Today’s question come from a NSW paramedic who has received the booklet ‘Paramedics: Welcome to the National Scheme’ published by the Paramedicine Board in July 2018. On p. 3 it says (emphasis added):
Check if you need to register. Anyone who works as or will use the title ‘paramedic’ (including people in non-clinical roles) must register with the Board. Students, medics, volunteer ambulance officers and emergency medical technicians (EMTs) do not need to apply for registration.
(And see also the video produced by the Paramedicine Board at http://www.paramedicineboard.gov.au/News/2018-08-18-get-ready-for-registration.aspx).
My correspondent says:
Previously, I had understood that the title paramedic will be restricted to those who are registered, and you have made references to people who would “hold themselves out to be” paramedics.
Further, in your blog of 10 June you said, at least regarding WA, “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. ”
In other words, it all turned on the use of the term, not the actual position held or work being done.
However, the line from the Paramedicine Board’s booklet now suggests that the restriction applies not only to one who would call himself or herself a paramedic but to anyone who performs the role.
I can imagine there will be some Ambulance Officers – perhaps those close to retirement – who want neither the status nor the cost of registration, but would like to keep doing their job, even though they would not be called a Registered Paramedic.
Given the statement in the booklet, do you think it will be possible for someone to continue employment with NSW Ambulance in a frontline clinical position (currently called a paramedic) without being a Registered Paramedic? In other words, is it possible for a non paramedic-registered employee to perform the same clinical duties as a paramedic without being understood to “work as a paramedic”?
If your previous advice remains correct that ambulance services can operate using staff other than paramedics, then is the wording of the booklet misleading?
In my view the wording of the booklet is misleading. The Health Practitioner Regulation National Law (‘the National Law’) appears as the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld). That law has been adopted in all Australian states and territories to create the national scheme.
The National Law operates by the protection of title, so only a registered health practitioner can use the titles reserved for that profession (ss 113-120). The National Law has very little to say on scope of practice. It does say that there are some practices that only relevantly registered health practitioners may engage in (see s 121 ‘Restricted dental acts’; s 122 ‘Restriction on prescription of optical appliances’ and s 123 ‘Restriction on spinal manipulation’). None of those are directly relevant to paramedicine.
There is no law that says what it is that paramedics do that distinguishes them from other people or other registered health professionals. Remember that ‘back in the day’ the term paramedic was reserved for intensive care paramedics. NSW Ambulance officers (at least) were given the title ‘paramedic’ at the stroke of an administrative pen (see NSW Ambulance ‘in the news’, 3 December 2007).
The Paramedicine Board is required ‘to decide the requirements for registration or endorsement of registration in the health profession…’ (National Law s 35(1)). The Board could determine that the appropriate qualification for registration as a paramedic is a first aid certificate. No doubt it will not do that because there is a common understanding that paramedics are something more than first aiders, but at this stage ‘paramedic’ remains undefined. With registration the term will mean ‘a person registered as a paramedic’ but that won’t add much context to distinguish between a paramedic and anyone else. It certainly means that today there is no clear indication of whether or not ‘medics, volunteer ambulance officers and emergency medical technicians (EMTs)’ are or could be paramedics (see Are St John volunteers paramedics? Should they be? (July 19, 2012)).
We can see that as the Board has endorsed some qualifications for admission – see http://www.paramedicineboard.gov.au/Education/Qualifications.aspx#approved-qualifications. So we can begin to understand what paramedics do by reference to the curricula of those approved qualifications. What it does mean is that if you do not hold one of those qualifications it is not that, in the future, you don’t need to apply for registration, it’s that you won’t be accepted for registration. We will begin to understand who is a paramedic by seeing who is not a paramedic.
The new rules also provide for grandfathering. One way to get registered, during the transitional phase is for an applicant to demonstrate that he or she “has practised paramedicine during the 10 years before the participation day for a consecutive period of five years or for any periods which together amount to five years and satisfies the Board that they are competent to practise paramedicine.’ But what does practice paramedicine mean? Again that’s not defined. But what the Board determines is ‘competent to practise paramedicine’ will give substance to the definition. As the registration processes continues it is the Board that will define what practice constitutes practice as a paramedic and therefore what essential skills paramedics, as opposed to first aiders and emergency medical technicians (whatever that might mean) have.
If it’s only protection of title, what’s the point?
The point and benefit of registration will come with time. At the moment anyone can call themselves a paramedic and so anyone, including medics, volunteer ambulance officers and emergency medical technicians, could apply for registration as a paramedic. The Paramedicine Board will accept some applications and reject others. Provided they do that on a principled basis that will begin to define what or who is a paramedic – and that is key.
At the moment who is a paramedic is up to whoever wants to use the title. With registration it is the profession, via the Paramedicine Board, that will determine who gets to join the club of ‘paramedics’. If they do that with integrity and build and maintain public confidence in the paramedic profession, other regulators will follow. For example under current law paramedics can carry and use drugs because they are endorsed by their employer. Under the Poisons and Therapeutic Goods Regulation 2008 (NSW), Appendix C, cl 7:
(a) who is employed in the Ambulance Service of NSW as an ambulance officer …, and
(b) who is approved for the time being by the Director-General for the purposes of this clause,
is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Director-General…
In the future health departments may decide to provide that ‘A paramedic’ can carry scheduled drugs ‘in the lawful practice of his or her profession’. That is the sort of language that is applied to medical practitioners (see Poisons and Therapeutic Goods Act 1966 (NSW) s 10) so a medical practitioner can carry scheduled drugs by virtue of their registration. That is not the case with paramedics, but it may be one day. If the Board throws the net too wide on who can be registered as a paramedic then the confidence of the government and the public may not allow that sort of development.
On the question of practice as a paramedic (as currently understood) when registration comes into place people can still practice their skills. An ambulance service could still employ people and still authorise them to practise as they do now. In the long term that may not be defensible and the community will say they want paramedics in their ambulances in the same way they want doctors in the hospital emergency room and nurses in nursing homes. As the status of the profession increases it will become harder for employer to engage non paramedics, even if they have the same training and skills, to do the work that becomes defined as paramedic work.
Registration is a first step in the developing professionalisation project. It is up to the Paramedicine Board to manage that project to create a unique profession of paramedicine. For more detailed arguments see Ruth Townsend, The Role of Law in the Professionalisation of Paramedicine in Australia, Unpublished PhD thesis, ANU, 2018.
When paramedic registration comes into place only a registered paramedic can use the title ‘paramedic’. Anyone who wants to use that title needs to register with the Paramedicine Board. Because the National Law does not define scope of practice people who are not registered will still be able to practice as they do now, but they won’t be able to use the title ‘Paramedic’.
Anyone who currently works, or think they work as a paramedic could apply for registration and if granted they will be able to use the title paramedic. Anyone who currently uses the title ‘paramedic’ will need to apply for registration if they want to continue to use that title.
… Ambulance Officers – perhaps those close to retirement – who want neither the status nor the cost of registration, but would like to keep doing their job, even though they would not be called a Registered Paramedic
Don’t have to apply for registration; but whether their employer will continue to employ them is a matter for that service. No doubt there are many industrial issues to be worked through during the transition phase – see Paramedic registration and changing the terms of employment (February 16, 2018).
If the advice from the Board is that ‘after registration you want to continue to practice in a way that is understood to be paramedic practice then you need to register even if you are not using the title’ then that is incorrect.