Today’s correspondent says:
In your post “What it means to be a professional paramedic” on 15 May 2021, you stated that “……..paramedics may practice in a number of ways, many of which we’re just waiting for entrepreneurial paramedics to invent.”
In the knowledge that I am a registered paramedic capable of cannulation and setting up drips and infusions, I have been asked if I I be interested in doing work for a non-paramedic employer (an allied health professional registered by AHPRA) to perform these particular skills on cancer patients undergoing alternative IV therapies in Australia, under the umbrella of this registered health professional and innovative cancer specialists from Japan and Germany.
As a registered paramedic in Australia, what might you see as any possible legal or registration complications if I was to work for a non-paramedic employer? Would I be considered that entrepreneurial paramedic you refer to were I to practice in that manner, or as my own entity, providing traditional paramedic skills to patients that are requesting such care, be it from within Australia or overseas?
\What would I need as a paramedic employee, or as a solo operator, to satisfy AHPRA and to protect myself (as far as possible) from any legal complications?
I cannot give legal advice on how to set up a business so I cannot answer the last question – ‘What would I need as a paramedic employee, or as a solo operator, to satisfy AHPRA and to protect myself (as far as possible) from any legal complications?’, but I can comment on the general principles.
As I have noted before, the Health Practitioner Regulation National Law does not define scope of practice, rather it works via title protection. If you are a registered paramedic, and you have the capacity to cannulate, and set up drips and infusions you are free to do that as an employee or as a private contractor.
The critical issue is complying with the Paramedic Code of Conduct. That says a paramedic has to deliver evidence based, patient centred care. In answer this I refer to the Advance Copy of Code of Conduct that is available on the Paramedicine Board website and which takes effect on 29 June 2022. (This post is written on 26 June, so the new code comes into effect next week). Importantly a paramedic must:
- 1.1(e) recognise and work within the limits of your skills and competence, and refer a patient to another practitioner when this is in the best interests of the patient;
- 1.2(a). ensure you maintain adequate knowledge and skills to provide safe and effective care;
- 1.2(b). ensure that, when moving into a new area of practice, you have sufficient training and/or qualifications to achieve competency in that new area;
- 1.2(d). consider the balance of potential benefit and harm in all clinical management decisions;
- 1.2(f). provide treatment options that are based on the best available information and are not influenced by financial gain or incentives;
- 1.2(g). practise within an evidence-based and patient-centred framework;
- 1.2(n). reflect on your practice and your decisions and actions in providing good and culturally safe care; and
- 1.3(d). investigate and treat patients based on clinical need and the effectiveness of the proposed investigations or treatment, and not provide unnecessary services or encourage the indiscriminate or unnecessary use of health services.
The proposal to practice with ‘an allied health professional … [providing care to] cancer patients undergoing alternative IV therapies in Australia, under the umbrella of this registered health professional and innovative cancer specialists from Japan and Germany’ raises a number of ‘red flags’. Are the alternative therapies supported by science and evidence? Is the paramedic familiar with the evidence in support of the treatments? Does the paramedic understand the limitations and contra-indications so patients can be property informed? Are the therapies legal in Australia?
Conclusion
In short paramedics can move into new areas away from traditional ambulance services. When considering new practice opportunities, a paramedic needs to be satisfied that the proposed work is within the limits of his or her ‘skills and competence’, that they have looked into the proposed treatments and have obtained adequate knowledge, skills training and/or qualifications to obtain competency and to provide safe and effective care. They need to understand the ‘balance of potential benefit and harm’ in the treatments so they can ensure that ‘treatment options … are based on the best available information’ and they can advise patient’s accordingly, or decline to provide care that is not in the patient’s best interests, They need to be satisfied that any treatment is ‘evidence-based and patient-centred‘. The paramedic must ‘reflect on [his or her] … practice’ and be satisfied that treatment is ‘based on clinical need and the effectiveness of the proposed … treatment’.
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.
Australian Emergency Law 
Hello Michael
I read with interest your comments regarding Paramedic moving into a new area of practice and entrepreneurial paramedics.
I am under the understanding that a person engaged as a “Paramedic” is a “Paramedic” whilst employed or engaged by a service provider licensed/authorised to provide services provided by a paramedic. For the purpose of AHPRA Registration, I understand this is primarily a protection of title.
A person wishing to provide services such as to practice with ‘an allied health professional … [providing care to] cancer patients undergoing alternative IV therapies in Australia, under the umbrella of this registered health professional and innovative cancer specialists from Japan and Germany’ is providing his/her services outside of the title of “Paramedic” but relying on their skill/qualification as a diploma/bachelor graduate in Health Sciences.
Would the practice and supply of these skills fall outside of the governance of the paramedicine Board?
No, a person is not a paramedic only whilst “employed or engaged by a service provider licensed/authorised to provide services provided by a paramedic”. First there is no list of what are services provided by a paramedic. If a paramedic is doing the work described in this post he or she is a paramedic and has to engage in good paramedic practice. If for example they don’t understand the treatment they are giving or if the treatment is not supported by appropriate evidence then a paramedic should not be involved. They would not be delivering good paramedic care and their registration could be at risk. If they don’t deliver good care they don’t gat to call themselves a paramedic so the practice and supply of those skills does not fall outside the governance of the Paramedicine Board. The Board regulates paramedics, not paramedic practice.