserved for level V intensive care paramedics, everyone else was called an ‘ambulance officer’. On 3 December 2007, the Ambulance Service of NSW announced that from that date forward, ‘our highly qualified ambulance officers will now be referred to as paramedics’.  There was no change in the law, no change in role or duties, they became paramedics simply because the ambulance service decided that they would now be called paramedics (see http://www.ambulance.nsw.gov.au/newsletters/summer0708/)).  In the absence of professional registration, the term ‘paramedic’ means whatever the person using it wants it to mean.  In light of that sub-paragraphs (a) and (b) cover anyone employed by ambulance Victoria, regardless of their job title, but it is up to the Ambulance Service to determine who can carry the drugs.  In effect, a paramedic who volunteers their time at a music festival could not carry and use schedule 4 or 8 drugs except as authorised by ambulance Victoria which, I would guess, would not extend to carrying and using those drugs except when directly employed by Ambulance Victoria.

b)            Nurses – what can they do? and do they need to be registered in Victoria to do these things? or are they just a over-qualified first-aider if they are not working in a hospital?

Again, no-where is it generally specified what they can and cannot do at least not in general terms.  There will be limitations imposed by the Nurses and Midwifery Board based on types of registration and people may have endorsements on their personal registration, so for example in Victoria, a registered nurse

… registered nurse whose registration is endorsed … is authorised to obtain and have in his or her possession and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in relation to the relevant category of nurse in the lawful practice of his or her profession as a registered nurse and by their particular registration’ Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 13(1)(bb)).

In that case regard must be had to the particular nurse’s registration and any limits imposed, either generally or particularly by the Nurses and Midwifery Board.  For further discussion, see the earlier blog post at ‘Volunteer nurses and their skills’.

c)            If they are working under the direction of a registered Medical Practitioner (a doctor) does it change what they can do, particularly in regard to drugs administration?

Yes it does as the doctor can issue a prescription for a patient that the nurse or paramedic could administer, but that would not authorise them to carry the drugs ‘just in case’, the doctor couldn’t (and shouldn’t) authorise people to carry drugs nor in my view should they authorise the administration of drugs without seeing the patient themselves (Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 8).  Certainly however if there was a medical centre and a doctor examined the patient and authorised the administration of a drug that the doctor was entitled to be in possession of, then a nurse or paramedic could administer that drug to the patient in accordance with the doctor’s written authority (Drugs, Poisons and Controlled Substances Act 1981 (Vic) ss 45, 46 and 47).

Michael Eburn

30 December 2012.