Following my post, Legal error in reporting on NSW paramedic registration bans (December 5, 2023) I received the following as a question/comment via Facebook, but I’ve decided to give a detailed answer as a post in its own right.

It is my understanding that when registration for paramedics in Australia was implemented, it required the passage of National Law legislation in each state to bring registration into effect (please correct me if I’m wrong). Out of interest, is there any legal reason that would prevent the NSW government from modifying this legislation such that registration would no longer be required for NSW paramedics? Obviously would possibly not reflect well on the government from a public relations perspective, but just wondering what options are open to them if paramedics opt not to register come the end of December.

It’s true that the national law is not really a national law at all, it is the same (or more accurately a similar) law passed in each jurisdiction to create a national scheme. It follows that NSW could pass amendments to the law as it applies in NSW. But I’m not sure why it would bother, even though the NSW government is threatening to do just that – see Michael McGowan and Laura Banks, Paramedic pay dispute threatens NYE emergency response, Sydney Morning Herald, 8 December 2023, which says:

… with thousands of paramedics threatening not to renew their registrations by the end of the year, he [NSW Health Minister Ryan Park] did not rule out taking the dramatic step of recalling parliament from its summer break to pass legislation to break the deadlock….

Park would not go into detail on what that legislation might look like, but said it could change rules to allow paramedics to work without registration.

People cannot call themselves, or be called, paramedics without registration but there is no law that says people who are not paramedics cannot work in ambulance services or provide advanced patient care. Registration is required for people who call themselves paramedics, but it’s not required for ‘ambulance drivers’.

An issue is not only must a person not hold themselves out as a paramedic (s 113(1)), but their employer must also not hold them out as a paramedic (s 113(2)) and that could see ASNSW in breach if it holds out that its dispatching paramedics if they’re not registered (eg by having ‘paramedic’ written on their cars). As I said in my earlier post that is probably avoidable by having an HSU member paired with a person who has renewed their registration.

As for drugs, the Poisons and Therapeutic Goods Regulation 2008 (NSW) Appendix C cl 7 says:

A person–

(a) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and

(b) who is approved for the time being by the Secretary for the purposes of this clause,

is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Secretary for use by such persons in the carrying out of emergency medical treatment.

Similar wording is used in r 101 relating to s8 drugs.

Those provisions don’t refer to paramedics, they refer to ambulance officers.  What is relevant is the terms of any authority issued under paragraph (b). If the approval is made to people personally, ie by name, there is no issue. If it is made by reference to position – eg ‘ambulance paramedic’, ‘critical care paramedic’, ‘intensive care paramedic’ etc then presumably an unregistered person is no longer a paramedic so no longer fits the description of an authorised ambulance officer. But that could be resolved by changing the terms of the authorities rather than any legislative change.

The final issue, as I see it, is an industrial one and whether it is an essential part of one’s job to be a paramedic (see Potential consequences of proposed NSW Ambulance industrial action (September 16, 2023)).  In that post I referred to the Paramedics and Control Centre Officers (State) Award 2022 (28 July 2022) and noted that:

It doesn’t specifically say that the person has to be registered with the Paramedicine Board but I think that can be implied given that only a registered person can use the title ‘paramedic’.

If registration is an essential part of the job then, I argued, fail to renew registration may amount to abandonment of employment, but that is not automatic. That may give ASNSW the option to terminate a person’s employment, but it doesn’t mean they have to, they could continue to employ their current staff, but not call them paramedics.  It really does depend on an interpretation of the award, the detailed job descriptions, and employment contracts and what they say about maintaining registration. I do not have access to those details so can say no more than it is possible that ASNSW could seek to terminate a former paramedic’s employment if they fail to renew their registration by 31 December.

Conclusion

The NSW government doesn’t have to change the law to allow ‘paramedics to work without registration’. Rather it would have to change the law to allow people to be called paramedics who are not registered or, and this would be legally easier, admit to the people of NSW that it is staffing its ambulance with a mix of workers, some of whom are paramedics and some of whom are not.  It need not affect the level of service but would affect the regulatory environment for those non-paramedics who continue to work as ambulance drivers.

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.