A Paramedic student in WA is
… concerned about job prospects in this competitive industry within Australia. I’d love to view your thoughts on Paramedic registration and what that will mean for services that rely heavily on volunteers in regional and remote areas (SJAWA, SAAS). Will there be a push for these services to fill these positions with career paramedics? Or have ambulance volunteers been incorporated to allow said services to continue operations as usual?
Also, if you could please shed some light, I am also curious as to why WA and NT contract private companies to provide pre-hospital care as opposed to a government run organisations like the remainder of states in Australia.
I’ll answer these questions in reverse order. First, I don’t know why WA and NT continue to rely on private providers rather than providing government operated services. One can imagine it has much to do with distance and no doubt costs and they think the public are getting as good or better service than they would with a government run service for the same, or less cost. St John Ambulance, in particular, has led the development of ambulance services in Australia but over time the governments have stepped in to take over the provision of ambulance services. Having said that, I am not aware of the history of ambulance services in WA or the current thinking of the WA and NT governments. I wouldn’t be surprised if a number of regular correspondents to this blog won’t be able to shed some light on the question ‘why WA and NT contract private companies to provide pre-hospital care as opposed to a government run organisations’?
As for the first question, paramedic registration won’t make any difference. Registration under the Health Practitioner Regulation National Law does not define scope of practice, it merely restricts who can use the title. The regulation of paramedics doesn’t go any way to regulating ambulance services or imposing quality or service standards. It doesn’t compel an ambulance service, such as St John Ambulance Australia (WA) to employ paramedics in its ambulance services.
What registration will mean is that only registered paramedics will be able to call themselves paramedics. An ambulance service can still use volunteers, but everyone will know if they are not called ‘paramedic’ they are not a registered paramedic with the minimum qualifications and professional oversight that registration brings. Whether there will be a ‘push for these services to fill these positions with career paramedics’ will depend on the will of the electorate. If people demand a paramedic service, that can only be provided with registered paramedics. It should however be noted that a paramedic doesn’t have to be a career paramedic, a person could be a volunteer registered paramedic.
The short answer is therefore that registration of paramedics will not require ambulance services to staff their service with paramedics. They can use people with other qualifications and volunteers. Whether that is acceptable to the community remains to be seen.
Australian Emergency Law 
I don’t think you can be an Unregistered Paramedic anymore than you can be an Unregistered Nurse or Unregistered Medical Officer. Another title will have to be used e.g. Ambulance Assistant. The differentiation of unregistered personnel from Registered Paramedics could make the position far less attractive for many. Will we see people falsely holding out to be Paramedics as we sometimes do with people falsely claiming to be Doctors or Nurses? On another note will Registered Paramedics be known as RPs?
Indeed you can’t be an unregistered paramedic. So people who are not paramedics will not be able to use the title ‘paramedic’ but it doesn’t mean they can be employed, or volunteer, to provide ambulance services and even use equivalent skills. There have been examples of people falsely holding out that they are a paramedic – see https://www.illawarramercury.com.au/story/3904901/unemployed-teen-caught-posing-as-paramedic/. With registration there will be a clear distinction between who is, and who is not, a paramedic.
In simple terms. The State recieves funding from tbe Commonwealth’ to provide health services. This includes ambulance services.
The history of all Australian Ambulance Services will show several groups both state and volunteer formed services.
Victoria for example had 28 different services under the ASV banner. Before that a stretcher known as an Ashford Litter was at Eastern Hill Fire Stn and The West Melbourne Police stn. Heritage Funerals in Healesville ran an ambulance service into the 70s. William Anglis Hospital in Ferntree Gully did as well
South Australia even had a “police ambulance” before the State handed it over to SJAB.
In WA there are 6 registered ambulsnce services with the Health Department. Only one is responsible for emetrgency response. That service is a private limited liability company that provides medical and dental clinics, training services, safety audits and staff to public events and industrial sites.
The company has been in business in WA for over 125 years.
Its known as St John Ambulance WA inc. As well as WA Ambulance Service Inc A limited liability company that was previously incorporated under the Incorporated Associations Act.
As the company utilises volunteer labour in some areas it still is eligible for ATO Benevolent Charity concessions.
The State of WA has excersised its right to outsource services. Hospitals, public transport security and alike. Many State, Commonwealth and Local Government Authorities contract out services for one reason. Cost.
The previous WA state government stated it could not run a state ambulance service for the same cost as the contractor.
As there is no “Ambulance Act” per se in WA, the service is governed by industry standards. However this is not mandatory in WA.
The registration as i see it is to protect the title of “paramedic” nationally similar to use of the word “ambulance” in some states. As well as setting the minimum national standard for individual registration, like nursing for example.
It will stop Joe Citizen First Aid Service putting a siren on his car and calling himself a”paramedic” with his one day first aid certificate and buying a nice big kit off eBay and offering his services as a bona fide professional
Bit harsh on the skills of the volunteer workforce though…and perhaps implicitly on the level of service delivered in rural
You comment “they [volunteers] are not a registered paramedic with the minimum qualifications and professional oversight that registration brings”
Certainly in South Australia it’s actually badged as a ‘professional service delivered by volunteers’
They have a minimum qualification
They have oversight (through their employer)
They place LMAs, can defibrillate, administer midazolam, adrenaline, benzylpencillin and glucagon
They may deal as solo crew to a rollover with no immediate backup nd indeed some of the jobs they attend may be more complex than some career crews in the city, with less support.
