When I wrote my post Paramedics and drawing professional boundaries (July 30, 2020) I did think it had been some time since I’d received any questions. Between then and now I now have 8 questions/comments to respond to! If you have written to me ‘watch this space’ as I try to get through them, generally in the order received.
The first question relates to Chevra Hatzolah, a private ambulance service operating in Sydney, Melbourne and around the world, but this question relates to their Sydney (ie NSW) operations. My correspondent asks:
I wonder where non-secular jurisdictional services fit in here. In Sydney and Melbourne for example, I have come across Hatzolah, a charity serving their respective religious communities as an ambulance service. In NSW they have received funding in form of training and equipment from NSW Health and they respond to call outs in NSW Ambulance uniforms. Their webpage states:
‘Hatzolah should be called:
– for all medical emergencies
– to bandage a serious injury
– if you are involved in a car accident or witness a pedestrian struck
– even when in doubt. We are happy to assist patients that don’t turn out to be as serious as previously thought’
There have been a few interesting incidents with Hatzolah attending as they do not respond to calls from outside their religious community. Apart from the obvious question, ‘How is that legal?’, I wonder whether they fall under the private ambulance service banner or do they qualify as jurisdictional service due to the NSW Ambulance uniforms and equipment?
All I know about Hatzolah I know from their website https://www.hatzolah.com.au/ so the answer may not be comprehensive. The ‘when to call’ information, quoted above, can be found at https://www.hatzolah.com.au/about-us/.
On the news page they report ‘Hatzolah’s Bondi Lifesavers’. This is a report of an incident of ‘August 30’ but they don’t say which year. In that story they say:
SIX Jewish volunteer lifesavers from Hatzolah helped save the lives of two Indonesian Muslim teenagers who nearly drowned at Bondi Beach on Tuesday (August 30).
Hatzolah’s Mendy Litzman said his volunteers responded in less than two minutes when the call for help came through after the boys were rescued from the surf by Bondi lifeguards.
“We received the 000 call that patients weren’t breathing and we assisted straight away,” Litzman said.
“We assist everyone regardless of religion, race or gender, and I’m proud that we were able to help the teenagers that were plucked from the surf.”
I will accept their version, and that it is not true that ‘they do not respond to calls from outside their religious community’ so I won’t address that claim any further.
Also on their news page they report:
PARTNERSHIP WITH NSW AMBULANCE
Rabbi Mendy Litzman is the founder and President of Hatzolah in Sydney. Hatzolah started responding to emergencies in June of 2006. Since our inception we have rendered care for the sick and injured in the Jewish Community and anyone who calls.
Read the reports from NSW Ambulance.
The links to the website of NSW Ambulance but the specific pages are no longer at those links nor can I find relevant pages with a search of the Ambulance Service website. But let us assume for the sake of the argument they are a CFR (Community First Responder) unit.
NSW Ambulance operates cooperative arrangements to create community first responders now called ‘clinical volunteers’. NSW Ambulance says (at (https://www.ambulance.nsw.gov.au/get-involved/volunteer)
NSW Ambulance operates a number of clinical volunteer responder models across metropolitan, regional, rural and remote NSW…
Over 350 clinical volunteers provide first response clinical care to our patients in approximately 60 locations.
These programs are an important part of building the resilience of small communities and minimising the time between calling for help, and receiving initial care from clinically skilled responders, until paramedics arrive. This leads to improved patient outcomes.\
I will infer that Hatzolah is part of the ‘clinical volunteer responder’ network.
The Health Secretary is to ‘provide, conduct, operate and maintain ambulance services’. To that end he or she may ‘co-operate with or provide assistance to any person or organisation for the purposes of providing, conducting, operating and maintaining ambulance service’. He or she is also to ‘consult and co-operate with individuals and organisations (including voluntary agencies, private agencies and public or local authorities) concerned with the provision of ambulance services’ (Health Services Act 1997 (NSW) s 67B). Further ‘The Health Secretary may appoint such persons as the Health Secretary thinks fit to be honorary ambulance officers’ (s 67H).
Akin to a debate that’s been discussed here, the NSW RFS is the combat agency for fires in a rural fire district but that means they are to coordinate the response, it does not mean that RFS brigades are the only responders. The RFS can call on others such as the FRNSW, National Parks, the private sector or anyone that can assist (see Coordinating firefighting with NSW RFS, FC and NPWS (February 29, 2020). The Health Secretary may be responsible for ensuring that there are ambulance services available to members of the NSW community but that does not mean those services can only be provided by NSW Ambulance.
It is illegal (s 67E) to
(a) … directly or indirectly provide or take part in the provision of transport for sick or injured persons for fee or reward, or
(b) conduct for fee or reward any operations similar to the operations carried on by the Health Secretary under this Chapter,
without the consent of the Health Secretary and except in accordance with such conditions (if any) as the Health Secretary may from time to time impose.
