The answer to this question might seem obvious, but it isn’t and it has again arisen in the context of who can put flashing warning lights on their vehicles in New South Wales.
The relevant rule is in the vehicle standards that are set out as Appendix 2 to the Road Transport (Vehicle Registration) Regulation 2007 (NSW). Rule 86 says that an emergency services vehicle may be fitted with a flashing headlight. An emergency service vehicle includes ‘an ambulance’ (r 86(7)(a)).
Rule 124 deals with lights and reflectors. It says, as a general rule, that a vehicle may not be fitted with a light that flashes or rotates. There are exceptions and ‘ambulances’ may be fitted with a flashing blue or red light (r 124(4) and (7)).
So, what is an ambulance? The term is not defined. A google search brings up the following definitions:
Ambulance | Define Ambulance at Dictionary.com
www.dictionary.com/browse/ambulance
Ambulance definition, a specially equipped motor vehicle, airplane, ship, etc., for carrying sick or injured people, usually to a hospital. See more.ambulance – definition of ambulance in English | Oxford Dictionaries
https://en.oxforddictionaries.com/definition/ambulance
noun. A vehicle equipped for taking sick or injured people to and from hospital, especially in emergencies. ‘we called an ambulance’ambulance Meaning in the Cambridge English Dictionary
dictionary.cambridge.org/dictionary/english/ambulance
ambulance meaning, definition, what is ambulance: a special vehicle used to take sick or injured people to hospital: . Learn more.Ambulance | Definition of Ambulance by Merriam-Webster
https://www.merriam-webster.com/dictionary/ambulance
Medical Definition of ambulance. : a vehicle equipped for transporting the injured or sick.
The critical parts of these definitions is the nature of the vehicle ie a vehicle equipped for patient transport, rather than who uses it.
(As a matter of interest in South Australia, 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’ (Health Care Act 2008 (SA) s 3). In Police v Zammitt [2007] SASC 37 the defendant was acquitted of operating an unlawful ambulance service because even though the vehicles used were painted with the term ‘ambulance’ and fitted with warning lights and sirens ([27]), ‘The evidence did not suggest that the vehicles were modified to provide medical care to patients being transported’ ([28]).)
If the matter came before a court in NSW that is if someone claimed to have an ‘ambulance’ and therefore claimed the right to have red/blue lights on it, and if the police disagreed, then a court would have to decide whether r 124 applied or not. To do that the court would have to decide what does the term ‘ambulance’ for the purposes of the Road Transport (Vehicle Registration) Regulation 2007 (NSW) mean?
It could mean a vehicle as defined above. But if that’s the case then a lot of vehicles that are operated by NSW Ambulance and which have red/blue lights on them are not ambulances. Things like rapid response motor cycles, sedan cars, operational support vehicles etc.
Let’s add some complexity here. For the purposes of the Road Rules 2014 (NSW) an ‘emergency vehicle’ is a vehicle used by an emergency worker and that includes ‘a member of the Ambulance Service or the ambulance service of another State or Territory, in the course of providing transport in an emergency associated with the provision of aid to sick or injured persons’ (Road Rules 2014 (NSW) Dictionary). So, a rapid response motorcycle operated by NSW Ambulance is an ‘emergency vehicle’ (at least when responding to an emergency) even if it is not an ‘ambulance’. That means it may be fitted with a siren (Road Transport (Vehicle Registration) Regulation 2007 (NSW) r 33(3)(b)) and red, but not red and blue, flashing warning lights (r 124(7)(b)). But we know they are fitted with red and blue lights. So either RMS has given approval for the blue lights or someone thinks they meet the definition of ‘an ambulance’ (despite the dictionary definitions above).
A court may well accept that for the purposes of the Road Transport (Vehicle Registration) Regulation 2007 (NSW), an ambulance should be defined as any vehicle operated by an ambulance service. But a correspondent has said that this would mean anyone could buy an ambulance, paint Joe Bloe’s Ambulance Service on it and then fit red/blue lights (but not a siren).
I think that’s probably true. According to the Health Services Act 1997 (NSW) ‘”ambulance services” means services relating to the work of rendering first aid to, and the transport of, sick and injured persons.’ Anyone who provides ‘first aid to, and the transport of, sick and injured persons’ are providing ambulance services. If they have a vehicle that is ‘equipped for taking sick or injured people to and from hospital, especially in emergencies’ then they have an ambulance. If they have an ambulance then they might also have, as NSW Ambulance Service does, other vehicles that are part of their ambulance service.