Unfortunately they are excluded from accessing many of the online and professional resources available via membership of organisations such as ‘Paramedics Australasia’
Whilst I fully support the move to AHPRA-registration of paramedics, it does seem a shame that volunteers working under a system of clinical governance (their employer) and delivering a professional service to cases that may be more complex than in metro, are excluded
I believe that there is merit in ensuring ‘first aiders’ and those who are operating outside governance are excluded from the professional recognition of ‘paramedic’
But those volunteers who work for an Ambulance organisation and deliver high quality care are further ostracised by this move.
I doubt that many paramedics will be bothered by this; sadly they are often the folk who wont come and work in rural areas even as interns or in early years of their registration.
Disenfranchising the volunteer workforce may well work against the health benefit of rural communities, sadly
Volunteers can be registered paramedics if they have the necessary skills and qualifications. During the first three years they may be able to register under the grandfathering provisions if they do have requisite skills and experience. There is nothing intrinsic in registration that says a paramedic has to be employed. After three years applicants for registration will need to have the approved qualifications but a volunteer may chose to do a paramedic degree or a career paramedic may chose to move for a tree change, but continue to volunteer. What I meant by my comment was that if a volunteer is not a paramedic, then patients and others will know that as they can’t use the title. And volunteers can continue to provide those services even when paramedic registration is in place.
Couldn’t agree more!!
Paramedics don’t work in the rural areas because there are jobs – most rural areas are staffed by volunteers (even though rural people pay the same emergency services levy).
If the Australian private providers follow the US trends I wonder how long it will be before we see EMT-A, EMT-B and EMT-P (without using the word Paramedic) replacing job titles at different levels. The term EMT without any suffix might also be used to describe personnel such as First Aiders or even First responders who do qualify for registration. The EMT description is not a protected title in Australia nor does it have any qualifications attached.
John,
I’m glad you brought that issue up. I was going to as well. My comment would have taken a swing in the “fancy” titles used.
The USDOT system was brought in to manage the National Highway Codes
You would be the expert on that field with all your research. I quite often quote your findings on various Facebook pages.
John, a private provider can employ a paramedic just like a public provider can. Your comment implies inferiority in clinical competence. St John is a private provider as works in two states.
As someone who works in public and private, I am glad registration is upon us. It will weed out all those managers and clinicians who don’t have a qualification, cannot demonstrate competency, never work on the road, but still call themselves a paramedic.
If registration doesn’t improve quality of care of patients in regional area then protecting the name is pointless. Someone sees the uniform and assumes they are a paramedic. To the comments implying that volunteers can do ALS skills, this simply isn’t true- quick google on SA volunteers CPGs disproves that. The one and only reason WA and NT are contracted to SJA is money, same reason we still use volunteers in large regional areas.
Professor Eburn – for the paramedics who are required to work with volunteers to form a crew there is potentially a higher risk for clinical complaints etc. Is there an argument not to use a paramedic volunteer model post registration?
John, it is important to note that in the US, being an EMT and its various designations are qualification and need to be maintained, but you can also be a Registered EMT (NREMT) or not (EMT), depending on whether you want to go through the registration process. It only makes a difference if their is an actual benefit to the EMT though, most often there wasn’t with the exception of patch. The minor designations like EMT-A, EMT-B, EMT-IV, EMT-T, EMT-W etc vary depending on state and include EMT – P or EMT – Paramedic. They also have EMTs who are qualified as Paramedic Assistants, and stand alone courses that are predominantly for EMT-P, such as ALS.
The use is better set up than Australia for allowing this, based on their decentralised model of government that mean many EMS agencies are local or private and they have an anti-monopoly legislation that allows better competitions. Unlike here, where it is painful to get basic information form the state agencies. The decentralised approach, means that local Academies and Hospitals often provide various training for free to volunteers and to others (paid). You will allows get someone who abuses the title or illegally uses it but but goal should not be to create a second tier of paramedics who have undergone the same training but cannot be called such because of some nonsensical government legislation set up to protect state based ambulance service.
As mentioned, the Australian system is very protective over its patch, and this is to the detriment of the Australian public from state based monopolies to refusing to release what should be public information on response times. I have also heard stories that would make you cringe coming from at least one services of poor leadership and management, that is bad enough to make me never to want to work for them. While many would be concerned over the privatisation of medicine, in particular, the US model. The Australian model is far from perfect and while I agree on the registration of the title. I am very concerned that it will become a way for the government to tighten the noose and stop any potential to break its monopoly and any improvement on the service. Specifically, when I have heard it directly from state organisations developing their policy and procedures are more interested in Policy writers and not paramedics as the writers “learn this stuff”. This makes me very scared for the position and the future of the role…
Matt, thanks for those points. I expect that registration will in fact weaken state monopolies. Registered paramedics will be able to take their qualifications with them and no doubt entrepreneurial paramedics will see ways to create businesses that will make use of registered skills. As it is a paramedic is only a paramedic at the whim of their employer, and for consumers they can’t know what skills someone offering ‘paramedic’ services is offering. I think the fear that registration would cause some loss of state control was evident in the submissions by NSW Health to the Senate Inquiry on paramedic regulation.
