This question, in various forms, is often asked – see all the posts at https://australianemergencylaw.com/?s=volunteer+scope+of+practice. Even so it’s worth revisiting for people new to the blog and because it is clearly a common and recurring issue. The question is:
A large percentage of SA Ambulance Service SAAS staff are volunteers (approx 47% of the workforce).
SAAS trains lay people who volunteer on their 90+ rural stations in 3 distinct volunteer Authority to practice/Credentialing levels – Ambulance Assist (non accredited training), Ambulance Responder (Certificate II) and Ambulance Officer (Certificate IV).
Many of these volunteers are Registered Health Care Professionals’ including Nurses and Paramedics. Registered Paramedics volunteering for SAAS are currently limited to practice at the Ambulance Officer (Certificate IV) credentialing level.
Considering their registration status with AHPRA, could a SAAS volunteer who is a Registered Paramedic:
1. Be held to a high level of care or knowledge compared to a lay trained non-registered volunteer should an investigation occur e.g. coronial;
2. If a patient or relative discovered the volunteer was a Registered Paramedic and limited by the employing organisation to practice at a lower level of scope (despite medications and equipment being available to them on shift), could the individual volunteer or the organisation be at risk of legal action? Example could a family take action if they discover after the fact, the volunteer present at their family members cardiac arrest was trained in advanced life support procedures as a Registered Paramedic but their scope of practice was limited by the Statutory service engaging them?
The simple answer to both questions is ‘yes’.
A paramedic is a paramedic. A paramedic who is volunteering with an agency like SAAS, or any other ambulance service or event first aid service, is volunteering in an area that is part of the traditional paramedic area of practice. It is not the same as volunteering to help prepare meals on wheels.
A registered paramedic is expected to deliver patient centred, evidence-based care (see Revised Code of Conduct that takes effect from 29 June 2022). Whatever one’s assigned status, as a paramedic you know what you know. If you are asked to treat a patient a person with a Certificate IV may form a view about the patient’s condition but a paramedic may know to ask more or different questions or may be able to form a more complete picture of the patient’s condition based on the history, signs and symptoms. One cannot deny that knowledge. Where a person with the Cert IV may reasonably say ‘I think you should go to hospital’ a paramedic may know that the advice should be ‘I think you go to hospital as a matter of urgency and we, not your family member should take you’. To pretend you don’t know that just because, today, the service pretends you only have a Cert IV would be both unprofessional and negligent.
As for question 2 imagine you are indeed the relevant family member. How would you feel if you found that the person treating your family member had the skills and knowledge to identify the patient’s condition, knew what the recommended treatment was, had the skills and knowledge to administer the treatment but failed to do so to comply with a direction from the agency rather than acting in your family member’s best interest? Personally, I would make a complaint that the paramedic had failed to deliver good patient centred care.
The definition of unprofessional conduct is “professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers…’ What would the public, or paramedic peers, expect of a paramedic, on duty with an ambulance service and faced with a patient in cardiac arrest and who had “medications and equipment … available to them” but did not use them to benefit the patient? My guess is that paramedics would, and as a member of the public I would, expect them to use that equipment and medication particularly if they are part of an ambulance response.
It is important to remember that there is no fine line (at least in law) between what is first aid, or ambulance work or paramedic work. The Australian Health Practitioner Regulation National Law does not define a professions scope of practice. If you are a paramedic, and particularly if you are wearing an ambulance uniform and responding to ambulance calls (ie traditional paramedic work) then you have to provide patient centred care. Now there can be limits. If you don’t have the ‘medications and equipment’ that you would have if you were in an intensive care ambulance, then you cannot use them. If the patient’s condition is such that they will not be disadvantaged by a delay in waiting for the on-duty paramedic crew to attend, then it may be reasonable to hold off. But if it’s ‘life and death’ then a statement from the agency that you are only to pretend you have a Cert IV cannot be justification for not doing what you can within your skills and training.
Paramedics are registered health professionals. One of the advantages of that registration is that it can empower Paramedics to insist on providing appropriate care. It is no longer the case that an agency can say ‘you only practice at this level’ because the paramedics obligations are now owed to the profession and directly to their patient – not just or even to the agency for which they work or volunteer.
A paramedic or a nurse knows what they know and cannot deny that just because today they are volunteering in a ‘different’ capacity. Your duty is always to provide ‘reasonable’ care, but it cannot be reasonable to pretend to not know something. It can be reasonable to provide a lower level of care in the circumstances but only if there are good reasons for that decision. In my view telling a paramedic ‘pretend you are not a paramedic’ is not going to count as a ‘good reason’.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Associationand the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.