Today’s question raises issues of admiralty law rather than emergency law. My answer will therefore be incomplete and confirm my correspondent’s own conclusion ‘that these things are “complicated”’. The answers below are much more ‘gut feeling’ than my usual answers and reflect more the sort of questions a lawyer would need to consider and research in detail if a case arose – they are more ‘issue spotting’ rather than issue resolution.
My correspondent is:
… an Intensive Care Paramedic with NSWA, and recently I was on holidays on a cruise ship with my family. Shortly after leaving Sydney via the heads, we were walking through one of the restaurants when I came across a teenage female on her side, having a generalised convulsive (tonic-clonic) seizure… After checking ABCs and taking a history, I had concluded that this was a seizure and that the patient had not had one before. I did some basic observations … The patient had a good radial pulse, and reasonable respiratory effort…
At this stage one of the cruise ship staff came over and wanted to start CPR. I told him it wasn’t necessary and to please get the ships doctor and medical team. I further identified who I was but my credentials were never checked, and interestingly I was never asked for my room number or any identification.
A short time later, another member of staff came along, who was obviously part of the medical team (nurse maybe?). I again identified who I was and asked if the nurse would like a handover. She said no and told me to remove myself from the area as my presence was not wanted or something to that effect…
For your information the, ship was … registered in Malta. The incident occurred in Australian waters (within sight of land and just outside the heads)…
This case did raise some questions though;
- Does the Civil Liabilities Act still apply on a cruise ship in Australian and NSW waters?
- Common sense prevailed here, but what would have happened if the first staff member insisted on starting CPR? Would the provisions in the law to stop paramedics being obstructed in the course of their duty come into play here?
- Does registration make a difference when it comes into force?
I have tried to get some answer via research, but most of the literature I have read, even around criminal matters seems to conclude that these things are “complicated” and that competing jurisdictions come into play.
At the time my thought was “Aussie paramedic, in Aussie waters, and an Aussie patient – no worries!” But thinking about it later it might be more complex than that.
This is an issue where the choice of laws (or ‘conflict of laws’) comes into play. The jurisdictions that could be relevant would be New South Wales (if the ship was still within 3 nautical miles of the shore, it’s in NSW waters, see Meaning of ‘marine’ and ‘land’ rescue in NSW (June 18, 2012)); the country in which the ship is registered (Malta), the country where the company that actually operates the cruise (which is probably different to the company that actually owns the boat) is based and then there would be any conditions set out on the ticket that may identify which law applies to the contract between passengers and the cruise company.
It can’t be that the relevant law is necessarily the law of the port of last departure. If that were the case the industrial standards on the ship would change with each port. If someone died on the boat, the NSW Coroner would have jurisdiction as the death would be related to the state and whilst the boat is within state waters, the body is also within the coroner’s jurisdiction. Equally criminal law would appear to be the state’s law whilst the ship is in port, it would be less clear once the ship has sailed and certainly once it’s sailed into international waters. In that case it might be the criminal law of the next port that the ship sails to that is relevant as it would be the police from that port that would have to come on board to investigate the matter.
What that means is that if someone wanted to sue, the relevant law may be who they want to sue. If the patient described in this story wanted to sue the cruise companies staff they would probably be bound by the terms of the ticket and sue in whatever country the ticket said governed the terms of the contract. If they sued over the conduct of the ship’s company (who may be different to the cruise company staff) then the issue would be where are they employed. If the allegation was about the state of the ship itself, then the relevant jurisdiction may be the country of registration. If they wanted to sue the paramedic, my correspondent, they could not doubt chose the jurisdiction that they thought would be most favourable.
The very poor answers to the questions asked are:
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Does the Civil Liabilities Act still apply on a cruise ship in Australian and NSW waters?
It would if the potential plaintiff brought any legal action in a NSW court, but I’m not sure that is what they would have to do.
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Common sense prevailed here, but what would have happened if the first staff member insisted on starting CPR? Would the provisions in the law to stop paramedics being obstructed in the course of their duty come into play here?
That begs the question of whether a paramedic on holiday provided that care is acting in the ‘course of their duties’. That would be the case if the paramedic flew to the ship to take part in a medical evacuation of a patient because in that case they represent a NSW Agency performing its statutory role. In that case (and without being able to quote authority) I think it would be much more certain that if there was an allegation made about the paramedic the relevant law would be NSW law. The paramedic who is despatched to the ship is authorised and acting under NSW law. The passenger on the boat, even if he or she is a paramedic, is not exercising any NSW authority at that time.
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Does registration make a difference when it comes into force?
Not that I can see.
Australian Emergency Law 
This comment was received by email:
This article I found very interesting as I too have provided first aid on a cruise ship before, with similar experience to your correspondent (no acknowledgement of skills, no acceptance of a handover and dismissal by the medical staff).
This led me to think at the time whether the someone providing first aid on a cruise ship (whether or not experienced or qualified) could be personally sued should that first aid be in contradiction to the ‘local’ first aid practices (whatever jurisdiction that may be!).
For example (hypothetically), if CPR was given as compressions only, with no breaths (as per current Australian guidelines) and the pt didn’t survive, could the family sue the first aider because under whatever jurisdiction is deemed relevant, CPR is required to be done with breaths? [This isn’t intended to be a genuine example, just to illustrate the point of my question.]
Or are Good Samaritan protections global?
Extrapolating this a bit further, should the pt in the original article have had a negative outcome would the Cruise Ship crew be liable for dismissing the services of an experienced person (especially a nurse dismissing the assistance of the ICP in the original article)?
No one is going to sue the first aider. If you are on a ship it’s the ship’s captain and the cruise company that are under an obligation to ensure that reasonable care is provided to the passengers. If the passenger doesn’t get that care, the defendant will be the cruise company. Good Samaritan protections are not global, but remember there are no cases of people getting sued for stepping forward to assist – none, anywhere.
In terms of care, one can only do what one can do. The first aid standard may be different but, to stick the example, dong CPR without breaths is better than nothing which is the alternative. So again I can’t see how in any jurisdiction doing something is worse than doing nothing, particularly if you are doing what you are trained to do ie doing all you can.
In the original article the cruise ship would not be liable for dismissing an experienced person. It would be hard to prove it would have made a difference and ultimately they have to take care of their passenger. Eventually they have to say ‘we’ll take it from here’. But if they passenger didn’t receive ‘reasonable care’ then, depending on the jurisdiction, they may have a claim against the cruise company.
The risk of getting sued for doing first aid, anywhere in the world, is so remote as to be fanciful. And where people want to sue they want to sue someone with money. So I suppose some of the suggestions may be hypothetically possible and I don’t know tort law world wide but it seems so entirely improbable that one shouldn’t worry about it.