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.
Basically, one of the aspects of this whole shamozzle, is that the entire process is designed to look after those who are employed by state ambulance services, and those run by St. John. Anyone trying to register and whose not employed by the state, or, whose qualification is not from one of the ‘approved’ university courses, as laid out after the board consulted with – state ambulance services, will find it very hard, if not, nearly impossible to register with the board, let alone join Paramedics Australasia. And, they’ve ridden roughshod over all other qualifications and classifications for Medic’s, where, they had a huge opportunity to control the whole sector, public or private.
Sure, in the end, registration will work out, but only for those with a vested interest, since it’s lop sided in set up and a wholly narrow edged scheme. They missed the boat.
Jason, I don’t think they missed the boat, just that it’s a different boat. What I’m about to say is at best speculation in that I don’t have evidence to support it, but from my understanding of the process and the outcome I think you are right, that this process does favour those employed by the members of the Council of Ambulance Authorities (state ambulance services and St John (WA) and (NT)) but I don’t think that’s a mistake. The process is designed to limit who can call themselves a paramedic. When paramedics worked only for those ambulance services issues regarding patient safety and quality control were managed by the state. Note the submission by NSW Health to the Senate Inquiry into Paramedic Registration – they said:
In NSW, the majority of paramedics are employed by NSW Health through NSW Ambulance, which exercises strict clinical governance over paramedics through protocols, policies and procedures, as well as setting training and education standards for those who are entitled to call themselves paramedics. In addition, these employees are subject to NSW Health policies, including the NSW Health Code of Conduct, recruitment policies governing such matters as criminal record and reference checking, clinical governance oversight and a range of other policies…
The community protection argument arises because of the growth in the non-government sector. Anyone can call themselves a paramedic, so there’s no idea what skills and qualifications those that are practising outside the government services have (and for convenience sake I include St John (WA) and (NT) as a ‘government service’).
The development of the registration standards starts to define who is a paramedic. People who find that they can’t meet those standards will now know that despite what they used to call themselves, they are not paramedics. They can still work and practice, they just won’t be able to use the title.
That means in turn that people who contract with agencies outside the government services will know that if the private provider can supply paramedics, they’re getting a level of qualification akin to the government services; but if the private provider can’t then they’ll know that too. Either way the consumer is better informed.
And yes, the Board has chosen not to accept ‘all other qualifications and classifications for medics’. They’ve not adopted other qualifications, in the same way that the medical board doesn’t register people with paramedic or nursing degrees – they use their professional status to be able to define their profession and who is in it and paramedicine will be able to do the same. The Board could have accepted Diploma’s or even first aid certificates but that would dilute the professional standing of those with 3 year university degrees and the extra training that involves. Being able to define the profession and who is in it are key indicia that what we are talking about is indeed a profession.
The Paramedicine Board isn’t there to govern the ‘whole sector’ it’s there to govern the paramedic profession. They will govern the private sector when private sector employers chose to employ paramedics because that is what their customers want or because it’s easier. You don’t have to assess qualifications or character of a registered Paramedic because that’s done by the Board. A registered paramedic is a paramedic in good standing and when there are defined skills as to what makes a paramedic, the employer will know that this person has those skills. Private providers will be able to employ, and deploy, a range of people in their teams, whether they’re called ‘first responders’, ‘advanced responders’, ‘emergency medical technicians’ or whatever. But if they are called ‘paramedic’ that will mean something; just as it means something to identify someone as a ‘nurse’ or ‘medical practitioner’.
Today the word ‘paramedic’ means nothing. With registration it will mean something. Those that currently think of themselves as paramedics but who cannot meet the registration standards will know that from that date that they are not a paramedic. That’s not ‘missing the boat’ that’s sailing the boat for the very purpose for which it was designed.
Following in from this, even after the consultation process, it would seem someone has decided to change the goal posts. Now you need 1700 hours with the jurisdictional ambulance service. By what I am being told, military and private paramedical roles, careflight etc are not regarded as JAS hours.
I recall there is a federal law which states that a person has a right to earn a living. If employment requires someone to be a paramedic and loses their job because of a procedural change, the federal law comes into play. I wished I could remember the law the lawyer used to successfully defend a change to registration in another industry.
Your thoughts would be appreciated on these new unsolicited grandfather clause changes.
You can see a response to this comment as a seperate post – see Grandparenting for paramedic registration – some will be ‘in’ and some will be ‘out’
I am trying to gain some clarity in regard to using the term Paramedic. After being employed as a Paramedic (with MICA qualification) for 34 years, I resigned from AV two years ago. For the last six years I have been running my own small business providing first aid training and event cover. The skill set I use with event cover is that of a Senior First Aid Officer. I make it known that I served as a Paramedic and my website quotes “former Paramedic” and “served as a Paramedic for 34 years”. Is this accepted given current Paramedic Registration requirements. This may be a lame question but a colleague has brought this issue to my attention. Thank you…in advance.
The Health Practitioner Regulation National Law (as adopted in Victoria) says at s 113:
The table does not yet contain the restricted titles that will apply once paramedic registration commences but we can be confident it will list the term ‘paramedic’ in due course.
A person who worked as a paramedic before registration, and then after registration describes them self as a ‘former Paramedic’ or accurately says that they “served as a Paramedic for 34 years” would not appear to breach s 113. Those terms ‘former’ and ‘served’ are all references to the past. A statement by a person that they ‘used’ to be paramedic could not ‘be reasonably expected to induce a belief’ that they are currently registered.