There are three new shows that have, or are soon to start, on Australian television
- “Emergency Call” on Channel 7;
- “Paramedics” on Channel 9; and
- “Ambulance Australia” on Channel 10.
We’ve all seen these reality shows before and there have been shows from the UK riding along with the ambulance services or broadcasting emergency calls. I’m sure they are great entertainment but how are they legal or ethical?
From an ethical point of view people don’t ring 000 in order to be a source of entertainment. They ring in order to receive services at times when they are most vulnerable. If an ambulance turns up either with cameras in the ambulance or on the paramedics, or worse, with a camera crew, those things are not there for the benefit of the patient. The ethical duty on the service and on the paramedics (more so when they become registered) is to act in their patient’s best interests and filming them has no therapeutic benefit for the patient.
Although there is no common law right to privacy so people can film whatever they see form a public place, inside a patient’s home or inside an ambulance is not a public place. Further there is a right to confidentiality in relationships that come with that expectation. Being in an ambulance (or a doctor’s surgery or an emergency department) would be the sort of places where an expectation of privacy is highest yet people are being filmed when they are at their most vulnerable. And their experience is being used for entertainment, not to advance patient care.
Paramedics Australasia (PA; of which I am a board member) says:
Members must maintain confidentiality of any information they obtain in the course of their work. They must not disclose any such information to a third party unless there is a legal or professional duty to do so.
Filming that information and releasing it to a television channel is not consistent with that principle. Of course PA is not a regulator. The Paramedicine Board is the regulator The Code of Conduct for Paramedics, that will apply when paramedics are registered says:
Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have a right to expect that practitioners and their staff will hold information about them in confidence, unless release of information is required by law or public interest considerations. Good practice involves:
a) treating information about patients or clients as confidential and applying appropriate security to electronic and hard copy information
b) seeking consent from patients or clients before disclosing information, where practicable
c) being aware of the requirements of the privacy and/or health records legislation that operates in relevant states and territories and applying these requirements to information held in all formats, including electronic information
d) sharing information appropriately about patients or clients for their healthcare while remaining consistent with privacy legislation and professional guidelines about confidentiality…
f) providing appropriate surroundings to enable private and confidential consultations and discussions to take place
g) ensuring that all staff are aware of the need to respect the confidentiality and privacy of patients or clients and refrain from discussing patients or clients in a non-professional context…
Coming in with cameras and worse, no clinical film crews is simply inconsistent with these principles.
With respect to collecting data, and in particular triple zero calls, the Privacy Principles enshrined in law say that an agency that collects data can only use that data for the purpose for which it is collected (Australian Privacy Principle 6). Agencies received triple zero calls for the purpose of dispatching emergency assistance. Using it to supply a television channel with content appears to be a breach of the Australian Privacy Principles (Privacy Act 1988 (Cth)).
It is irrelevant to suggest that the footage will only be used with the patient’s consent. It is being being recorded when they cannot consent or even if they can consent it is unfair and unreasonable to ask them to consent at the time of service provision. How is a patient assured that if they refuse consent, it won’t affect the level of care that they receive when the paramedics have cameras on their uniform and perhaps a cameral crew with them? When it comes to seeking consent to use the footage, there may be pressure on people too consent given the footage has already been recorded.
With respect to calls to triple zero, it is an offence to share calls made to triple zero. Under the Telecommunications Act 1997 (Cth) s 278 it is an offence for an ‘emergency call person’ (that is a person who receives triple zero calls and forwards them to the relevant emergency service) to:
… disclose or use any information or document that:
(a) relates to:
(i) the contents or substance of a communication that has been carried by a carrier or carriage service provider; or
(ii) the contents or substance of a communication that is being carried by a carrier or carriage service provider; or
(iii) the affairs or personal particulars (including any unlisted telephone number or any address) of another person;
A person rings the emergency services and discloses details about themselves to obtain an emergency response. Those details may be very personal and may be admissible in court proceedings or at least relevant to subsequent investigations. This legislation says that the person who takes the call is not allowed to share the information – what happens at work stays at work but not if a television station is allowed to record and rebroadcast that recording.
How are these programs legal?
I have no idea. I was asked this question some time ago and wrote to both NSW Police and NSW Ambulance media and received no response. I have no idea how the ambulance services can justify allowing these programs to be made. They may be great PR for the service and good recruiting they may even serve some role in community education but fundamentally they use the patient as a means to an end – the patient is being used for the purposes of the ambulance service or television station. To film events within an ambulance without the patient’s consent (even if it not used without their consent) is a fundamental breach of confidentiality and trust.
For related discussion, including a paramedics concern to protect a patient’s privacy see Bystanders photographing an emergency (February 2, 2016).
The cynic in me says the ambulance services are using these to garner public support when they’re under a lot of scrutiny and pressure around PTSD support, paramedic suicides, etc.
I know that doesn’t address the legal issues you’ve discussed, but…
With regards to patient privacy how is it acceptable that SAAS pager messages and activations are available in the public domain?
That’s a very difficult question and depends on the difference between radio and tele-communications – see Intercepting emergency service pager messages – amended (March 9, 2016) <>
My undergrad Sociology Teacher used to say the question to ask is ‘Who benefits and with what?’
A good question.
