Today’s question was very long, so it’s been edited to capture what I think are the essential parts of the question.  I have also numbered the questions to make it easier to find the answers.

 My correspondent is a paramedic who works part time in a number of positions, including as a casual with NSW Ambulance and with a private provider. My correspondent says:

The private company I work for utilises me based on my current certificate to practice and scope of practice with NSW as an ICP.

1. Given the advent of paramedic registration and in noting that each state and territory ambulance service in Australia maintains their own CPG’s, training, assessment and scope of practice and subsequent certificate to practice, is my certificate to practice with NSW Ambulance transferrable to a ‘for profit’ private company that operates where I do?

2. Is the company I work for required to have their own separate CPGs, training and assessment and issue me a certificate to practice under their name and clinical governance?

3. If there was an adverse clinical event with me using NSW CPGs in my capacity as a paid private sector paramedic, and I was contested, could that risk my registration?

4. Would you think that the professional indemnity I have in being a member of HSU provide me with the necessary coverage in other states and territories of Australia (including India Ocean Territories) and international waters?

5. Would a private company …, hiring paramedics from each state and territory require permission from each ambulance service that the employer is employed with, to use their CPGs and scope of practice out of the originating state, in other states and territories in Australia?

6. Would each state and territory I work in require to be notified that I as a registered paramedic (or the company I work for) is operating in their state and territory under another states CPG’s and scope of practice?

Important limitation

After first writing my answer to these questions, a correspondent wrote and said ‘Is it possible that the questioner meant that they were to administer drugs under their Authority as a NSW ambulance paramedic?’ (see the comments, below). I did not read the questions that way so it is very important to note that nothing that follows refers to the possession, supply or administration of scheduled drugs. The authority that NSW paramedics have to use drugs is limited and only applies when working for NSW Ambulance. It is not transferable.

Nothing that follows should be taken to be talking about the possession or use of scheduled drugs.

What it means to be a professional?

Paramedics are registered health professionals under the Health Practitioner Regulation National Law. Their ‘authority to practice’ comes from their registration. As a registered paramedic they are free to hold themselves out as a paramedic and to practice ‘paramedicine’ (whatever that may entail) as they see fit. They don’t need an ‘authority to practice’ from NSW Ambulance or from anyone else.

Paramedics may practice in any number of ways, many of which we’re just waiting for entrepreneurial paramedics to invent. The traditional way to practice is however as an employee. If a paramedic is employed to practice paramedicine, then their employer may want to assess their skills and experience and define what it is they are employed to do. That is what is meant by an ‘authority to practice’ when issued by an employer such as NSW Ambulance. It is the Ambulance Service’s statement of ‘this is what we authorise you to do in our name’ (see What is a paramedic’s ‘authority to practice’? (August 19, 2014) but note that this post was written before paramedic registration came into force).

It is up to each employer to determine how they define what a paramedic is employed to do. A large ambulance service like NSW Ambulance with lots of experience, managers who are themselves paramedics and that is holding itself out as providing paramedic services and as being a world leader in those services is going to be quite prescriptive and be able to draw fine distinctions between paramedics – hence various titles and roles.  It makes sense that NSW Ambulance has detailed CPGs and attempts to define and certify what different paramedics can do. But the ‘authority to practice’ is their internal document. It is the ‘authority to practice as a paramedic employed by NSW Ambulance when working for NSW Ambulance’.  It is not an ‘authority to practice as a paramedic’; that authority is your registration.

Other employers won’t be able to do that. If I run a factory and am aware of my obligations to have first aid services available (Work Health and Safety Regulation 2017 (NSW) r 42) I chose to employ a paramedic. I’m not going to prepare CPG’s or define the paramedic’s scope of practice, that is what I’m employing the paramedic to do.

The obligation on a paramedic is to deliver the level of care that can reasonably be expected of a paramedic of equivalent training and experience. ‘The standard of care expected … [is] that of the ordinary skilled … paramedic …’ (Masson v Queensland [2020] HCA 28; see also Health Practitioner Regulation National Law s 5, definitions of ‘unprofessional conduct’ and ‘unsatisfactory professional performance’).

Let me then turn to the questions.

Question 1

Your ‘certificate to practice with NSW Ambulance [is] transferrable to a ‘for profit’ private company’ if that company wants to say ‘well employ you to do whatever NSW Ambulance employ you to do’. It is up to you as a paramedic, and the employer as the Person Conducting the Business or Undertaking, to determine whether or not that is actually fit for purpose in the jurisdictions in which they operate and the work that they (and you) do.

A certificate or authority to practice from an employer is a limit on one’s practice, not a licence. If your employer wants to impose the same limits as NSW Ambulance does, that is their lookout. Of course for an employer who knows little about paramedicine and paramedic practice it’s a useful shortcut but for a company that claims an expertise in the field, they can adopt it or not as they see appropriate.

Question 2

No, a company is not required to ‘have their own separate CPGs, training and assessment and issue me a certificate to practice under their name and clinical governance’. They certainly don’t have to issue a ‘certificate to practice’; they can just have a duty statement. Equally they don’t have to have ‘their own separate CPGs, training and assessment’.  Imagine an employer who employs someone as a first aid officer and that person has a first aid certificate issued by a Registered Training Organisation. The employer does not have to develop their own first aid manual and reassess the person’s competence. They are employed because they have a first aid certificate.