What might stop that is the Health Services Act 1997 (NSW) s 67E which 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.
Prima facie not anyone can set up an ambulance service, but we know that they do. There has been a massive growth in private ambulance services and at least in 2010 when Dr Jason Bendall and I wrote ‘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), NSW health had issued no authorities under s 67E. If the Health Services Amendment (Ambulance Services) Act 2015 (NSW) comes into force, then the situation will be even clearer with the prohibition then only applying to emergency ambulance services (see Changes to ambulance legislation in NSW – about time too! (August 24, 2015)).
What I don’t think ‘ambulance’ means is ‘an ambulance operated by the Ambulance Service of NSW’. If the legislature meant only an ambulance operated by NSW Ambulance they could have said so, or could have used the term ’emergency vehicle’ as they did in r 33 (relating to sirens). The fact that they did not use the same phrase as in r 33 leads to the conclusion that they did not mean the same thing.
The irony is that merely fitting warning lights to a vehicle does not mean the driver or vehicle gets any exemptions under the Road Rules 2014 (NSW). To get the benefit of r 306, a vehicle must be an emergency vehicle. What is an emergency vehicle is not defined by reference to the vehicle, but the person driving it, who has to be an emergency worker. In the context of this discussion that is ‘a member of the Ambulance Service or the ambulance service of another State or Territory, in the course of providing transport in an emergency associated with the provision of aid to sick or injured persons’ (Road Rules 2014 (NSW) Dictionary).
To summarise the position so far, an ambulance is at least a vehicle equipped for transporting the sick or injured. NSW Ambulance operates ambulances so their ambulances may be fitted with red/blue flashing lights (putting aside the issue of support and rapid response vehicles). A NSW Ambulance officer is an emergency worker so if he or she is driving the ambulance and needs to respond to an emergency then he or she may activate the warning devices (lights and sirens) and enjoy an exemption from the road rules if they otherwise comply with r 306. So far so good, that’s all how it should be.
Joe Bloe on the other hand is running a not-for-fee or reward service providing ‘first aid to, and the transport of, sick and injured persons’ that is he is providing ambulance services and is therefore operating an ambulance service. It does not matter that the transport is limited to transport around an event site and not to hospital, it’s still transport and therefore he is providing an ambulance service (Paramedical Services Pty Ltd v The Ambulance Service of New South Wales [1999] FCA 548). When the Health Services Amendment (Ambulance Services) Act 2015 (NSW) comes into force it will be the case that by not providing transport to hospital, there is no ‘emergency ambulance service’ so the prohibition that will then be in s 67E will not apply to Joe Bloe’s Ambulance Service, but he will still be providing a non-emergency ambulance service. In that case, it will be even more certain that Joe can set up his own ambulance service. But Joe Bloe’s staff won’t be emergency workers so they can’t use the warning lights, can’t fit a siren and get no exemption from the Road Rules 2014.
That may be an argument against my conclusion – the law can’t allow Joe Bloe’s ambulance service to fit red/blue lights if they don’t also get the exemption in r 306. But the law does do that. A ‘Red Cross vehicle used for conveyance of blood for urgent transfusions’ can be fitted with a red flashing light (r 124(7)) but a red cross employee is not an emergency worker for the purposes of the Road Rules 2014 so a Red Cross vehicle is not an emergency vehicle for the Road Rules 2014. Finding that an ‘ambulance’ can be fitted with a red/blue light (see rr 124(4) and 124(7) but that the driver does not enjoy the benefit of r 306 is therefore not inconsistent with other provisions of r 124. It’s not clear then when the Red Cross or Joe Bloe’s Ambulance could use the warning lights, but they would be of some use when parked eg if Joe Bloe is providing an ambulance service to provide first aid and transport in a city on Saturday nights, the lights would help people find the service and also warn other drivers not to run into the ambulance. So there may be some use in having the lights even if they can’t be used when driving.
Returning to rapid response and support vehicles
We can now return to the problem of the rapid response and support vehicles operated by NSW Ambulance. If NSW Ambulance has authority from RMS to fit red and blue lights (not just red) to those vehicles then that’s fine. If they don’t but rather fit red and blue lights (rather than just red) on the basis that they are vehicles operated by NSW Ambulance and therefore an ‘ambulance’ then that argument will also be open to Joe Bloe’s Ambulance Service. I of course don’t know what approvals are held by NSW Ambulance.
