Today’s correspondent has:

… a question regarding what a paramedic can do when “Off duty.”…

In acknowledging that with AHPRA registration comes greater responsibility in that one is always a paramedic now and not just when “on duty with the employer” like we used to be, I refer to a previous blog of yours regarding a medical practitioner being sued for not attending to a fitting member of the public next door just prior to the start time at his surgery, and being found neglectful in his duty of care as a result. Would it go without saying therefore then that we as paramedics are always obligated to provide paramedical care whether on or off duty, and across Australia?

If that is the case, would it be reasonable then, in order to provide comparable paramedic care (in line with the community expectation of paramedic) at an accident … to carry my own purchased paramedic equipment and consumables in my own small kit to use in such a scenario, provided of course I acted within what is reasonably expected to be that of a paramedic with my skills, experience and training?

Do you see any complications in this at all? I have always carried a bare minimum of items in the family car for my own family members so I could at least decompress a TP, stop bleeding and/or put up fluids, remove a foreign body or deal with an anaphylaxis, and accept the risk, one I would take for a family member, but broadening that to the obligations on the public of a registered paramedic and any possible recourse? Considering too that some paramedics may go over the top and have more elaborate kits/set ups, where is the limit?

First, there is no general duty to rescue ie to come to the aid of a stranger. The exception is in the Northern Territory where it is a criminal offence for

Any person who, being able to provide rescue, resuscitation, medical treatment, first aid or succour of any kind to a person urgently in need of it and whose life may be endangered if it is not provided,

to “callously” fail to provide that care (Criminal Code (NT) s 155 and see NT police officer gaoled for failing to render assistance (October 31, 2016)).

The case of “a medical practitioner being sued for not attending to a fitting member of the public” was Woods v Lowns (1995) 36 NSWLR 344; affirmed on appeal in Lowns v Woods (1996) Aust Torts Reports 81-376). Dr Lowns was at his place of practice ready willing and able to see patients. He was not ‘off duty’.  Further that case did turn on particular provisions of the Medical Practice Act 1938 (NSW) now repealed. The case also relied on various admissions made by Dr Dekker. That case did not hold that a doctor had a duty to provide medical care.

In Dekker v Medical Board of Australia [2014] WASCA 216 the Supreme Court of Western Australia set aside a finding that Dr Dekker had been guilty of professional misconduct when she failed to stop at a motor vehicle accident but instead drove to a nearby police station to report the accident and summon assistance. The State Administrative Tribunal had found that a doctor did have a duty to stop at a car accident. The Supreme Court said:

The duty, as formulated, arises without regard to the mental state of the doctor, the circumstances in which the doctor is, or may be, aware that a motor vehicle accident has occurred in his or her vicinity, and the circumstances of the accident. The duty as formulated would apply, for example, to a medical practitioner who lacked mental capacity or, for example, was affected by alcohol (eg, a doctor who has been drinking and takes a cab on the way home at the end of a long social evening). The duty would apply even if there were other emergency services on their way or already in attendance. It would apply irrespective of whether the doctor has other medical commitments (eg, if the doctor were on his or her way to perform an urgent operation). It would also apply irrespective of other, non-medical, commitments that the doctor may have (eg, a doctor on the way to a court to give evidence in answer to a subpoena). The duty as formulated would also require performance irrespective of the location of the accident. Thus, it would apply equally in a remote location in the bush where there is no town and no ready access to police or other emergency services, as in a city where the occupants of the vehicle or passers-by may be readily in a position to contact police or ambulance services. It would also require the doctor to attend where, in the circumstances in which the doctor is made aware of the accident or possible accident, it would appear that any injury would be minor.

Given the myriad and unforeseeable circumstances that can arise it is not possible for a general obligation to exist (see Further legal ruling affecting ‘Doctors as ‘good Samaritans’ – do I have to stop?’ (January 3, 2015)). We can safely say, for the same reasons set out by the Supreme Court, that paramedics are NOT always obligated to provide paramedical care [when] … off duty, and across Australia”.  Whether a duty to assist would depend on all the circumstances eg are they in the Northern Territory? Were they involved in the accident? What other competing demands are there? What did they know? How vulnerable was the person in need? How close are other services? Who else is on the scene? What equipment do they have?

In simple terms, there is no duty to go the aid of a stranger whether you’re a paramedic or not. Of course the answer is not the same if paramedics are on duty – see Failure to attend by NSW Police and Ambulance (December 18, 2013) and High risk industrial action by NSW paramedics (June 7, 2021).

Even if there is no duty to attend, paramedics may choose to assist. And like anyone paramedics can carry a first aid kit. And they can put into that kit anything they want to provided that it is not legally regulated. They can use any equipment that they have in their possession, where they are competent to do so.  A paramedic can ‘carry [their] own purchased paramedic equipment and consumables in [their] own small kit to use in such a scenario, provided of course I acted within what is reasonably expected to be that of a paramedic with my skills, experience and training’.

The limit is what is regulated and what is regulated is scheduled drugs. This has been a regular topic, in most jurisdictions the authority to possess, supply and administer scheduled drugs is given to employers who then authorise their paramedic employees. Generally an off duty paramedic does not have the authority to carry drugs, this is unlike medical practitioners who can make their own choices about the registered drugs they wish to carry in their ‘doctor’s bag’ – see Drugs in the (volunteer) doctor’s bag (WA) (July 7, 2021) and Paramedic’s authority to carry and use drugs (May 25, 2021) and generally all the posts that appear here: Like anyone, a paramedic cannot carry scheduled drugs without lawful authority and generally speaking, registration as a paramedic is not (yet) sufficient authority.