I have been asked two questions relating to practice subject to conditions and prohibitions. My first correspondent:

… thought about the following scenario which may be an interesting question for the blog:

A registered health professional has conditions imposed on their registration which prevent the provision of clinical care, or a registered health professional who transitions to non-practising registration wants to engage in work as a first aider or event medic for a private organisation who provides healthcare services to the public. This organisation credentials both first aiders and health professionals as part of their clinical team.

Is an individual who engages in such practise as a first aider in breach of their registration conditions or non-practising registration?

What about the scenario where either of the above individuals assists as a good Samaritan to a member of the public and provides first aid care, aided by their knowledge? I am especially thinking about where the individual might be already registered to an app like GoodSAM.

The second question, from another correspondent was:

… can you please do an article or provide a link to one if already done on persons claiming to be paramedics when either unregistered or registered with conditions and operating outside of those conditions. For example I know of some claiming to be paramedics at a work place that is not on the approved plan or where no approved location is listed.

I did seek some clarification of the second question and my correspondend added:

… when there is an approved location as their condition and they are operating at a different site. My understanding is they can only use the title when operating under the conditions of the approved plan

Question 1

The AHPRA Code of Conduct which applies to most of the registered health professionals, including paramedics, defines practice as:

… any role, whether remunerated or not, in which the individual uses their skills and knowledge as a practitioner in their regulated health profession. For the purposes of this code, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with patients, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that have an impact on safe, effective delivery of health services in the health profession.

There are 15 registered health professions. Not all health professionals would be using their professional knowledge if working as a first aider or event medic – eg optometrists, podiatrists, Chinese medicine practitioners etc.  This question will be of most relevance to medical practitioners, nurses and paramedics.  I’ll limit my discussion to paramedics.

A paramedic who is working as a first aider or event medic cannot, seriously, avoid using the skills and knowledge they have acquired on the road to registration.  It would seem therefore that they would be practising their profession.

The Health Practitioner Regulation National Law primarily works through protection of title rather than restriction of practice. Prima facie then one might think a paramedic with non-practising registration could work as a first aider/event medic without using the title ‘paramedic’.  Section 75 of the Health Practitioner Regulation National Law (Qld) (the model adopted by the other states) says, however:

(1) A registered health practitioner who holds non-practising registration in a health profession must not practise the profession.

(2) A contravention of subsection (1) by a registered health practitioner does not constitute an offence but may constitute behaviour for which health, conduct or performance action may be taken.

It is not a criminal offence, but the practitioner could be subject to professional discipline.

As for a paramedic who has had conditions imposed on his or her practice it depends on what those conditions are.  In the recent case, discussed in the post Paramedic deregistered for sexual abuse of patients (July 3, 2023), the Tribunal made orders prohibiting the paramedic from any health practice specifically because he ‘was able to be employed as a first responder/medic team leader with Safety Australia Group without being a registered paramedic. Without a prohibition order, there may be nothing stopping him from applying for jobs that do not require registration as a paramedic.’  The order was made under s 149C(5) of the NSW Act and prohibited him from providing any form of health service including ambulance services which are, in turn, defined to mean ‘services relating to the work of rendering first aid to, and the transport of, sick and injured persons’ (Health Services Act 1997 (NSW) Dictionary).

Where a person is subject a prohibition order, failure to comply with the terms of that order is a criminal offence (Health Practitioner Regulation National Law (Qld) s 196A).  If the person’s registration is subject to conditions, failure to comply with the conditions is not a criminal offence but may be subject to disciplinary proceedings.

As for first aid care, I have argued elsewhere that a person who come across a scene where first aid is required should not be considered as practicing their profession such as to require Professional Indemnity Insurance nor, it would follow, with respect to any restriction on their practice.  Whatever has led to restrictions on their practice does not mean that they may not be able to help where life or death depends on it – see Eburn M. Registered paramedics, insurance and first aid – looking for coherence in law. Australasian Journal of Paramedicine [Internet]. 2019 Feb. 4 [cited 2023 Jul. 4]; 160. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/663.  I would hope therefore that it would not be considered a breach of either conditions or a prohibition order if a person stepped up to render assistance at an accident that they came across by chance and where their actions could relieve suffering or save a life.

I think it would be different if they have gone so far as to register with the GoodSAM app as then they are holding themselves out as being available to render care so I shall return to that situation, below.  In that case whether they are in breach of the terms of any condition or prohibition order would depend on the terms of those orders.  I think a person with non-practising registration could argue that they are not practicing their profession if they simply respond to provide CPR but as noted in my article cited above, that does not appear to be the view of the Paramedicine Board.

Question 2

This is largely answered, above. A breach of a condition is not an offence, but it may be subject to disciplinary proceedings where further conditions could be imposed or the ultimate sanction of de-registration. If a person has a condition that they are only to practice at a particular place they could not practice at another place – even if they did not call themselves a paramedic – as they would be using ‘their skills and knowledge as a practitioner in their regulated health profession’ (ie paramedicine) and whatever purpose that the conditions were meant to meet, would be defeated.

Conclusion

I think a paramedic who is working ‘as a first aider or event medic for a private organisation’ cannot help but use ‘their skills and knowledge as a [paramedic] practitioner’ regardless of the organisations scope of practice. I would think therefore that even if they are not using the title ‘paramedic’ they are practising the profession of paramedicine. 

Whether that is a breach of any conditions on their registration, or a prohibition order would depend on the terms of those conditions or registration.  A paramedic who holds non-practising registration or is in breach of conditions of their registration may be disciplined for such conduct.

A person who is acting in breach of a prohibition order commits a criminal offence.  I would think it would be intended that someone subject to a prohibition order is also not being held out as a fit and proper person to respond to an emergency call via the GoodSAM app. I would suggest that a court would consider signing up for that app would be a breach of a prohibition order and would also be a breach of relevant conditions of registration.

I don’t think a person who comes across a scene requiring assistance should be considered to be practising the profession if they render first aid but that is a debatable point.

A person who is eligible for registration, but is not registered, can do what they like provided they don’t use the title ‘paramedic’.

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.