Even if Hatzolah are not getting any fees they are still operating for ‘reward’ in the broad sense of achieving their purpose and objective and providing a valuable service to their community (see Castle v Director General State Emergency Service [2008] NSWCA 231). One assumes that Hatzolah have specific authority under s 67E but if they don’t the Health Secretary’s consent must be inferred by the decision to task Hatzolah in response to triple zero calls.
The legal status of Hatzolah is not clear but I would infer that the volunteers are appointed by Hatzolah to Hatzolah, they are not appointed by the Health Secretary to NSW Ambulance so I would infer that they are not honorary ambulance officers (though they maybe, I just don’t have those details).
It would appear that Hatzolah is providing an example of what might be called a ‘public/private partnership’ where Hatzolah is cooperating with the Health Secretary to provide ambulance services in Sydney’s Eastern Suburbs. It might also be akin to a visiting medical officer at a public hospital. The doctor has the right to admit patients for treatment but, in return, agrees to treat public patients as well. It would appear that Hatzolah accept private patients (ie you can call them direct) as well as public patients if they are allocated a task by NSW Ambulance via the Ambulance ComCen and the triple zero call process.
The question
The question I was asked was ‘I wonder whether they fall under the private ambulance service banner or do they qualify as jurisdictional service due to the NSW Ambulance uniforms and equipment?’ I suggest it’s a bit from A, and a bit from B.
They are clearly a private ambulance service but when responding to an incident at the request of NSW Ambulance they are providing a service as part of the ambulance services provided by NSW. In that sense they are part of the service provided by the jurisdictional ambulance service but of course subject to their own structures and the terms of any consent issued by the Health Secretary. They are not part of “NSW Ambulance” but they are part of the ambulance services provided to citizens of NSW in the same way that CFR units operated by NSW SES (https://www.ses.nsw.gov.au/volunteering-details/community-first-responder/) and NSW Fire and Rescue (https://www.facebook.com/frnsw/posts/community-first-responders-play-a-vital-role-in-small-communities-across-nsw-and/3246649385369616/) are part of those services. The first responders with FRNSW and NSW SES are also trained by NSW Ambulance and wear NSW Ambulance vests over their uniforms in the same way the Hatzolah volunteers are shown to do in the photos on their webpage.
Conclusion
It would appear (based solely on their website) that Hatzolah form part of the community first responder network established by NSW Ambulance. They are not part of NSW Ambulance, they are a private provider, but they work with and coordinate with NSW Ambulance. That doesn’t make them part of NSW Ambulance but it does make them part of the ambulance services provided to the citizens of NSW.
Australian Emergency Law 
The relationship between Hatzolah and NSW Ambulance is unique, and unlike the arrangements between other statutory authorities and NSW Ambulance. It took the current Hatzolah group many years of effort and negotiation to secure the current relationship with NSW Ambulance, and there have been some excellent clinical outcomes as a result of their extremely short response times and brilliant availability in the small part of Sydney that they respond in.
The relationship is governed by a Formal Memorandum of Understanding which sets out the obligations of each party which I imagine would be available under the NSW Freedom of Information arrangements.
Essentially Hatzolah are only responded to Category 1A incidents, and even then they are not responded to all 1A incidents in the Bondi Response area.
Whilst in attendance at those incidents Hatzolah volunteers are required to wear their provided NSW Ambulance Uniform, and identify themselves as part of the NSW Ambulance response.
In these circumstances Hatzolah volunteers are obliged to act in accordance with the NSW Ambulance code of conduct and as such Hatzolah is precluded from (amongst many other obligations) soliciting donations whilst acting in this capacity.
Hatzolah volunteers are further precluded from Self Responding to any incident as this is a direct breach of both NSW Ambulance Policy the NSW Ambulance Code of Conduct.
For Clarity, NSW Ambulance consider Hatzolah an Available NSW Ambulance resource for 1A incidents in the Bondi Response area only , and their volunteers act in accordance with the powers and responsibilities of an “Ambulance Officer” per the relevant act. They operate at the Clinical Volunteer – CFR Skill Level with an independant (basic) scope of practice and do not operate as Paramedics or Doctors on behalf of NSW Ambulance. NSW Ambulance will never dispatch Hatzolah on their own to any clinical incident, and their First Responders will always be immediately backed up with an Operational Ambulance resource.
As somewhat of an aside, Hatzolah are not considered an Emergency Service for the purposes of the Road Traffic legislation (even when acting in the course of their duties as NSW Ambulance Officers), and are not permitted to fit or use blue/red lights or sirens to their vehicles. This has been clearly agreed with them in writing for some years.
I would encourage anyone with first hand knowledge of behaviour not in accordance with these obligations to contact the NSW Ambulance Professional Conduct Unit with relevant details ambulance-complaints@health.nsw.gov.au
Hatzolah are part of the volunteer CFR unit, like the ones found in most the most isolated parts of NSW. They are trained up to the same skillset of these responders.