In recent times I’ve been asked to comment on whether a service being provided outside the traditional state operated emergency services is legal – see

In a comment made on FaceBook a correspondent said:

I’m just getting a bit tired of people using this platform to try and oust  people/services/practices. It’s not it’s intent…..or never used to be anyway.

My response was

I share your concern given that I’ve been asked to comment on services and no doubt their members are surprised to see their service discussed in this forum. I’m not sure how best to address that as people don’t have another ready forum to ask their questions. Given (so far) I have concluded that everyone’s acting ‘above board’ I hope that actually makes it easier for these services; but I agree it’s not nor has it been my intention to provide a forum for people to “to try and oust people/services/practices”.

Having said all that I’ve now been asked about another organisation in NSW that I won’t name. Their FaceBook page has pictures of vehicles with the word ‘ambulance’ on them, red/blue flashing lights and the emergency triple zero logo.  They offer, for a fee, to respond a first responder to a scene to “assist whilst waiting for an ambulance.”  I’m asked:

Would [they]… be in violation of Health Services Act by conducting fee or reward in NSW or any other legislation by operating similar to NSW Ambulance by advertising this post alone.

I like your thoughts of these points above as it raised questions about if it’s an Ambulance Service or First Aid Service in NSW.

Let me again stress it’s not my role to give legal advice and certainly not to someone who did not ask and I infer it’s not anyone from this particular organisation asking the question.

Health Services Act 1997 (NSW) s 67E

Trying to remain generic – the Health Services Act 1997 (NSW) s 67E(1) says:

A person must not–

(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.

Responding to an emergency at the request of a person may be conducting ‘for fee or reward any operations similar to the operations carried on by the Health Secretary under this Chapter’.  But there is a defence if the agency has the consent of the health secretary.  I have no idea whether the agency in question has that consent. Further, context is everything so if one wanted to actually judge whether they are in breach one would need to actually look at their work practices, something I cannot, nor am I prepared to, do.

First aid v ambulance service

The Health Services Act defines ambulance services as ‘services relating to the work of rendering first aid to, and the transport of, sick and injured persons.’

There is no definition of ‘first aid’.  In the ACT it is an offence to provide an emergency ambulance service without permission, but that prohibition does not apply to ‘an entity in relation to the provision of first aid’ (Emergencies Act 2004 (ACT) s 63. What distinguishes an ambulance service from ‘the provision of first aid’ is not explained. In an earlier post Unauthorised ambulance services in the ACT (February 7, 2020), I concluded “…the critical issue is patient transport- if you transport the patient you are providing an ambulance service …” and if you don’t provide any transport then it’s ‘first aid’.

One could make a similar argument in NSW that is if an ambulance service provides ‘first aid to, and the transport of, sick and injured persons’ (emphasis added) then a service that provides first aid, but does not transport the sick and injured is not providing ambulance services. That does not mean they don’t fall foul of s 67E.  Section 67E(1)(a) refers to transport but that is not the only way to breach the section. Section 67E(1)(b) is more expansive. Just because an organisation is providing only first aid (ie no transport) it does not mean they are not in breach of s 67E as the Ambulance Service of NSW will, for a fee, provide event first aid that may not include transport. For related discussions see any of the posts that appear here: and, in particular:

The Triple Zero logo

The Commonwealth government manages the triple zero call system – see They say (at ‘You can apply to use the Triple Zero logo and information by emailing Fire and Rescue New South Wales on with ‘Triple Zero logo’ as the subject line’.  The company the subject of my correspondent’s concern may have the necessary permission.

Red/blue lights

It is often discussed here that a person, or a company, cannot simply put red/blue lights on their car. But they can if they have the relevant permission. Equally they may be proclaimed as emergency workers which then gives their vehicles status as ‘emergency vehicles’ with all the rights and responsibilities that carries (Road Transport (Vehicle Registration) Regulation 2017 (NSW) Sch 2, cl 114(4)(q); Road Rules 2017 (NSW) definition of “emergency worker” and definition of “emergency vehicle”).  I have no idea whether the organisation the subject of my correspondent’s concerns has the relevant permissions.


The conclusion then is that s 67E says what it says. I cannot say whether any particular organisation is or is not acting in breach of that section as I do not know what authorities they have or the exact scope of their practice.

There is no clear, or even necessary, distinction between an ambulance service and a first aid service. Arguably an entity that provides out of hospital health care but does not provide any patient transport, is not providing an ambulance service but the implications of the distinction are not clear.

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 Association and 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.