A paramedic from Victoria has asked me a question that I’ve been thinking about for sometime so I’m pleased to now get the opportunity to comment. My correspondent says:

I am a Paramedic with Ambulance Victoria, the statutory Ambulance service in Vic. It is an almost 100% belief amongst our paramedics that we MUST transport patients should they request it, regardless of if they need an ambulance or not. There are many documented cases of people using us purely as a taxi and a case I attended recently had a patient use us to get into the CBD then leave the hospital prior to assessment. He told us before he left that he had a business meeting to attend and can’t stay.
My query to you is; Does an ambulance service have to transport anyone that requests transport to hospital, despite our professional assessment of their need?
Thanks for your time,

The answer to this question is simple, it is ‘no; there is no law that says an ambulance service has to transport everyone’.

Consent is a fundamental issue in medical care; we all know the basic principle that treatment cannot be given to someone without their consent; but that does not mean that all treatment that the person consents to, or wants, must be given. Some examples will make the point:
• A person may go to the doctor and ask for antibiotics, if the doctor forms the opinion that the illness is caused by a virus, he or she is not required to prescribe antibiotics;
• A person may go to the doctor with a myriad of symptoms and have decided that what they need is a kidney transplant. No amount of ‘patient consent’ would require, oblige or even permit the doctor’s to provide that treatment.

So just because a patient wants to go to hospital that in no way obliges the ambulance service, or a paramedic, to take them. So why do they do it? It’s clearly it’s a ‘cya’ response (I’ll leave it to others to explain that acronym for readers who don’t know what it means); that is it is a belief from the service, or individual paramedics, that transporting everyone is a low risk option. The belief has to be that if you don’t transport someone who ends up needing care, there will be all manner of difficulties with complaints, investigation and possible liability, and for government services ‘bad press’. On the other hand transporting everyone is a low risk option and leaves it to someone else, the hospital staff, to decide whether care is required.

Paramedics are however required to transport everyone if that is a term of their employment, that is if the ambulance service insists that is what is required. In that sense the law does require everyone to be transported as the law requires an employee to meet the terms and conditions of their employment and to comply with the lawful directions of their employer. So paramedics do have to transport everyone if that is what their employer directs them to do; but the law does not require ambulance services to impose that condition on their employees.

Apart from tying up ambulance resources, such an approach, if it is imposed by the ambulance service, fails to treat paramedics as professionals who can be trusted to make clinical judgments. One might hope that when paramedics are registered (if that occurs) and their registration is independent of their employer, then they will not only be able to, but will be expected to, exercise professional judgement including making a call on whether or not their services are required. That will, indeed, carry a risk that they will make the wrong call , and perhaps even a negligent call, but that would in fact reflect their status as a professional.

For further thoughts, and explanation of the relevant principles, see the earlier post ‘Transport everyone or act as a professional? A question for paramedics’ (6 May 2013).

I hope that helps.
Michael Eburn
3 February 2014.