As I mentioned in a previous post, Regulating first aid services in Victoria (April 17, 2019) Victoria is planning to introduce legislation to regulate the commercial first aid sector.  In that post I said ‘It is my intention to travel to Victoria to attend the May forum.  I will report, via this blog, of developments in this interesting project.’ The forum was held on Tuesday 14 May.  This is my report.

Recognising that this was a very preliminary discussion, this is my interpretation of what was said.  There are no direct quotes nor is it any official or endorsed report.

The message from the speaker the Department of Health and Human Services was that there was a commitment to have legislation in place by 1 July 2020, but the content of that legislation was open to negotiation.  At this time nothing is written but they are engaging with the sector and those that engage first aid providers to inform a discussion paper to be released in June inviting feedback.

The proposal is to define standards of first aid.  At this stage they are taking about three tiers.  Here they did give these definitions:

Tier 1: Anticipated to cater for minor injuries and conditions.  Access to over-the-counter medicines. Usually managed by first responder (or similar titles), usually below health professional scope.  Call triple zero (000) for any emergency assistance. Minimum equipment may be defined (may include AED, EpiPen), Minimal clinical governance. Low licencing fee.

Tier 2: Anticipated to cater for moderate injuries and conditions, eg fractures, altered conscious state, serious bleeding. Stabilising patients and calling triple zero (000) for emergency assistance.  Drug permissions broadly equivalent to current NEPT [Non-Emergency Patient Transport] sector.  Significant clinical governance requirements.  Staffing provided to match event risk profile.  Minimum requirements for set up and equipment; and

Tier 3: Anticipated to cater for complex injuries and conditions eg critical illness, unconscious patients, behaviours of concern.  Use of critical care (including up to anaesthesia or IV sedation).  Emergency stabilisation prior to transfer. High level clinical governance.  Staffing provided to match event risk profile.  Minimum requirements for set up and equipment.  Reporting [on patient numbers and outcomes] to the Department.

(I note that the conversation confirmed that they were not committed to these definitions or to having three tiers.  There may be more (or less) depending on the outcomes of the consultations, but these are preliminary ideas to start the discussion).

The idea is that event organisers will need to conduct a risk assessment of their event, determine their first aid requirements and then engage an organisation licensed to provide Tier 1, 2 or 3 first aid as required.  Equally a first aid licensee will need to do their own risk assessment of the event and refuse an event if they assess a higher level of care is required.

It is organisations (including sole traders) rather than individuals that will be licensed.  Further, it was stated that there would be no inter-state exemption.  Anyone providing first aid services in Victoria would need to be licensed in Victoria.  The obligation will be upon licensees to ensure that all their volunteers and staff have relevant competencies and scope of practice to provide care at the contracted tier.

The speakers did agree that they wanted to ensure that they did not want to stop people doing first aid when they were aware that people needed care.  The aim is to regulate those that are providing first aid service to public events for ‘fee or reward’ (taking a broad view of ‘reward’) not those providing first aid at an unexpected event. They do not want to collect ‘mum and dad volunteers who get paid petrol money’ to stand by at the games played by their children’s teams.  They are also not seeking to regulate work places that are regulated by (in Victoria) the Occupational Health and Safety Act 2004 (Vic).  An employer who employs staff to provide first aid at the employer’s workplace will not be caught by the licensing requirements.

It was further noted that the licensing tiers would not stop first aiders providing care should injuries occur beyond the expected level.  For example, where a service provider was providing ‘Tier 1’ first aid, the first aiders would not be stopped from rendering first aid to a seriously injured person even though that was beyond the scope of their engagement.  If the expected risk of an event is ‘minor injuries and conditions’ but a person is in fact seriously injured, the first aiders will still have to respond and assist to the best of their ability.  The scheme is not designed to limit people’s capacity to preserve life as required.

There was a discussion of providing data to event organisers about patients both aggregated data (number of patients, type of injuries etc) and individual data.  The speakers took that on board as something the Act may be able to address.

Some people posted questions in response to my first post.  Again recognising these are not official answers but my answer based on my interpretation of what I heard:

Lets hope it flows through to training as well…

It was clear that it would not extend to training.  The Department of Health and Human Services was not in a position to regulate registered training organisations or training syllabi.

I hope it is broad in that it recognises the place of first aiders and the value of them, and doesn’t become overly burdensome from requiring much higher levels staffing and scope than are really needed. I hope it might also give small low risk events the confidence to operate with their own staff acting as first aid…

There is a risk, I suspect that the scheme would impose some burdens both in cost and what is required but that remains to be seen in the detail.  I did ask about staff employed by event organisers and whilst the detail is to be worked out I think the view was that if a person was employed by the event provider and was only providing first aid at that event then they would not be licensed as they are not in the ‘business’ of providing first aid.  We will need more detail before any conclusion on these issues can be drawn.

.. there is also the question of the level of insurance coverage and a minimum standard of equipment…

These issues are ‘within scope’ of the project.

I wonder how it will affect site-specific, employer-organised and funded first aid

That sort of first aid is not intended to be caught by this proposal. It’s not the delivery of first aid that is being regulated but the delivery by organisations that provide first aid to third parties for ‘fee or reward’.

… a pure volunteer service will not need a licence…

There was nothing said to suggest that a volunteer service will not need a licence.  If they are regularly providing first aid to third parties they will be caught up and need a licence.

I’m sure someone asked, but I can’t now find it, whether it would affect agencies like the CFA or SES where members may have to provide first aid as an ancillary part of their duties.  My answer would be no when it comes to first aid when fighting a fire or responding to any emergency, but it would if a brigade or unit wanted to provide first aid at a community event as a fundraiser (as described in Can NSW SES provide event first aid services? (November 13, 2016)).

Everyone should ‘watch this space’.  Whilst the Bill that is developed and passed will only apply in Victoria, once one jurisdiction leads the way, others may be expected to follow. A discussion paper is expected in June and then everyone will have more detail and the opportunity to respond to what will be more concrete proposals.