Today’s correspondent asks
Why can’t paramedics work in hospitals? In clinical roles
Apparently there are legislative reasons.
There are no legislative reasons. Hospitals could employ paramedics in clinical roles if hospitals wanted to create clinical roles for paramedics. They would not doubt have to negotiate with the nurses and doctors to do so, but they could do it if they saw a benefit.
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Australian Emergency Law 
I think your response might have missed an element of what the author was asking. I think it’s clear that paramedics CAN work in hospitals, and they might even be able to work “in a clinical role” in hospitals, but (at least in some states), it won’t be much of a clinical role at all.
In QLD, for example the legislation has definitely NOT caught up with the professionalization of paramedicine. The last time I checked, paramedics who were not acting as employees of QAS had a severely limited scope of practice. I think they could only administer about 5 medications. I’m not sure if they’re allowed to start IVs, intubate, defibrillate, cardiovert, etc.
So I think that legislation doesn’t restrict them from working in hospitals “in clinical roles”, but in QLD at least, I believe it does SEVERELY limit their clinical abilities to an extremely small scope of practice – much less than any registered nurse could perform.
I think we’re confusing legislation with policy. There is no legislation that says paramedics cannot ‘start IVs, intubate, defibrillate, cardiovert, etc’. There is no law that says I cannot do those things. Whether a hospital wants to let them is a policy matter. The hospital sets the scope of practice for its employees and has to be satisfied that they are competent, so accepts some level of competence on registration but then no doubt has induction and training in particular skills. A hospital could create a clinical position and fill it with paramedics and could define their scope to include those things mentioned. There is no law stopping them.
Thanks Michael,
I can’t seem to find the reference now (I’ve been looking), but I remember seeing legislation that says that paramedics in QLD have to be employed by an ambulance service and, unless the service has been granted specific authority by the QLD government to delegate otherwise, paramedics working for a non-QAS service can only administer about 6 medications.
That may have changed, or my initial understanding may have been wrong, but I remember a case study we did at our university asking if paramedics in QLD could be employed by a school to replace a school nurse and the answer was no. because of the restrictions I’ve just mentioned.
Are you saying that you are unaware of any LAW that would restrict paramedic practice in non-QAS settings? Could I, for example, work to a normal scope of practice if I hired myself out to corporations as a “private paramedic” and just showed up with my own personal kit bags and medications to just … paramedic away with impunity? I didn’t think I could (though I’m AHPRA registered).
I think the confusion arises because you have in mind the Medicine and Poisons (Medicines) Regulation 2021 (Qld) Schedule 5. That schedule identifies the drugs that QAS officers can use. It also says that ‘first aiders’ can use methoxyflurane, adrenaline, naloxone and an inhaled asthma reliever; and that may be the ‘about 5 medications’ you referred to.
The Ambulance Services Act 1991 (Qld) further defines an ambulance officer as an employee of QAS (Schedule 1 definition of ‘ambulance officer’ and s 13). Paramedics do not have employed only by the ambulance service; they can be employed outside the ambulance service but if they are they cannot call themselves ambulance officers. If employed outside the ambulance service they cannot use or carry scheduled drugs unless they, or their employer, have an appropriate drugs authority.
There is indeed no law that says you ‘cannot work to a normal scope of practice if I hired myself out to corporations as a “private paramedic” and just showed up with my own personal kit bags and medications to just … paramedic away with impunity’. What’s in your kit bag depends on your scope of practice and you have to assess what is, and practice within, your level of competence. There is no law that says you cannot ‘start IVs, intubate, defibrillate, cardiovert, etc’ if you know how to do it. (In the days of AEDs everyone can and is encouraged to defibrillate and there’s been no change I law to allow that). You cannot carry any scheduled medications unless you have obtained an authority from Queensland Health and that would limit your scope of practice and my the issue that means you cannot offer your services; but drugs authorities can be given. You cannot ‘imply that [you] … provides or participates in providing ambulance transport without the approval of the Minister’ (Ambulance Service Act 1991 (Qld) s 43). You will have to have relevant professional indemnity insurance in place (Health Practitioner Regulation National Law).
That is indeed what I was looking for (but couldn’t find!), thanks for your help with that. That helps clarify why doing skills wouldn’t be a problem. But, in terms of a (non-QAS) hospital paramedic, would they be able to work under the drug authority of the hospital and work to the scope of their practice that way? Can a hospital delegate their drug authority to a paramedic?
Generally no, but applications could be made to Qld Health for necessary approvals and given the hospitals (at least the public ones) are administered by Qld Health if there was a policy decision to bring paramedics on board that wouldn’t be hard to arrange. And there are lots of clinical things a paramedic could do that don’t involve scheduled drugs hence my claim that hospitals could employ paramedics in clinical roles but that begs the question of what roles and what constitutes a clinical role.