An employer can employ a paramedic because they are a paramedic. Their registration identifies that they are trained and a fit and proper person for that role. The various Codes and Standards published by the Board set limits and minimum standards, but a registered, professional paramedic can determine their own scope of practice based on their own assessment of their skills. If they need more skills and training, then they arrange that themselves as part of the CPD process.

Both an employer and an employed paramedic have obligations to their patients and their staff, and they have to make their own assessment on how they will ensure that patients receive appropriate care and that only qualified and competent staff are employed to provide that care. How they manage those obligations is up to them. 

Question 3

Absolutely, but it’s not because you’re ‘using NSW CPGs in my capacity as a paid private sector paramedic’. You have to provide good paramedic care which includes care that is of the standard to be expected of a paramedic with similar training and experience and meets the Paramedicine Board’s code of conduct, including ‘practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes’.

If you’re using ‘NSW CPGs’ that may be evidence that your practice was in ‘accordance with the current and accepted evidence base of the health profession’.  If you have no documented procedures that evidence may be missing. But if the CPGs aren’t appropriate in context, adherence to them may be evidence that you failed to consider ‘the balance of benefit and harm in all clinical management decisions’.  NSW CPGs may just not be relevant in areas of conflict or where there is less tertiary health care available.

If there is an adverse event and someone claims your care was not appropriate in the circumstances your registration is at risk. What CPGs you are using does not define that; it’s whether the care you provided, in all the circumstances, was the sort of care that other paramedics would consider reasonable in the circumstances.

Question 4

I cannot possibly answer that question. That needs to be directed to the HSU and an insurance broker and considered in light of the Paramedicine Board’s registration standard on professional indemnity insurance.

Question 5

A private company would need permission to use another agency’s intellectual property. In Paramedical Services Pty Ltd v The Ambulance Service of New South Wales [1999] FCA 548, Paramedical Services Pty Ltd was engaged to provide training to members of the NSW Fire Brigades (now Fire and Rescue NSW). In doing so they prepared a training manual. A review of that manual ‘… identified numerous similarities in course content and layout to course material used by the Ambulance Service of NSW. The reporting officers stated that there appeared to be high degree of plagiarism in the training manual’ (see [62]). Action by NSW Ambulance to report that to the Fire Brigades, and the decision of the Fire Brigades to terminate the contract, did not constitute a breach of Fair Trading legislation by NSW Ambulance.

The case is not directly applicable, but I cite it to make the point that if an employer say repackaged NSW Ambulance CPGs, ie produced a volume that said ‘Company X CPGs’ but they were a direct copy of the NSW Ambulance publication that would probably be a breach of copyright and yes, permission would be required to do that.

I suspect too, that you would need permission if, as a NSW Ambulance paramedic, you carried a NSW issued publication to work and carried it in your kit as your CPGs. I’m thinking here about using material issued by a government (NSW) for a private purpose and that may be in breach of public sector rules.  I do note that the NSW CPGs are available online. The Apple store app for ipad (https://apps.apple.com/au/app/nsw-ambulance-protocols/id1103576564) says:

The NSW Ambulance protocols and pharmacology are expressly intended for use by NSW Ambulance Paramedics whilst performing duties and delivering Ambulance services, for and on behalf of, NSW Ambulance. The protocols and pharmacology were current at the time of issue. The most current version of the NSW Ambulance Protocols and Pharmacology are available on the NSW Ambulance staff intranet.

Copyright NSW Ambulance 2016. All rights reserved. No part of this application may be reproduced or transmitted in any form or by any means, electronic or mechanical, including printing, recording, or by information storage  

You would certainly need permission if, during your work with a private provider, you had to use NSW Ambulance credentials to log into their internet to use NSW Ambulance IP for the benefit of the private provider.

I’m not an intellectual property lawyer but I think if you are going to use CPGs issued by one employer (and here I mean the printed volume or online access, not the knowledge in your head) for the benefit of another employer then you would need their permission. This is a question the private employer should direct to their lawyers.

Question 6

No.  A jurisdictional ambulance service does not need to know about every paramedic in their state. You’re a registered paramedic, the only agencies that have an interest in how you practice is your employer and the paramedicine board.

Conclusion

I have answered these questions to try and address a broader issue – what it means to be a registered professional. Paramedics are no longer simply people employed by jurisdictional ambulance services and jurisdictional ambulance services do not govern the paramedic profession. The regulator is the Paramedicine Board and professional paramedics can practice paramedicine as they see fit subject to the Codes and standards set by the Board.

An authority or certificate to practice issued by an employer is not required by the Health Practitioner Regulation National Law. It is an employer’s risk management process and part of defining what the paramedic is employed to do. It is not a legal requirement for practice; it is a legal requirement for practice with that employer. A paramedic’s right to practice comes with their registration.

Disclaimer

My hope here was to dispel myths about what it is to be a professional. As noted elsewhere this blog is not a place for legal advice and neither my correspondent nor any company they work for can rely on this advice for application to their particular circumstances. To actually manage their practice, any employer should refer these questions to a solicitor of their choice.