This question came as a comment on an earlier post – What’s an ambulance? (May 28, 2017) – but it deserves a reply in its own right. The comment is:

… recently, and in the absence of any regulatory or legislative changes – SA Health has “required” any company who is providing event first aid/health/medical services, who operate a vehicle that “looks like an ambulance” – to apply for a Non-Emergency Patient Transport licence.

The more interesting bit is that this appears to be only based on the interpretation of legislation by staff who work within the newly formed Health Protection and Licencing Services Unit.

Would be interested to understand if you have any opinion on the application of licencing and regulatory frameworks based on a change of interpretation without there being any case law to provide stimulus for change.

Regulators always have to interpret legislation. If there is a ‘newly formed Health Protection and Licencing Services Unit’ then the people in the new unit have to read and come to an understanding of what the legislation they are required to administer says. It is entirely appropriate for them to adopt their interpretation (if it is correct) without ‘any case law to provide stimulus for change’. The question is whether the interpretation is correct.

The Health Care Act 2008 (SA) gives the following definitions in s 3:

An ambulance is ‘a vehicle that is equipped to provide medical treatment or to monitor a person’s health and that is staffed by persons who are trained to provide medical attention during transportation’;

An ambulance service is ‘the service of transporting by the use of an ambulance a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment’.

An emergency ambulance service is ‘an ambulance service that—

(a)        responds to requests for medical assistance (whether made by 000 emergency telephone calls or other means) for persons who may have injuries or illnesses requiring immediate medical attention in order to maintain life or to alleviate suffering; and

(b)       is set up to provide medical attention to save or maintain a person’s life or alleviate suffering while transporting the person to a hospital’;

Finally a non-emergency ambulance service is ‘an ambulance service other than an emergency ambulance service’.

It is an offence to provide a non-emergency ambulance service without a licence (s 58). A person other than the South Australian Ambulance Service must not provide an emergency ambulance service unless permitted by the regulations, granted an exemption by the Minister. The holder of a ‘restricted ambulance service licence’ (ie a licence to operate a non-emergency ambulance service) may provide emergency ambulance services in some circumstances (s 57).

The question therefore is whether a person who is ‘providing event first aid/health/medical services’ is providing a non-emergency ambulance service, not what their vehicle looks like.

First, they are not providing an ambulance service if they are not transporting patients in an ambulance ie ‘a vehicle that is equipped to provide medical treatment or to monitor a person’s health and that is staffed by persons who are trained to provide medical attention during transportation’.  An earlier definition referred to a vehicle that is ‘modified’.  In the earlier post I said:

In Police v Zammitt [2007] SASC 37 the defendant was acquitted of operating an unlawful ambulance service because even though the vehicles used were painted with the term ‘ambulance’ and fitted with warning lights and sirens ([27]), ‘The evidence did not suggest that the vehicles were modified to provide medical care to patients being transported’ ([28]).

The need for the vehicles to be ‘modified’ has been removed but there are still requirements to convert a vehicle from a standard car to an ambulance. The mere fact that it ‘looks’ like an ambulance is not sufficient.

Second one is not providing an ambulance service if one is not providing transport. A company that provides event health services but does not transport ‘… a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment’ is not providing an ambulance service, emergency or otherwise. This definition is not limited to transport to a hospital. A service that transports a patient around an event, eg from where they have been injured to a first aid post or medical centre is still providing relevant transport if they are using an ambulance (see Paramedical Services Pty Ltd v The Ambulance Service of New South Wales [1999] FCA 548)).  Even so an ‘event first aid/health/medical services’ provider may have a vehicle that looks like an ambulance, it may even be an ambulance, but if they are not transporting patients, it is not an ambulance service. If it’s not an ambulance service, a licence is not required.

A company or person providing ‘event first aid/health/medical services’ may look like they are providing an emergency ambulance service. If an ‘event first aid/health/medical services’ provider has a process in place where they are notified when a person is ill or injured, they respond to that notification because it is a request for medical assistance ‘for persons who may have injuries or illnesses requiring immediate medical attention in order to maintain life or to alleviate suffering’ and provide ‘medical attention to save or maintain a person’s life or alleviate suffering’ then it looks like an emergency ambulance service.  However, the definition requires that the medical attention is provided ‘while transporting the person to a hospital’ so if the service does not transport to hospital, even if they do transport ‘around the site’ then they are not an emergency ambulance service.

Conclusion

The critical issue in South Australia is not what the vehicle looks like, but whether patients are transported. An ‘event first aid/health/medical services’ provider that provides no patient transport, or if it does transport patients, does not use an ambulance to do so (regardless of the exterior markings), is not providing an ambulance service so it is neither an emergency, nor a non-emergency ambulance service.

If the ‘event first aid/health/medical services’ provider does transport patients, even if that transport is limited to transport from the site of injury or illness to a first aid room or medical centre, then provided the transport is in a vehicle ‘that is equipped to provide medical treatment or to monitor a person’s health and that is staffed by persons who are trained to provide medical attention during transportation’ then they are providing a non-emergency ambulance service, even if the people being treated have ‘injuries or illnesses requiring immediate medical attention in order to maintain life or to alleviate suffering’.  If it’s a non-emergency ambulance service, a licence issued under s 58 is required.

If transport is provided to the hospital, then the ‘event first aid/health/medical services’ is providing an emergency ambulance service and that is illegal unless authorised by the South Australian Ambulance Service or the Minister under s 57.