Conclusion
This is a ridiculously complicated situation and is an example, with due respect to Parliamentary counsel, of poor drafting. It would be much better if r 124 said that red/blue lights can be fitted to an emergency vehicle as defined by Road Rules 2014 (NSW) and leave it at that, but that’s not what it says. It says that red/blue lights may be fitted to ‘ambulances’ not ‘ambulances operated by the Ambulance Service of NSW’ or ’emergency vehicles’.
Organisations that operate an ambulance service can, I would argue, fit red/blue lights to their ambulance; but if they want to use them when driving and get an exemption from the road rules they need to go further and have their officers declared as ’emergency workers’.
Post script
Depending on what one means by ‘law’ and ‘regulation’ this post may not have told the whole story. We do know that RMS does have a view on what is an ambulance. In their document Vehicle Standards Information (24 November 2010, Rev. 4.1) they say:
Blue, or blue and red flashing lights must only be fitted to: …
- Ambulances solely used by the Ambulance Service of NSW as defined under the Health Services Act 1997 or a vehicle authorised by the Ambulance Service of NSW under its delegated authority…
If you’re interested in ‘regulation’ then this is indeed relevant and it tells the reader what the RMS understand by ‘ambulance’. In terms of legal theory I think I well fit in the legal positivist line of thinking and would also be described as a ‘black letter lawyer’. In my mind law is what is set out in an Act of Parliament, delegated legislation (such as the Road Transport (Vehicle Registration) Regulation 2007 (NSW)) and the pronouncements of the higher courts in accordance with the doctrine of precedent which is what makes Australia a common-law jurisdiction.
Statements by a regulatory authority such as the RMS are not, on that definition, law. But a more expansive view would say that it is or at least it’s part of the relevant regulation as that is, in this context, the definition RMS are adopting.
The difference is that the definition adopted by RMS is not ‘binding’ on a court or anyone else. In my post I referred to Joe Bloe’s Ambulance Service but let us think of another example – imagine that the Kickatinalong Motorcycle Club has decided it’s too expensive to get NSW Ambulance to stand by at their events so they buy an ex-ambulance, restock it and make sure that some of their volunteer members are trained in first aid and perhaps even with paramedic qualifications. They will then provide their own event coverage and in the event a rider is injured they intend to transport them to hospital. At this point they are not in breach of s 67E as they are not acting ‘for fee or reward’. Assume they take their vehicle to the RMS for registration and the inspector says they can’t have the red/blue lights and refuses to register the vehicle as an ambulance. The Kickatinalong Motorcycle Club could challenge that decision either by appealing the decision or fitting red/blue lights and waiting to see if anyone issues an infringement or defect notice and then taking that to court. Once in court they could argue that the regulation refers to ‘an ambulance’ and on the plain English meaning of the word, that is what their vehicle is. A court would have to decide ‘what is ‘an ambulance?’ and that takes us back to my original post.
As I’ve argued one definition might be ‘any vehicle operated by an ambulance service’ (which appears to be the RMS definition) but it’s not axiomatic, ie it doesn’t have to be that and a court might well accept (because it seems to be true) that the Kickatinalong vehicle is indeed an ambulance. And if it is an ambulance it can have red/blue lights whether RMS like it or not as that is what the regulation says.
There is a problem with the RMS definition, and that is it’s circular; it is a definition ‘that uses the term(s) being defined as a part of the definition or assumes a prior understanding of the term being defined’ (https://en.wikipedia.org/wiki/Circular_definition). It says, in effect, ‘Ambulance means ambulances solely used …’ ie it uses the term ‘ambulance’ to define what is, for the purposes of RMS an ambulance. It still doesn’t say whether it must be a vehicle modified to transport the sick or injured or any vehicle operated by an ambulance service. RMS may well have a clear idea – they may accept that vehicles used for the transport of the sick and injured are ambulances but rapid response motorcyles are not but are given a special exemption or permission to carry the red/blue lights, that I don’t know, but I do know that this definition doesn’t help resolve the problem of ‘what’s an ambulance?’
There is a second problem with the RMS definition. It says an ambulance is a vehicle ‘solely used by the Ambulance Service of NSW as defined under the Health Services Act 1997 or a vehicle authorised by the Ambulance Service of NSW under its delegated authority’. Section 67E of the Health Services Act 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.
Maximum penalty: 50 penalty units.
