Today’s question comes from
… a member of a mine emergency response team [jurisdiction not stated] … [who holds] HLT41115 a Cert IV in Health Care.
There is an expectation that I should use an ECG (HLTCAR001 qualification) and perform cannulisation on patients (HLTHPS009 qualification). Neither of these two qualifications are on the Cert IV course list of core or elective units. In October we are being ‘trained’ by a provider to use interossa (sic) cannulas. On checking on Training.gov the provider does not have HLTHPS009 on their scope which I believe would render the training inadmissible.
I have served in a foreign emergency service and have always believed, medically, we can only perform tasks within our sphere of qualified competency.
My concern for both my ‘younger’ colleagues and myself is that in the event of an injury being exacerbated or worse, a fatality at the coronial enquiry/or any subsequent investigation we would be complicit and held to task.
Are you able to provide any clarity on this subject?
There is no list of procedures that says ‘you can only do these procedures if you hold these qualifications’. The rationale of the national training framework is to ensure that Registered Training Organisations (RTOs) meet relevant standards and that the training from one RTO can be equated to that from another RTO teaching the same competency. It is that which makes the qualifications nationally transferrable.
But you don’t have to be an RTO, or have the qualification in your listed scope, to provide the training. I could train someone in first aid but I could not issue a recognised first aid certificate and no-one would know whether my training was any good or up-to-date. It would be a silly person that paid me for first aid training.
An employer would, one hopes, want to provide training to staff that could be certified by an RTO as it would give them some confidence about the quality of training, knowledge about the competencies covered, and would give the employee a certificate that they can add to their CV. The use of an RTO would go so way to demonstrating, should it be necessary, that they have taken ‘reasonable care’ to ensure staff were trained and competent in the relevant task. It may also be necessary to demonstrate compliance with Work Health and Safety legislation, but it’s not mandated. As with both common law and work health and safety, it is always a risk assessment issue.
In this case the employer may be satisfied that the trainer can provide training that will make the employees’ competent in the skill that the employer wants them to perform. You don’t need a licence or a certificate to use an ECG or to cannulate. If you know what to do and how to do it, then it’s not illegal to do so. In any review the issue will be was the person competent more than what certificate did they have, though in some cases that will be relevant.
Let me assume then that my correspondent completes the training, cannulates and ‘an injury [is] exacerbated or worse, a fatality …’ (though I find it hard to imagine that it could cause a death, but I’ll accept that possibility for the sake of the argument).
My correspondent is an employee. As an employee they are held out by the employer to be competent and appropriate for the task. Other employees do not have a choice from who they receive care, they will receive care from the employer’s mine emergency response team. If there is negligence by the mine emergency response team, whether it is because they were not properly skilled, or being trained just got it wrong that day, then the employer is liable. Those responders are the hands and eyes of the employer, so their default is the employer’s default. Equally if the employer made a poor choice in the selection of the trainer that is also the employer’s problem.
If a person dies and the matter is investigated by the coroner or the work health inspectorate, it’s hard to imagine how the issue of cannulation would be relevant. But if we assume that it could be, and the coroner asks questions then my correspondent has the answers: “We were trained by the company, we did what we were trained to do”. If the training was substandard then that’s the employer or the trainer’s problem. Remember coroner’s cannot determine any liability – the coroner may make a recommendation eg that the employer should use an RTO for future training.
If my correspondent thinks that there is a risk to health and safety in the proposals that should be raised through the health and safety consultation processes at the workplace. My correspondent will not be personally liable for adverse consequences from undertaking tasks assigned by the employer in accordance with training that the employer has determined is sufficient. It may be that the employer is being imprudent in not using an RTO with the relevant training scope and maybe they don’t know that the trainer they have selected is not endorsed to issue that training, so make sure that is brought to the employer’s attention, but my correspondent is not going to be ‘complicit and held to task’ for doing that which the employer has directed and which is not illegal.
The procedure is less of an issue than the fluids being delivered. The real training is in why and how much fluid and what type of fluid.
People do die from cannulation.
If you are being trained on IO delivery, and you are cert 4 trained, how do you access local anesthesia? The drugs used are not in the scope of authorisation for a cert 4 medic. I know health W.A. will not allow it.
I would say, your employer needs to read up on the legislation.
Make sure you keep a written record as to what is expected of you, this way, your employer has some vicarious liability….they will develop selective memory when it goes pear shape.
A question that comes to mind is why on earth the company would be wanting to train their first aiders to cannulate, record ECGs or gain intraosseous access, because even if they did, first aiders are most certainly not qualified or legally able to prescribe or administer intravenous/intraosseous medications or fluids, or to interpret ECGs. Hard to see what good these interventions could do?
I’d also argue that significant harm can come these performing these procedures. It is not uncommon for patients to die of line sepsis from intravenous cannulae, and intraosseous access comes with a raft of other potential complications.
Every post can’t deal with every issue. I did edit the question where my correspondent made reference to the companies medical director and the relevant poisons licence on the basis that I didn’t think that was necessary to address the issue in the question ie is training that is not going to lead to a certificate of attainment from an RTO sufficient.
Thanks for the clinical information on how these procedures can indeed be fatal.
Apologies Prof, didn’t at all mean to criticise you’re excellent (as always) legal review, was more confused by the questioner’s dilemma. If there is a medical director present who’s able to prescribe drugs/fluids etc this makes much more sense!
Regarding the risks of IV cannulation, there are minor risks like thrombophlebitis and inadvertent arterial cannulation, but probably the most serious complication is introduction of pathogens into the bloodstream. Unfortunately one of the most common groups of bug implicated (staph species) are also the most deadly, and death from IV associated sepsis is sadly not uncommon.