In Victoria, there is a hope (or at least this is what has been advertised to us) that this production will increase public awareness about:
i) occupational/workplace violence, minimise aggression and violence towards emergency service workers to provide a safer workplace (#itsnotok)
ii) appropriateness of requests for an ambulance, and access other health care services (Leave triple zero for emergencies)…
– this in turn may increase our availability to attend other cases who require emergency care.
– although this may also educate others, who would not normally call for an ambulance, to then call, e.g. chest pain, altered sensations, shortness of breath, ….
Any other thoughts how these productions may be beneficial?
The fact that the programs are a good idea and bring many benefits doesn’t resolve the issue of the duty of confidentiality and the ethical prohibition on using a person as a means to an end, that is the patient is the means to achieving these good outcomes rather than being treated as the end in him or her self. As noted earlier if you are a complete utilitarian the greater good may outweigh any harm done but a deontologist would take the view that ethics lines particularly those in the code of practice, cannot be ignored. Complex question and no doubt the ambulance services have thought of them but that doesn’t make the answer clear or the conclusion obvious.
I’d be interested to see any compelling evidence that this type of reality TV format is actually successful in getting those messages across and not purely lay blame on frequent callers, elderly, people from the CALD communities, the socially isolated and frankly people’s perception of what can be an emergency to them. Can the solution really be a string of reality TV shows in a commercial format? In turn I suppose it might also just reaffirm some people’s belief that it’s perhaps best if they transport themselves to hospital rather than be a burden?
A bit off topic, but related is – does a Paramedic have a ‘right’ to say “no”, I don’t consent to:
(a) being filmed at work, in the back of my ambulance; or
(b) having a media crew accompany me all shift; having my personal discussions with my partner in the front, interactions with patient relatives/friends or other emergency services, patient assessment and treatment, and handover to other healthcare professionals broadcast for all to see.
Well you would hope so. That’s really an industrial issue about what’s a ‘reasonable direction’. If I was a paramedic in this position I’d be asking whether being filmed came with an extra allowance, it’s a pretty big addition and change to the job.
Within Victoria, paramedics were invited to express an interest in having recording devices, film crew, follow their daily activities. Therefore primarily yes.
Although, if you are a crew that assist the paramedics with recording device or vice versa, I am not sure whether you have an opportunity to provide consent. Yet there is generally a Team Manager/Group Manager who drives in another vehicle who either obtains patient/family consent prior to paramedic entry or some time after their arrival, who may approach secondary crews and obtains similar consent from them.
In other productions within Victoria I believe there is a period that elapses to ensure that there is no legal issues surrounding the case. With this time there might also be an opportunity for consent to be confirmed or even removed prior to airing/final production.
Thanks dralspe, but doesn’t it concern you to think someone may turn up and seek consent from people who are waiting for an ambulance prior to paramedic entry – imagine you think you’re loved one is need of urgent medical care and before the paramedics come in someone asks can we bring a film crew? What are you going to say? Is that real consent?
As I’ve said before my concern is not so much with airing the final production but in actually taking the footage and trying to get consent from people who are in need of paramedic care seems fraught. Further it appears to me to be contrary to the obligation upon paramedics to provide ‘appropriate surroundings to enable private and confidential consultations and discussions to take place’, in an ambulance, with cameras recording?
One would also have to suggest that any informed consent given during a time of stress or under the duress of the film crew being physically present might be a little dubious.
If the AMBO services are making money from this—-then that`s your answer
What about the use of cardiac monitors that record audio at the scene? Protection for patient, bystanders, crew?
For a discussion on this topic see Audio recording by Ambulance Tasmania (February 26, 2018) <>
This is a great opinion piece. There has been quite a bit of debate on various Facebook and LinkedIn groups around the issue of consent vs informed consent and consent given under coercion.
Let me ask you though, how does this work for a deceased patient? There has been a lot of talk around the right to be forgotten on social media recently. I understand relatives can consent but do I really want to be remembered as the hairy guy who passed away in a messy situation? Can my relatives consent mean that I will be the new Bondi-Rescue-Resus video shown at every First Aid course across the country? Was the Japanese tourist fully aware that his near-drowning experience would get millions of views and be used in perpetuity?
The only person who can consent on behalf of the deceased would be the executor of their estate or next of kin. Subject to any advance direction yes I suggest that the ‘relatives consent [can] mean that I will be the new Bondi-Rescue-Resus video shown at every First Aid course’ and what’s more, if the video is shot from a public place you don’t even need the relative’s consent.
Nothing but sensationalism and ratings for advertising.
Let alone the confidentiality issues its raised.
The promotional clip of the female AV Paramedic is nothing but coached acting.
Australian “reality” TV shows have been a phenomenon and a fascination since the 1990s. I believe there is a book published on the subject in 2000.
This stoops to an all time low. It shpild be a subject in the next editipn of the APA DSM
I get the intention from AV and it is admirable. But I think it is a bit rich to essentially seek consent under what might be viewed as duress or under the pressure of the film crew.
Not referring to any specific show but as someone in the industry I don’t think it’s a particularly glowing example of what we do either.
We are the most trusted ‘profession’ and when the public see us on TV getting excited about Priority 1’s or disappointed when we are called off the ‘sick person’ I cannot help but think the trust diminishes.
The Lone Ranger raises some food-for-thought. Some of the imagery and audio is not great PR- comments like “Drive it like you stole it” and “let’s beat the airwing, we always want to beat the airwing” don’t sit well with me and others I’ve spoken to. Whilst it may be taken out of context, it portrays an unprofessional view of emergency vehicle driving and similar.