This question raises the old issue of can I use my specialist skills when working with another agency – for other posts on this topic, see:  https://emergencylaw.wordpress.com/?s=volunteer+scope+of+practice

The basic principle will be that everyone wants you to save the patient’s life if you can.  No-one will look favourably on a person who says ‘I could have done more but I was concerned to cover my, or my agencies, arse so I did nothing and let the patient die’.  Or to be more polite and refer to the decision of the Scottish Sheriff in Fatal Accident Inquiry Under The Fatal Accidents And Sudden Deaths Inquiry (Scotland) Act 1976 Into The Death Of Allison Hume [2011] FAI 51 who said:

[The Incident Controller] in particular, considered that the rescue operation was “a success”. In his view he had adhered to the policies and procedures set out by Strathclyde Fire and Rescue Service. He had obtempered to the letter the instruction contained within the Memoranda from Strathclyde Fire and Rescue Service of the 14 and 27 March 2008. There had been no casualties other than the one to whom the Service was called upon to rescue.

Unfortunately this was not a successful operation: a woman died who had … survivable though life threatening injuries…

A person who fails to act when they could, but says ‘I strictly followed the agency rules’ is also not likely to be commended by the Sheriff or Coroner.  So now to turn to the question that arises in light of pending paramedic registration.  The hypothetical scenario is

… assume a paramedic is registered and maintains their skills through volunteer work or casual work and CPD.

They leave their state ambulance service role and move to the state fire department as a firefighter. In this state, the fire department is tasked with providing EMR (Emergency Medical Response) providing advanced first aid including BVM/Suction/o2 therapy to conscious patients, CPR and AED as well as other first aid where needed. If this paramedic who is now employed as a firefighter but still fully registered is called to an EMR event are they safe to only practice within the very specific protocols outlined by the fire department’s EMR protocol? If the paramedic is on the scene, as a firefighter, and observes something occurring which requires management outside the firefighter EMR skillset before the arrival of the ambulance and they do not intervene is there a liability?

If the ambulance arrives and the paramedics recognize the firefighter who used to work with them and is still registered (as described above) and request assistance where providing assistance would drastically improve outcome/save a life. Is the firefighter/paramedic to refuse, or assist? Again would there be liability here?

The first issue I need to consider is what does my correspondent mean by liability?  If they mean liability to pay damages, then the firefighter is an employee and the employer will be liable for any negligence.  Second if they are a registered paramedic we need to infer that they are actually competent and know what they are doing.  People have to back themselves.  There are no cases of paramedics being sued or liable. There won’t be liability of they perform their task competently and/or don’t make the situation worse.   Assuming the paramedic’s competent, liability for acting can’t be imagined.

Not acting is another matter.  Again however one needs to consider what is that they could do?  If they’re responding with the fire brigade they’re not going to have a drug kit, or an intubation kit, or any other ‘paramedic’ kit so what might we anticipate that they could do that a firefighter could not do?  But let us assume that there is some skill or procedure that the paramedic is trained in, is competent in, and which is not contra-indicated on clinical grounds.  The only thing stopping him or her doing it is that it’s not in the fire brigade procedures manual.

The fire brigades manual is however the minimum standard.  It’s not written for paramedics.  Assume that the patient dies and the evidence is that the procedure we have in mind would have saved them.  Who would you sue?  You know there is a paramedic there, you know they knew what to do and could do it but they chose not to because a rule book didn’t say they could.   Whether you win or lose that case it’s going to be unpleasant.

You would still sue the fire brigade – first rule of litigation is sue the defendant with money.  The action against the fire brigade would be based on the argument that they owed a duty of care to their patient particularly if EMR is one of their functions, and a reasonable fire brigade would not stop a paramedic using his or her knowledge and skills just because the fire brigade didn’t anticipate that they would have a registered paramedic on their appliance.  That is not to say that they would need to equip every appliance as an intensive care ambulance if there is a paramedic on board (which goes back to the question of what could the paramedic do without his or her kit to hand) but that if there is something that is indicated and for which the firefighter is trained and competent, why would any reasonable agency, with a core duty of saving life, want to stop that?

As for paramedic disciplinary action, a paramedic (once registered) may be subject to disciplinary action if he or she demonstrates ‘knowledge, skill or judgment possessed, or care exercised by, the practitioner in the practice of the health profession in which the practitioner is registered is below the standard reasonably expected of a health practitioner of an equivalent level of training or experience’ (Health Practitioner Regulation National Law Act 2009 (Qld), Schedule, cl 3).

What would practitioners of ‘equivalent level of training or experience’ expect?  On the one hand they would expect a paramedic to use the skills that they have been trained in to provide the best possible care to their patient.  On the other they may accept, or expect, a paramedic to practice as directed by his or her employer.  As a potential patient I would hope that they would expect the former.

Accordingly my first conclusion is that I can anticipate that there would be liability if ‘the paramedic is on the scene, as a firefighter, and observes something occurring which requires management outside the firefighter EMR skillset before the arrival of the ambulance and they do not intervene’.

As for the second question

If the ambulance arrives and the paramedics recognize the firefighter who used to work with them and is still registered (as described above) and request assistance where providing assistance would drastically improve outcome/save a life. Is the firefighter/paramedic to refuse, or assist? Again would there be liability here?

I cannot imagine why the paramedic/firefighter or indeed any firefighter would refuse to assist paramedics who asked for help particularly if the firefighters were there in an EMR capacity and so were not distracted fighting a fire.  If it could be shown that the failure to assist did make the situation worse, and there was no good reason for it (eg being engaged in firefighting) then again there could be liability.

For similar discussions see: