Today’s question comes from a paramedic who has moved interstate to take up:

… a senior operational position with a jurisdictional ambulance service. My position does not specifically require me to be a paramedic, however it is certainly beneficial and I believe that the paramedic experience I brought with me was a contributor to my originally obtaining the position.

Because I intend to continue to practice as a paramedic, and I have sufficient qualifications, experience and currency to do so, I have submitted my registration application. However, I do not yet have a certification/authority from my employer to practice to ‘paramedic’ level (as most jurisdictional ambulance services require). The certification process is quite comprehensive and involves many hours of ‘orientation’ and a series of clinical tests and scenarios that I am required to progress through.

My question is: Should I find myself in a situation where I am a registered (and suitably insured) paramedic and have the skills and experience to make a clinical difference by the application of a paramedic skill, however I do not yet hold jurisdictional certification/authority to do so, what reasonable considerations should be taken into account?

The impact of registration

It is my view that paramedic registration is going to bring significant changes to paramedic practice.  It will not make that difference on 1 December 2018 (the commencement date) but it will, over time.  One change will be to remove the need for this sort of assessment and the idea of an ‘authority to practice’ (see What is a paramedic’s ‘authority to practice’? (August 19, 2014)).

Today (17 October 2018) paramedics are not registered. Except in NSW, Tasmania and SA, anyone can call themselves a paramedic.  What a paramedic can and cannot do is not defined by law but by the person’s skills and training. It makes sense that in this environment employers want to assess a person’s skills and then say ‘as your employer we’re happy for you to do ‘a’, ‘b’ and ‘c’’.   That’s what an authority to practice is.  It does not make it illegal to do ‘d’, ‘e’ or ‘f’ but in the event of any allegation of unprofessional or negligent conduct it may allow the employer to argue you were on a ‘frolic of your own’.

With paramedic registration, I would expect that, over time, this will change.  First an employer will know that a registered paramedic has qualifications that meet the standards for registration so they don’t have to go and look at the course and try to identify the content.  Second the Paramedicine Board <<>>:

… has adopted professional capabilities for registered paramedics …

These capabilities identify the knowledge, skills and professional attributes needed for safe and competent practice of paramedicine in Australia and draw on the Professional Competency Standards – Paramedics Version 2.2 2013 published by the Council of Ambulance Authorities and the Australasian Competency Standards for Paramedics 2011 published by Paramedicine Australasia.

As registration ‘beds in’ employers will become confident that a registered practitioner moving from interstate has those ‘professional capabilities’.

Finally ‘The Paramedic Observer’ is reporting that

The Victorian government has taken a significant step to enhance the mobilisation of the paramedic workforce with its proposed Advanced Paramedic Roles Implementation Pilot, which will trial new roles for paramedics in rural communities.

What makes this move particularly significant is that Victoria has taken up this issue with the Council of Australian Governments Health Council. The Council has decided to task the Paramedicine Board of Australia with developing a nationally consistent approach to the scope of the practice, educational requirements and education provider accreditation for paramedic practitioners.

There has been no nationally agreed scope of practice for paramedics in the past outside of employer guidelines and protocols. Along with national registration, a national scope of practice will be a breakthrough in facilitating private practice by registered paramedics and expanding the role of the profession outside the traditional ambulance sector.

Once again, when there is ‘a nationally consistent approach to the scope of the practice … for paramedic practitioners’ much of this assessment when changing jobs will become unnecessary.

The answer

I can now turn to my correspondent’s question.  Assuming that my correspondent is a registered paramedic then his or her obligation is to provide care as a reasonable paramedic.   The Health Practitioner Regulation National Law, s 5 says:

“Unprofessional conduct”, of a registered health practitioner, means professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers…

The question would be “what would a registered paramedic’s peers make of a decision by a ‘registered (and suitably insured) paramedic … [with] the skills and experience to make a clinical difference’ who didn’t apply his or her skills or knowledge because their employer had not yet completed a process to sign off that the paramedic was competent and where no specific legal authority or endorsement was required for those skills (in other words it doesn’t involve the use of scheduled drugs)?”

The reasonable considerations that should be taken into account are what is the risk to the patient?  You may be able to make a clinical difference but perhaps the duty car is only a minute away so the delay won’t matter.  On the other hand if it’s act now or the patient dies then what’s more important – meeting the employer’s administrative needs (and that’s all it is) or saving the patient’s life.  And if you’re in attendance in the uniform or car of your employer would they prefer you let the patient die in order to comply with their administrative processes (and if the answer is ‘yes’ perhaps it’s time for another employer).

I won’t get into issue of potential negligence actions a) because I assume my correspondent or any paramedic both is, and believes they are, competent so I assume the procedure is not going to be done badly b) my correspondent has noted that they will be ‘suitably insured’ and c) the risk of such an action is so low as to be almost far fetched or fanciful for reasons discussed in many other posts on this blog.

In short if you’re a registered paramedic and you believe you have the skills and experience to make a clinical difference and in particular if the situation is urgent, then do it.   Any certification by the employer is not what gives you skills and experience, you either have them or you don’t.