Today’s correspondent is ‘… a paramedic with Ambulance Victoria’ who says:
… as I’m sure you are aware the hospital ramping issue is a hot topic within the industry at present.
There is currently a lot of discussion regarding the paramedic scope of practice while ramping for hours, in particular paramedics taking blood tests from their patients once a doctor has seen the patient on the stretcher and ordered the blood tests. I’m just wondering if there are any legalities around paramedics taking blood tests, in particular a paramedic who is also trained and currently practises as a Registered Nurse on their days off from Ambulance Victoria.
For related posts – see
- Victorian Paramedics treating patients inside the A+E (June 12, 2015);
- Treatment in a Victorian hospital carpark (August 19, 2015); and
- Treating patients whilst ambulances are ramped (December 28, 2018).
The issue will always be what is ‘reasonable’ and that requires consideration of all the circumstances including the patient’s needs and the paramedic’s skill set.
There is more to a blood test than simply taking blood. A phlebotomist has to know how much blood to take for particular tests and which tube to put the blood in given that some carry additives for the various tests (see https://phlebotomygeeks.yolasite.com/resources/TUBEZ%20AND%20USES.pdf). There must also be a process to get the blood to relevant laboratory for the necessary tests to be done. And it has to be recorded that the sample has been taken and the necessary paperwork completed to ensure that the sample is correctly identified, tested and the results accurately reported in the correct patient record. I imagine that paramedics treating a patient whilst ‘ramped’ cannot access the hospital’s record keeping system nor the various pathology requests. And if the patient is not yet admitted, how does the sample get linked to the particular patient? If on the other hand, it’s a simple test like blood sugar levels then presumably paramedics can test that and record the result on their own patient record form.
If you take blood and it turns out it cannot be tested or used there is little damage done other than the patient has a needle inserted in their arm that they did not need and even if that were negligent, or a battery, it is not going to sound in significant damages. But it is unprofessional to expose a patient to a procedure that is not in their best interests or that has no therapeutic benefit.
Conclusion
In simple terms if a paramedic is asked to do something that is clinically indicated in the patient’s best interests and is within the paramedic’s skill including their skill set because they are also a registered RN, then I cannot see any legal issues in performing that task. It is consistent with both the paramedic’s and the hospital’s duty to act in the patient’s best interests. But one should always stop and consider whether the task really is within their skill set taking into account not just the procedure but the context in which it is to be performed.
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 
In AV we are not taught the skill of phlebotomy or drawing blood, including things like OH+S requirements for drawing blood, how to collect properly, or what the tests are designed to achieve I accept we do complete a similar task of inserting an IV Cannula however this isn’t drawing blood. As you have alluded too, there are other requirements for drawing blood, including labelling, bottling and sending off for testing.
A few questions
If we suffered a blood splash injury, i.e blood vs eye when performing a task like drawing blood under OH+S laws are we protected? Do AV or the health service have an obligation to train us in those skills, is a failure to do so a breach of OH+S laws under section 21 (in VIC)
For those staff holding duel registration, does the fact that we are currently employed as a Paramedic, on duty as a Paramedic using the paramedic skill set mean our PII is covering that role and our nursing PII not covering those skills as we are otherwise employed in another role? (I hope that makes sense)
First I wonder what protection people think the law delivers. Occupational health and safety laws (in Victoria; Work Health and Safety everywhere else) provide for criminal penalties if a duty holder fails to meet their duty. That doesn’t actually ‘protect’ anyone save for the idea that people want to avoid criminal penalties and therefore do what the law requires.
Perhaps the question means would you be entitled to workers compensation under the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic). The entitled to compensation for ‘an injury to the worker arising out of or in the course of employment’ (s 11; Accident Compensation Act 1985 (Vic) s 82). The question would therefore be whether the person was drawing blood in the ‘course of [their] employment’. On the one hand paramedics are employed to provide health care and there are risks of needle stick and splash injuries in many things paramedics do. One could argue that this was part of their work as registered health professionals. On the other hand, AV may well argue that this was not a duty they were employed to do and they were ‘on a frolic of their own’ – particularly if they are in fact a trained phlebotomist – and this was not part of their employment. How that would play out would depend on all the circumstances.
Certainly, if AV wanted paramedics to undertake those tasks – if it was part of their duties – it would have a duty to think about the risks to staff and take reasonable steps to mitigate those risks (Occupational Health and Safety Act 2004 (Vic) s 21). And one of those steps is to ensure they are competent whether by training or recognition of prior learning (s 21(2)(e)).
As for PII that is only relevant if the patient decides to sue you. And if you’re a paramedic working for AV and you negligently injure the patient then AV will be liable. They’re not going to escape that by saying ‘but you were drawing blood’ because the reason you were there, and looking after the patient, and trying to help with their care, is because you are an AV paramedic. If you do have PII as both a paramedic and a nurse then your PII insurers may want to fight with each other to see who has to pay but it’s hard to see what damage you will have done.