Today’s correspondent is a paramedic who

… received a Signal 1 job (that’s the Victorian code for lights, sirens, urgent response) to one of the major nursing homes for a reported stroke patient.

On arrival at the facility, the receptionist was unaware of why we were there (pretty common, not a problem). She then asked us to read and sign a full A4 page document with questions relating to COVID-19 inclusion criteria; have we travelled overseas recently, have we interacted with other people who have been overseas recently etc.

She then insisted we submit to a tympanic temperature test.

My partner returned a reading of 37.3 and was refused entry to the facility.

I advised the receptionist that the normal temperature range is anywhere between 36.5 and 37.5 degrees Celsius.

She replied that her instructions were that nobody with a temperature over 37.2 would be permitted entry and the recently contracted security guard next to her desk would see those instructions were carried out.

We were both stunned.

A paramedic employed by a jurisdictional ambulance service is being refused access to a patient that on-site nurses had deemed to require urgent care and transport.

My question to you is; is that legal?

The question ‘is that legal’ raises so many issues because there are so many relationships at play. The operator of the facility has a duty to try to minimise the risk of COVID-19 to residents and staff, they also have a duty to ensure that residents get the medical care they need. Victoria ambulance also owes various duties to everyone involved.  The receptionist and the security guard have obligations to obey the directions of their employer and you cannot expect them to know whether 37.5o is or is not safe if they’ve been told no-one above 37.2 o  is to come in.  And you may think that’s an unreasonable and arbitrary line but all lines are arbitrary and we don’t know who came up with the 37.2 line or on what basis, but if it is a nursing home one might at least expect that medical advice was considered.

With all those variables the only question I’m going to answer is ‘is it legal to exclude a paramedic employed by Victoria ambulance’?

The Ambulance Services Act 1986 (Vic) does not give any statutory authority to allow Victoria Ambulance to insist on, or force entry (compare that to the Ambulance Services Act 1991 (Qld) s 38 ‘Powers of authorised officers’).  There is therefore no offence in refusing paramedics entry. (There may be relevant offences and obligations under nursing home licensing legislation regarding the proprietor’s obligations to residents but that is about the proprietor’s duties to the patients and that is beyond the scope of this blog).

The common law of necessity would suggest that paramedics can force entry – see Paramedics forcing entry to premises (March 25, 2014). The response has to be proportionate however and here they were not refusing entry to Ambulance Victoria or to everyone, just to one person. The other paramedic, my correspondent could go in and assess the patient and other paramedics may have been allowed in.  Using force to push past the receptionist and security guard would not only inflame the situation and risk injury, it may also have been unreasonable in the circumstances.

The Ambulance Services Act 1986 (Vic) s 39B says:

At the request of an operational staff member providing care or treatment to a patient or attempting to provide care or treatment to a patient, a police officer is authorised to remove any person who interferes or may interfere, by his or her presence or otherwise, with the provision of care or treatment.

Police could have been called and they could have ‘removed’ the receptionist and security guard but whether they would have done so is another question.

Imagine a paramedic turned up, untidy, obviously dirty uniform, unclean hands dirt with obvious dirt under the fingernails etc and strong body odour suggesting that they hadn’t had a shower for some time.  I don’t think anyone would think it would be unreasonable for a health facility to say ‘you’re not coming in here’.  In COVID-19 times the health risk is not so obvious but if there are indicia (in this case a temperature over 37.2o ) why would the right to refuse be any different?

Things are legal unless there is a law that says they are not.  The Ambulance Services Act 1986 (Vic) does not say that an occupier has to allow access to the paramedics, and in this case they were not refusing access to Ambulance Victoria just one paramedic. And if one were to consider their duty to their residents one cannot say that refusing access to this one paramedic was unreasonable where the institution had determined an indicium for access. Whilst that decision may have created an increased risk to one patient (ie they would be assessed by one, rather than two paramedics) it also reduced another risk to all the residents (the risk of introducing COVID-19).  It would no doubt be subject to a lot of expert evidence before anyone could determine whether the decision was or was not a reasonable response to the competing risks.


Given that they were not refusing access to Ambulance Victoria, and they were not refusing access for no reason I cannot see that the action was prohibited or unlawful.  It was not a breach of any provision of the Ambulance Services Act 1986 (Vic).  The issue is not however ‘was the action legal?’ but ‘was the indicia reasonable?’ and that’s a question for clinicians.