This post is in response to these comments that were made in response to my earlier post Workplace first aider, paramedic or both? (June 14, 2019).
Indemnity insurance is a requirement of registration – I feel that point should be made again in this circumstance…
Could you please provide some clarification on PII? My understanding was that to be registered you must have PII.
PII is not ‘a requirement of registration’, it is a requirement of practice and they are not the same. The Health Practitioner Regulation National Law s 129(1) says
A registered health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in force in relation to the practitioner’s practice of the profession.
If indemnity insurance was a required in order to obtain or renew registration, s 129 would be meaningless because a registered health practitioner would have to have insurance in order to be registered. What follows is that you can be registered without insurance, you just can’t practice without registration.
In the context of that earlier post the discussion was about rendering first aid where a person is not employed as a paramedic, in that case in a supermarket, but is paid a first aid allowance. Equally there is the issue of simply rendering assistance at an accident or emergency whether at a workplace or on the street. Is that ‘practising’ the profession of paramedicine? As noted by Walton J in Attia v Health Care Complaints Commission  NSWSC 1066, (quoted in AJP article, p. 5)):
‘The word ‘practice’ … is not defined in the National Law. Nor is the phrase [‘the practice of the practitioner’s profession’] itself. There appeared to be common ground that the word and the phrase were attended by some ambiguity’.
The Paramedicine Board’s Professional indemnity insurance arrangements registration standard (17 May 2018)) says:
Practice means any role, whether remunerated or not, in which an individual uses their skills and knowledge as a health practitioner in their profession. For the purpose of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery of services in the profession.
Being a ‘first aid officer’ is a ‘role’; merely stepping up at an accident would not, in my view, fit the description of ‘any role’. Putting that issue aside, Ambulance Victoria in its response to the Victorian Ombudsman (see Ombudsman investigates Ambulance Victoria’s practice of charging for non-transport services (June 13, 2019)) said (at  of the Ombudsman’s report):
The definition of ‘treatment’ is critical from a clinical perspective. A paramedic’s taking of a patient’s vital signs such as blood pressure, oxygen saturation, temperature, heart rate/pulse, blood sugar, electrocardiogram (ECG), and other observations including the external physical condition or injuries are all core to the work and duty of care of paramedics. A targeted clinical history and a thorough physical examination are the cornerstones of good emergency health care.
A paramedic paid a first aid allowance or who just steps up at an accident will use his or her skills to examine the patient and form a view of whether an ambulance is required, whether urgent lifesaving first aid is required, or whether all that is required is ‘the humane provision of comfort and reassurance in a patient that doesn’t need transport to hospital and may or may not need ongoing medical care at all’ (, Ombudsman’s report).
In the circumstances under discussion however they cannot be expected to, nor be equipped to measure ‘blood pressure, oxygen saturation, temperature, heart rate/pulse, blood sugar, electrocardiogram (ECG)’ etc.
If however a paramedic equips him or herself with the tools associated with the practice of paramedicine, such as ‘an AED (Defibrillator), Glucometer for testing sugar levels, advanced airways such as Igels, blood pressure cuffs’ then it is much more likely that they will be seen to be practising their profession (see What equipment can an off duty paramedic carry? (June 11, 2019); Legal Services Commissioner v Walter  QSC 132 and Eburn, M ‘Registered paramedics, insurance and first aid – looking for coherence in law’ (2019) 16 Australasian Journal of Paramedicine) (‘AJP article’, p. 5). Having said that I would say that using a publicly accessible or employer provided AED is not really using advanced equipment but is, today, standard first aid procedure, but not doubt there are AEDs and advanced defibrillators used by paramedics. And a paramedic who choses to buy an AED and if they put that with other equipment such as that listed above, then they look more and more like someone who is practicing their profession.
So there are two possibilities, the paramedic providing first aid, paid or not, is using ‘their skills and knowledge’ as a paramedic suggesting that even in the first aid scenario they are practising the profession of paramedicine. But if they are not doing that sort of assessment that would be expected when turning out with their ambulance they are not doing a ‘paramedic’s assessment’ (to again quote from AV’s response to the Victorian Ombudsman, ) which would suggest that they are not practising their profession.
Who, then, is to decide? The question is ultimately not a matter for the Paramedicine Board. The Act says that practising without insurance ‘does not constitute an offence but may constitute behaviour for which health, conduct or performance action may be taken’ (s 129(4)). Health, conduct or performance action is action that ‘a National Board or an adjudication body may take in relation to a registered health practitioner or student at the end of a proceeding under Part 8’ (s 5). If the Board somehow became aware that a paramedic administered first aid when they were not insured and assuming that the Board did not dismiss that as either ‘frivolous, vexatious, misconceived or lacking in substance’ (s 151(1)(a)) or determines that ‘the health practitioner to whom the notification relates has taken appropriate steps to remedy the matter the subject of the notification and the Board reasonably believes no further action is required in relation to the notification’ (s 151(1)(f)) then the matter has to ultimately end up before Performance And Professional Standards Panel or a responsible tribunal. It would be that panel or tribunal that would have to determine whether the conduct in question constituted practising the profession.
Notwithstanding the definition in the Insurance Standard, I have argued in the AJP article and with reference to case law that there is more to practising the profession that just using the skills that one obtained in training for that profession. There (at p. 5) I quote from the decision in Legal Services Commissioner v Walter  QSC 132 where Daubney J said:
In Legal Services Commissioner v Bradshaw  LPT 21, Fryberg J… explained:
‘One would look for evidence of continuity, of repeated acts; one would look for evidence of payment for those acts; one would look for evidence of seeking business from members of the public, or at least from other lawyers; one would look for evidence of a business system; one would look for evidence of maintaining books and records consistent with the existence of a practice; one would look for evidence of a multiplicity of clients. None of those things is in evidence before me’.
Those indicia may be present with the first aid officer in particular ‘repeated acts’ and the business system of the PCBU, but they would be absent from a person who just steps up and helps.
If the panel or tribunal did decide that the paramedic was practicing the profession, they would then have to consider whether rendering first aid in those circumstances was unsatisfactory professional conduct. Unsatisfactory professional performance is conduct of ‘the practitioner … below the standard reasonably expected of a health practitioner of an equivalent level of training or experience’. If other paramedics say that they, too, would have rendered assistance in those circumstances even without insurance it may be held not to constitute ‘Unsatisfactory professional performance’ and that there is no case to answer.
The conclusion is that it is not ultimately for the Paramedicine Board to decide what constitutes ‘practising the profession’ that will in the very unlikely case that it arises in a first aid context and is not dismissed out of hand, be a matter for a Panel or Tribunal. Further it will be up to a Panel or Tribunal to determine if rendering assistance without insurance is unsatisfactory practice in all the circumstances.
The point of this post is to confirm that PII insurance is not a requirement for registration – a paramedic doesn’t need to be covered by PII insurance to be registered. It is a requirement for practice of the profession.
What ‘the practice of the practitioner’s profession’ means is undefined and ambiguous. In my view a person who renders first aid as a good Samaritan, and probably as a person employed in a non-paramedic role but who is paid a first aid allowance is not practising the profession of paramedicine if they render first aid, unless they have chosen to equip themselves with advanced equipment such as ‘an AED (Defibrillator), Glucometer for testing sugar levels, advanced airways such as Igels, blood pressure cuffs’.
For paramedics concerned about what side of the line they fall ‘… the easiest solution… is … to obtain appropriate ‘top up’ insurance to cover them whenever they are not covered by an employer’s or other third party PII arrangements. Such insurance is available’ (AJP Article, p. 7).