(2) The Health Secretary may revoke any consent given, or revoke or vary any condition imposed, under this section.
(3) This section does not apply to:
(a) the St John Ambulance Australia (NSW) in respect of operations similar to the operations lawfully carried on by that body immediately before the day on which this section commences, or
(b) the Royal Flying Doctor Service of Australia (NSW Section), or
(c) the mines rescue company, within the meaning of the Coal Industry Act 2001 , (or a member, director or employee of that company) in the exercise of mines rescue functions under Division 3 of Part 3, or Part 4, of that Act, or
(d) a member of the New South Wales Mines Rescue Brigade established under the Coal Industry Act 2001 , or
(e) any person (or class of persons) prescribed by the regulations.
A person operating an ambulance service in accordance with section 67E(3) does not require approval from the Health Secretary and they are not acting under any delegated authority. They have a legal right to operate as they do, so they can operate an ambulance without approval from the Health Secretary.
AS for an authority issued under s 67E(1), that is not given by the Ambulance Service but by the Health Secretary. Presumably the Secretary has delegated the power to grant tht approval to the Ambulance Service and that is what they mean by the Ambulance Service’s delegated authority. To the extent that an authority can be granted on conditions I suppose the Service/Health Secretary could impose conditions about vehicles but it is a strange turn of phrase to refer to ‘a vehicle authorised by the Ambulance Service of NSW’ because the Ambulance Service/Health Secretary are authorising the provision of ambulance services, rather than the definition of an ‘ambulance’. These are minor quibbles. I’m sure the RMS are looking for a letter or something says the ambulance service has no objection to the red/blue lights but, to return to my point, the regulations doesn’t say that and the Kickatinalong Motor Cycle club, in my view, have a very solid argument that their vehicle is an ambulance and NSW Ambulance approval is not required.
As noted however, even if they can fit them, they can’t use them ‘on the road’ and they get no exemption from the road rules.
Australian Emergency Law 
Does the fact that a vehicle is registered in NSW as an ambulance with Joe Bloe’s Ambulance Service make a difference? There is certainly an ‘Ambulance’ category for vehicle registration in NSW and also in the ACT for that matter.
In relation to an “…ambulance service of another state or territory…” NSW Road rules, would this apply for interstate private services who are ‘registered’ as ambulance services with the relevant body (Health in VIC, ACT Ambulance in the ACT)? I don’t mean Joe Bloe’s who flies under the radar. I mean organisations who have ambulances registered as such, and a license to provide emergency medical treatment under and Act in a state or territory.
It RMS register it as an ‘ambulance’ that has to be the end of the matter – it is an ambulance, but that doesn’t avoid the question as one still has to decide what is ‘an ambulance’. To go to my post above, and the post script, if the RMS won’t register the Kickatinalong vehicle as ‘an ambulance’ they could appeal that decision or say ‘the law says that an ambulance can have red/blue lights, this is an ambulance (whether you register it as one or not) so it can have them and I’m putting them on – defect the vehicle if you will and we’ll see what a judge says’.
As for interstate services yes I would think it would have to be interpreted as those that belong to the state or territory (eg Ambulance Victoria, ACT Ambulance etc) as well as those authorised to operate in those states such as those with approval under the Emergencies Act 2004 (ACT). In any event you don’t need to meet the registration standards in one state if you meet them in another and are visiting (see ROAD TRANSPORT (VEHICLE REGISTRATION) REGULATION 2007 (NSW), Sch 1, cl 9) otherwise everyone would have to stop at the border etc to make changes so either way a vehicle approved in one state can be in NSW without having to take the red/blues off.
Michael, Another related question. What is an ambulance service then, given that ambulance services in Australia are not required to be registered or regulated independently?
Peter, Jason Bendall and I answer that question in our paper which you can find at https://ajp.paramedics.org/index.php/ajp/article/view/85/83
We say there (footnotes omitted):
it has been a couple of years since this was written, and note that recently, and in the absence of any regulatory or legislative changes – SA Health has “required” any company who is providing event first aid/health/medical services, who operate a vehicle that “looks like an ambulance” – to apply for a Non-Emergency Patient Transport licence.
The more interesting bit is that this appears to be only based on the interpretation of legislation by staff who work within the newly formed Health Protection and Licencing Services Unit.
would be interested to understand if you have any opinion on the application of licencing and regulatory frameworks based on a change of interpretation without there being any case law to provide stimulus for change.
They are required to be registered in the ACT!
