Today’s question is about currency for QAS paramedics who do not work ‘on road’.  My correspondent is:

… a paramedic in the QAS and my current role involves working in the communication centre providing secondary triage and assessing patients over the phone who have contacted 000. Other tasks involve providing clinical advice to dispatchers to ensure that the appropriate ambulance resources are sent to the right patients.

I believe that working on road is essential to maintaining clinical skills and clinical recency. Technical aspects of being a paramedic such as conducting physical assessments, calculating drugs, and muscle memory can only be maintained if they are regularly performed and practiced in real situations.

Several of my colleagues including myself who previously worked on road have accepted positions in the communication centres on a permanent basis under the premise that we would be provided with clinical on road time to ensure that our clinical skills could still be maintained. We were onboarded in these positions roughly 3 years ago and since then there has never been a roster which formally incorporated on road time. This has meant that many of us have not set foot inside an ambulance for 3 years despite us being registered paramedics. Adding to the complexity of this situation, our attempts to complete overtime on road in order to supplement our lack of clinical time when the organisation has advertised for additional on road officers as overtime are consistently being rejected as the argument has been made that we are more valuable in the operations centre so we either have to complete overtime in the operations centre or complete no over time at all.

Since our role is a supervisory role and thus the expectation is that we perform as such, how can we confidently provide clinical guidance to dispatchers and paramedics when we are clinically out of date? This has raised ethical concerns about our ability to remain clinically competent and whether or not we should even be providing clinical advice to dispatchers and other paramedics who call for advice.

So the question is essentially does the QAS have a responsibility to provide opportunities to their paramedics to ensure that their clinical skills are maintained? I guess another question is does the QAS have the right to decline us of the opportunity to complete voluntary over time on road because we would be “more valuable” working in the operations centre despite them seeking additional on road officers?

This is not a question that will have a clear answer, rather it raises principles and issues that need to be negotiated.

First are obligations under the Work Health and Safety Act 2011 (Qld) and the obligation upon the PCBU to ‘ensure, so far as is reasonably practicable, that the health and safety of other persons is not put at risk from work carried out as part of the conduct of the business or undertaking’ (s 19). The argument here would be that the health and safety of patients is put at risk by the lack of currency within the communications centre.   If that is a risk the PCBU (that is QAS) must take reasonable steps to address that risk and if allowing communications centre staff to spend some time on the road addresses that risk that is going to prove a reasonably easy and cheap risk mitigation measure.

Another argument relates to the professional obligation of paramedics. Paramedics are required to keep themselves current taking into account their scope of practice. It is recognised that ‘practice’ may not involve direct patient care. The Paramedicine Board’s Registration Standard: Continuing Professional Development (17 May 2018) (‘the Registration Standard’) says that practice means:

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

The practice of a paramedic in the communication centre may not be involved (usually) in ‘direct clinical care’. Their practice is as described above but within that practice they need to do not less than 30 hours of continuing professional development that ‘contributes directly to improving [their] competence (performance and behaviour) and keeping [them] up to date in [their] chosen scope and setting of practice’ (Registration Standard, p. 2).  If a paramedic identifies that spending some time on the road is necessary to achieve that objective, then that can be part of their CPD.   Of course, a paramedic simply going to work as a paramedic does not count as CPD (Paramedicine Board, Guidelines: Continuing Professional Development (17 May 2018), p. 3) but working ‘on the road’ is not part of the ‘day-to-day routine work duties’ (ibid) of the communications centre staff.  They would however need to identify how doing an on-road shift will contribute to their practice in the communications centre and formally reflect on the shift .   In the same way an on-road paramedic may be able to identify that spending some time in the communication centre is part of their CPD (see Paramedicine Board CPD activities that meet the standard (December 2019); see also Continuing Professional Development (CPD) for paramedics (December 5, 2018)). The extent to which the employer supports a paramedic’s CPD is a matter for negotiation (see Responsibility for paramedic skills maintenance (July 26, 2021)) though one would hope that QAS works with its paramedics to help them get the professional development that they have identified that they need and that meets their professional obligations.

Conclusion

There is no simple law that someone has written specifically about the obligation of QAS ‘to provide opportunities to their paramedics to ensure that their clinical skills are maintained’.  Rather the paramedics concerned need to negotiate with QAS but can point to the obligations of QAS under Work Health and Safety laws and the need for QAS and individual paramedics to ensure that paramedics meet their CPD obligations.  Exactly how that is translated into practice is a matter for negotiation and to that end could and should be raised with the relevant industrial union and professional bodies (for example two sponsors of this blog, the Australian Paramedics Association (Queensland) and/or the Australasian College of Paramedicine).

This blog is made possible with generous financial support from (in alphabetical order) the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), the Australian Paramedics Association (Qld), 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.

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.