Today’s correspondent asks a question about
… handing over care to other paramedics/ supervisors to facilitate meal breaks while being ramped.
Officers will be forced to handover patient care to facilitate a meal break where a supervisor identifies crews, and workload allows or ramp times look to be excessive. This has been conveyed to be in the paramedics best Interest for health and safety reasons. Were it [is] really just to reduce meal overtime penalty payments.
Many of these supervisors have not had performed on road shifts for months and are hospital-based ambulance employed paramedics. My question surrounds responsibility for patient care if there was anything to go wrong with the patient. For example: a patient had an adverse reaction due to morphine administered by you and the supervisor or other paramedic crew member you have been forced to handover to was, unbeknown to you at the time, not capable of identifying the deterioration of the patient for reasons such as lack of patient exposure, lack of clinical experience, handling to many patients at once on the ramp. And the patient ended up with a hypoxic brain injury or worse due to lack of appropriate care who would be held responsible in the court of law?
There is no clear standard operating procedure provided on who is responsible if an incident like this was to occur?
As a registered paramedic do you have the right to refuse direction from a supervisor to take a meal break when patient care is your responsibility until handing over to hospital staff and patient is off stretcher?
One has to feel sorry for the ambulance services. One the one hand they are subject to industrial pressure to ensure that officers get their break entitlements (see for example HSU criticised by the Industrial Relations Commission (November 29, 2024)). The APA (one of the sponsors of this blog) said (Our Paramedics are being… – Australian Paramedics Association NSW | Facebook, 13 August 2024):
Our Paramedics are being pushed to their limits, often going without the meal breaks they are entitled to during their 12-hour shifts. This isn’t just an issue of comfort—it’s a critical concern for their health, well-being, and ability to continue serving the community effectively.
“There’s not a chance to sit down, switch off, eat your food, and not get a gut ache from eating too quickly,” said Mr. Brendan McIlveen, APA (NSW) Secretary.
Despite ongoing promises, the delays in opening new ambulance stations and adequately staffing them continue to put immense strain on our paramedics.
We’ve been waiting for years for these additional resources, and it’s time for action.
We deserve the support to perform our jobs safely and efficiently.
And (APA (NSW) | When will NSW Ambulance management heed their own advice and allow their staff to take breaks??? Reports are again being received today… | Instagram December 1 2024):
When will NSW Ambulance management heed their own advice and allow their staff to take breaks???
Reports are again being received today of Paramedics being told they can’t have a break due to NSW Ambulance not being able to cover the workload.
As NSW rings in the New Year spare a thought for Paramedics sweltering all over the state not able to take breaks to survive the heat!
NSW Ambulance – time to stop the meltdown!
I confess to being surprised of any paramedic being critical of their employer and supervisors taking steps to ensure that they get the breaks they are entitled to and see it as motivated by cost saving rather than the interests of their staff and patients. But everyone’s entitled to their point of view.
But let us turn to the legal issues.
Under Industrial law an employer is obliged to meet the terms of the employment contract whether that is set out in an award or an enterprise agreement. Were the agreement provides for breaks there has to be an attempt to meet that but it stands to reason that in a 24 hour emergency service breaks cannot be scheduled with precision so provisions are made to compensate staff who do not get the prescribed breaks, but the expectation is that people will get their breaks.
Equally under Work Health and Safety legislation a PCBU has to ensure, as far as practicable, a safe workplace which will also include necessary breaks (see the discussion in Carrying meals in an ambulance (October 17, 2022)).
An employee is required to comply with the lawful and reasonable directions of their employer (see the discussion in Paramedic’s use of AI for clinical practice (November 15, 2024)). A worker is also required to comply with policies and directions issued to allow their employer to meet its work health and safety obligations (Model Work Health and Safety Act s 28(d)).
It follows that if a member is directed to take a break where that break is in accordance with the relevant award or enterprise agreement then prima facie they need to follow that direction. One never wants to say a paramedic could never be justified in refusing to take a break when directed. For example, I can imagine that if a paramedic is in the middle of a complex resuscitation they would be acting reasonably to refuse to step out for a break. On the other hand, one may be involved in a very complex rescue with a critically unwell patient but where the rescue is going to take some time and of course it would be reasonable to have paramedics step in, and out, to ensure their safety and the ongoing care of the patient. But these are not the sort of situations being discussed here. Here the concern seems to be that the other paramedics are simply not up to the task. To assume that no other paramedic is qualified to care for the patient smacks of hubris rather than a legitimate reason to refuse to hand over to them.
Who is then responsible for the patient if something goes wrong? The answer is clearly the paramedic who at the time has the care of the patient. The idea that paramedic A could be responsible for the performance of paramedic B after paramedic B has taken over the care of the patient makes no sense. A treating paramedic doesn’t ‘own’ the patient. He or she is responsible for the patient care whilst they are caring for the patient. If they hand over to anther paramedic, then that second paramedic is responsible for the care he or she administers, and they are responsible and accountable for their decisions.
There is no ‘clear standard operating procedure’ on who is responsible because it simply isn’t needed. You are responsible for your actions and your decisions and not those of others. If a paramedic were somehow responsible for the future care of a patient, on site paramedics could not confidently hand over to jurisdictional ambulance services and presumably to other medical staff. What if the doctor failed to identify a deterioration of the patient? The paramedic would not be responsible for that doctor’s performance and neither would they be responsible for care provided by another paramedic.
Conclusion
In the context of waiting to offload the patient they are not ‘your’ patient. The service for which you work for is responsible for providing the care to the patient and they employ you, and others, to deliver that service. If you are directed to take a break and hand over to another paramedic, then the care for that patient ceases to be your responsibility. You are no more responsible for the conduct of your colleague than you would be responsible for the conduct of the doctors and nurses once the patient is ‘off stretcher’ or responsible for any adverse consequence of their ongoing care.
In short as ‘a registered paramedic … you [DO NOT] have the right to refuse [a reasonable] direction from a supervisor to take a meal break when patient care is your responsibility until handing over to hospital staff and patient is off stretcher’. A direction does not cease to be ‘reasonable’ because you doubt the competence of the colleague who is going to take over the patient care. If you really have serious questions about the other paramedic’s competence then that should be raised through internal or professional channels.
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.
Australian Emergency Law 
In the case where a patient had an allergy to morphine which was not handed over and the patient has a reaction after this being administered by paramedic B, does the responsibility then fall back on paramedic A? Or is it still B as they are expected to check contraindications before administering?
It all depends on what is reasonable in the circumstances which in turn is some classic risk assessment. What’s the likely outcome, I assume pretty bad. How likely? If the patient has a known allergy, very likely. What steps can A take to mitigate the risk? Tell paramedic B about the known allergy at the time of the handover. What’s the cost, inconvenience or conflicting interest? None – so A could well be negligent for failing to tell B. From B’s point of view what’s the risk if someone who is allergic to morphine is given morphine? Same as for A and assume pretty bad. How likely? here the issue is how likely is it that any random person will have an allergic reaction to morphine – that’s much lower than the risk where a person is known to be allergic but it’s not zero. What could B do to mitigate that risk? Ask the patient if they have any known allergies. What’s the cost, inconvenience or conflicting interest when it comes to that step? Nothing, so B could be negligent for failing to ask about known allergies regardless of what A said at handover. What is reasonable is to be judged against the standard of a ‘reasonable’ paramedic of similar skill, training and experience. What would you expect paramedics A and B to do?