And the ROAD TRANSPORT (VEHICLE REGISTRATION) REGULATION 2000 (ACT) refers to an ’emergency vehicle’ (which is defined) and not ‘an ambulance’
Hi Michael,
Thanks for your responses.
Apologies for that last post, I meant it in relation to Peter and licensing of ambulance services in the ACT.
Ben
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.
I’ll answer this in a seperate post.
It might be worth nothing that often the Statutory Ambulance Service in a particular State or Territory is the sarrogate for the government health department and is essentially the license issuer and may not be subject to the same conditions as any private service.
I found this RMS definition of an ambulance in the motor dealers guide 2015 (http://www.rms.nsw.gov.au/documents/business-industry/motor-dealers/motor-dealers-guide.pdf).
The important part is that the RMS considers support vehicles (sedans, station wagons, utes) as ambulance, for the purpose of registration. Interestingly, motorcycles are not included in this list. The vehicle use and vehicles shapes don’t seem to match very well, as I’m confused at how a sedan can be specially constructed to transport patients.
Extract from Appendix B (page 42):
AMBU – Ambulance (non-Government)
Evidence required: Declaration of Eligibility for a Registration Concession (Form
1193).
Vehicle Use: Vehicle (other than a government owned) specially constructed
and solely used for carrying sick or injured persons.
Only the following vehicle shape codes apply: PVN, SBS,
BUS, PVS, PVW, RVP, SED, SNO, VAN, WAG, UTE, PVF.
This registration usage does not entitle the operator to fit flashing
lights and sirens.
Just to clarify my first comment, ASNSW motorcycles can actually be registered as ambulances, according to that document.
There is a separate category for government ambulance, of which there is no restrictions on vehicle shape. Therefore any vehicle operated by ASNSW can be registered as an ambulance.
Thank you for the reference to the RMS document, Josh. I agree that it makes no sense. A vehicle can be an ambulance if operated by the Ambulance Service of NSW ‘to carry
sick or injured people and for connected work’. The reference to connected work could include various specialist and support vehicles. For a non-government ambulance the vehicle has to be “specially constructed and solely used for carrying sick or injured persons” and that would seem to exclude a sedan or a ute.
Further the document says, with respect to non-government ambulances, “This registration usage does not entitle the operator to fit flashing lights and sirens.” With respect to RMS, that has to be wrong. The definition of ‘emergency services vehicle’ includes an ambulance, not ‘an ambulance operated by NSW Ambulance Service’. An emergency service vehicle may be fitted with flashing headlights (Road Transport (Vehicle Registration) Regulation 2017 (NSW) Sch 2, r 73(5)); flashing blue and red warning lights (r 114(4) and 114(7)). (Note that in the post I refer to the Road Transport (Vehicle Registration) Regulation 2007 (NSW). This has now been replaced by the 2017 version referenced here).
An exempt vehicle may be fitted with a siren but an exempt vehicle includes an ‘emergency vehicle’ (r 3, Definitions). An emergency vehicle is not the same as an emergency services vehicle. An emergency vehicle includes a vehicle driven by ‘a member of the Ambulance Service rendering or providing transport for sick or injured persons’. I have argued elsewhere that reference to ‘the Ambulance Service’, as opposed to ‘an ambulance service’ must be a reference to the Ambulance Service of NSW.
So an ‘ambulance’ may be fitted with flashing headlights and red/blue emergency lights, but not a siren. There is no need to get extra permission, the rules simply refer to an ‘ambulance’. If a person has a vehicle that is registered as “AMBU – Ambulance (non-Government)” then it is an ambulance. If they received an infringement or defect notice for having the red/blue warning lights or flashing headlight that would have to be challenged. The rules allow an ambulance to have those devices; it is an ambulance.
It is still the case however to that to get an exemption from the road rules the driver has to be an emergency worker and that is limited to, inter alia, ‘a member of the Ambulance Service …’ or ‘a person (or a person belonging to a class of persons) approved by the Authority’. A non-government ambulance employee is not an emergency worker unless they have the approval of RMS. That means the ambulance can be fitted with the flashing lights, but they can’t be used at least not whilst the vehicle is moving and if they are, they have no legal effect but will simply confuse everyone.
I do note that I have argued elsewhere that the RMS guidance material in this area is wrong – see comments in response to Red/blue lights in ACT and NSW (October 10, 2013) and in particular Andrew’s comment of April 17, 2018 and my reply also of April 17, 2018.