It will be the case that ambulance service providers, whether state based or private, will be able to operate using staff with any sort of title that they like (as they can now) but it will be the case that only registered paramedics can use the title ‘paramedic’. In due course that will affect both state based services as consumers/electors demand ‘paramedic’ services, and also private services if consumers want to ensure that they are getting a paramedic service or at least know when they are not contracting for that level of service.
I think registration will change the shape of the delivery of pre-hospital emergency care. Some of those changes will occur with the commencement of registration; others will take time to develop.
Some interesting but also ill informed comments
In the USA to be an EMT no matter who you work for requires individual state registration as an EMT
In the NT St John has been the contracted provider for Ambulance services in the NT since the aftermath of Cyclone Tracy. Before that there was hospital based ambulances that only operated during the day. After hours and all weekends and public holidays it was St John volunteer that provided the ambulance service. Cyclone Tracy was on Christmas day so there were no hospital ambulances. Only St John volunteer ambulances operated initially. At that time NT had a very limited legislature and was controlled by the Commonwealth. After Cyclone Tracy St John was asked to run the ambulance service. Autonomous self government was not granted iune until 1978.
Yes, RemoteOne, I should have clarified. There is state registration but you can still work for private companies and then there is the National Registration process.
There’s no state registration in WA or any other Australian state or territory.
As previously stated, there are 6 registered ambulance services with the State of Western Australia Health Department.
Only one is contracted to The State as the provider of 000 emergency ambulance response. That is St John WA LLC.
There is no Act of Parliament in relation to an Ambulance Service.
There is referance to an “ambulance” and “St John Ambulance ” in the regulations in relation to the fitting of warning lights and audible devices. There is a referance to training of driver’s who operate emergency vehicles.
A “paramedic/ambulance officer/ ambulance volunteer” is not a public officer as defined under the Criminal Investigation Act. Therefore it is not a protected title.
Private ambulances such as mining company vehicles are not “emergency vehicles ” on WA roads. However private fire brigades such as mining are registered with DFES and are defined as emergency vehicles.
In relation to First Aiders working for private companies and “paramedics” moonlighting for said companies, it would be interesting to see how this would fall in under the structure of registration.
If this is the case of grading the title as in Nursing i.e. Division 1 and 2 expanding into other industries, would we see security guards and council rangers/parking officers/community safety officers calling themselves “parapolice”?
I feel that the question as posed was not answered. Currently paramedics are required to work with volunteers as part of their jobs to form a crew. With registration, and the personal liability that paramedics will hold due to registration, are the paramedics able to be forced to work with a volunteer?
Currently a volunteer works under the medical director of the company. If an error is made or a clinical incident occurs, the paramedic and volunteer are covered by the company somewhat. Post registration if an error is made by a volunteer the only person personally liable is the paramedic. I would argue that a paramedic should have the right of refusal over working with someone they feel could jeopardise their registration, and by extension, career.
I’m not sure what you mean by ‘personal liability that paramedics will hold due to registration’. Registration won’t change the rules of vicarious liability, that is there employer will still be liable to pay any civil damages. Paramedics won’t suddenly be personally liable any more than nurses or employed medical practitioners are.
If what you mean is that paramedics may be subject to disciplinary proceedings that is true but first note that the relevant panels will include paramedic members who understand the nature of the practice. Second unprofessional conduct means ‘conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience’. That is an assessment of the paramedics conduct in all the circumstances, not the outcome. If a paramedic is working with a volunteer who is not a paramedic (and there may be volunteer, registered paramedics) then the paramedic’s conduct has to be assessed in that context. The fact that the patient may have had a better outcome if there had been two or more paramedics on scene is not relevant to the question of the particular paramedic’s clinical practice in that context.
Having said that the fact that paramedics are or will be registered my increase their ability as a profession to bring pressure on ambulance services to ensure that professional practice and standards are maintained. Whereas now ambulance officers in NSW have no say in how St John (WA) operates, with registration there will be a profession and the profession as a whole may be able to bring change – that is one of the advantages of registration.
To return to the point, however, registration won’t make any immediate difference in the scenario discussed. Nurses and doctors, too, work in different areas, in different contexts and the level of service provided in a remote bush nurse clinic is not the same as one gets in a metropolitan tertiary hospital. In some areas a call to triple zero will see a response of 3 or more paramedics, a doctor, a helicopter crew etc, and in other areas you get a paramedic and a volunteer if you’re lucky. Paramedics currently work with volunteers with varying training and experience to deliver services in what is a vast country and where it’s not feasible to staff every ambulance with two or more full time paramedics. That will still be the case. The obligation on individual paramedics will be to practice their profession at ‘the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience’ and in that context.