The correspondent who wrote to me, and prompted the answer in Paramedic registration if you are “working as a paramedic”? (August 6, 2018) has been following up with NSW Ambulance:

… on behalf of a growing number of employees who are reluctant to become registered as they are quite competent at their job and do not feel the need (or to pay) for registration, and who would not mind being called something other than “paramedic”.

In reply, the ambulance service explained that it believes that under Sections 113 and 116 of the national Law it would be insufficient simply to change uniform labelling as anyone arriving in a NSW ambulance and performing duties identical to those of a registered paramedic would effectively be being held out to be a paramedic, by both the individual and the service.  The expectation is therefore that all Ambulance Officers with the Award classification “Paramedic” (i.e. all clinical positions apart from Trainee, Intern and Volunteer) will become registered.

While NSWA is preparing to discuss with individuals their circumstances, it appears that no other option is being made available.  On the face of it, it seems the only alternative to registration in NSW is to seek reclassification as some form of non-clinical employee or to resign.  Since registration, and even the use of the term “paramedic”, have been introduced through circumstances beyond individuals’ control, it seems an unfair impost on employees who have been performing their duties safely and effectively for years.

Given your previous comments in various threads, I would welcome your further comment on the legality of this situation.

I repeat again I don’t claim any expertise in industrial law and these are industrial law issues but I will throw my 2c worth in to the debate.

Section 113 of the Health Practitioner Regulation National Law says

(1) A person must not knowingly or recklessly–

(a) take or use a title in the Table to this section, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the health profession listed beside the title in the Table, unless the person is registered in the profession, or

(b) take or use a prescribed title for a health profession, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the profession, unless the person is registered in the profession.

That section refers to using a title to give the impression that one is registered.  I don’t see how ‘being held out to be a paramedic, by both the individual and the service’ (even if that were established) would breach this section if their uniform clearly indicated they were something other than a paramedic.

Section 116 says

(1) A person who is not a registered health practitioner must not knowingly or recklessly– … (c) … hold himself or herself out as being registered under this Law…’

One can see how the NSW Ambulance argument applies there but equally if one was in a different uniform with different title it would seem to defeat that claim.  The Act says that it is an offence to hold oneself out as a paramedic. If there were steps to ensure that this did not happen, eg with a different uniform and badges that said ‘ambulance officer’ but not ‘paramedic’, then it would seem to me that no offence is committed under s 113 or s 116.

I think that is indeed part of the point of registration.  Today event first aid providers can supply people with all sorts of titles, including paramedic and patients and event organisers may not know what that means.  From 1 December 2018 those providers may continue to operate but everyone will know that people that have ‘first aider’ or ‘first responder’ or ‘EMT’ on their uniform are not paramedics, even though they may continue to practice as they have in the past.  Ambulance services may, in the future, chose to have ‘ambulance officers’ to do more routine or less urgent matters and save ‘paramedics’ for acute emergencies. Whether they will or not remains to be seen but it would be lawful under the Act in the same way that Assistants in Nursing exist and practice, but are not registered as nurses.

But just because there is no offence it does not mean that such an step would be reasonable or acceptable to either the government or the public.  The issue is not so much legal as political.  If the government of NSW said ‘we staff our emergency ambulances with non-paramedics’ that would be unacceptable, just as it would be to say that emergency departments are not staffed by registered doctors or nurses even if the people working there have medical and nursing degrees.  Medical practitioners are registered so everyone, including their employer, can be sure that they have been assessed and more importantly they are subject to open disciplinary proceedings and review by their peers should the need arise.

The Council of Ambulance Authorities (of which NSW Ambulance is a member) has accepted that registration is required, and governments have also accepted that the role and skills of paramedicine means that registration is justified for the benefits that will flow both to the public and the profession.  NSW Ambulance/NSW Health resisted paramedic registration when it appeared that only a degree would be an accepted qualification.  NSW Ambulance could have stayed out of the scheme and continued to employ ambulance officers who held the Diploma of Paramedical Science issued by the Ambulance Service of New South Wales.  Rather than say ‘our non-paramedics are as good as the paramedics in other states and territories’ NSW advocated for, and succeeded in ensuring that the ‘Diploma of Paramedical Science issued by the Ambulance Service of New South Wales’ is an ‘Accepted qualification for general registration in paramedicine’ – and NSW employees can be registered as a paramedic even if they don’t hold a qualification endorsed by the Paramedicine Board as a qualification for registration.  To now staff ambulances with non-registered health professionals would be inconsistent with every move that has been taken to ensure paramedicine enters the list of registered health professionals.

As for being unfair to employees there is always a transition when systems change.  If one couldn’t introduce a change to current employees nothing could ever change. One concession for current practitioners is the grandparenting clauses to allow people to register who have been working as paramedics even if they don’t have the accredited qualifications.   It may be ‘unfair’ but it is the will of the Parliament and it is the role of the executive arm of government (including NSW Health) to implement the will of Parliament.

The extent to which NSW Ambulance has to accommodate the concerns of current employees is, as I say, an industrial issue and beyond the scope of this blog.  I can imagine, however, that if NSW Ambulance did agree to continue to employ current practitioners in a clinical role but with a different uniform and different title, it would require quite a reorganisation of positions.  I would anticipate that non-registered ambulance officers would be subordinate to registered paramedics which may mean current senior staff would be considered more junior to current subordinates. Where there was clinical practice that was identified as being ‘paramedic’, NSW Ambulance may also seek to restrict the sort of practice engaged in by a non-registered employee. I can imagine that given the patient protection in registration NSW Ambulance may want to remove the drugs authority of a non-registered practitioner.    I would also anticipate that there would be a pay adjustment and a non-registered ambulance officer would be paid less than a registered paramedic.


If I was an employee and concerned about these issues, I’d be taking it up with my union as they are the experts in industrial law.