This is one of those posts where you think ‘I’ll just sit down and write a quick answer’ and it turns into a major essay.  So perhaps make a cup of tea and settle back before you read this one.

Today’s correspondent is a Queensland paramedic who has a question regarding

… EEA’s [Emergency Examination Authority] when they no longer apply.

It’s my understanding that capacity is time and decision specific.

Let’s say a patient is assessed to be at significant risk to themselves, lacking capacity and requiring urgent assessment. They are transported under an EEA, they are triaged and ramped with paramedics.

The paramedics now feel that the patient has regained capacity (now sobering/ reduced emotion distress etc), however are now being held at hospital against their will due to the EEA.

Requesting a doctor’s urgent review is at times possible, however in the age of ramping and where EEA’s are commonly extended to 12 hours this is often not possible.

I’m wondering if the crew that wrote the EEA could then revoke it?

The Public Health Act 2005 (Qld)

I think this question again demonstrates a misunderstanding of the EEA (see Off duty Queensland paramedic and the EEA(July 11, 2025)). Paramedics do not detain a patient under an EEA. Paramedics detain a patient under the authority granted to them by the Public Health Act 2005 (Qld) s 157B. They then issue an EEA (s 157D). The receipt of the EEA is a ‘condition precedent’ that is a condition that must be met before staff at a public health facility can exercise their discretion to detain a person under s 157E.

Section 157B says:

(1) This section applies if an ambulance officer or police officer believes—

(a) a person’s behaviour, including, for example, the way in which the person is communicating, indicates the person is at immediate risk of serious harm; and

Example—

a person is threatening to commit suicide

(b) the risk appears to be the result of a major disturbance in the person’s mental capacity, whether caused by illness, disability, injury, intoxication or another reason; and

(c) the person appears to require urgent examination, or treatment and care, for the disturbance…

(3) The ambulance officer or police officer may detain the person and transport the person to a treatment or care place.

First let us note that the section does not require an assessment that the person lacks capacity. A mentally ill person who has capacity can consent to or refuse treatment (Mental Health Act 2016 (Qld) s 5).  The provision of the Public Health Act allows for involuntary treatment, and note here the use of the word ‘detain’.  The patient’s capacity is not an issue when deciding whether to act under s 157B.

Section 157E(1) says:

A person subject to an emergency examination authority may be detained in a treatment or care place that is a public sector health service facility for a period (the examination period) of not more than 6 hours starting when the authority is given to the health service employee under section 157D(4).

I won’t go into the definition of what is a ‘public sector health service facility’. For the sake of this discussion (given we’re talking about ambulance ramping) I’ll say, simply ‘hospital’.  So section 157E says the staff at the hospital can detain the person once they have received the EEA from the paramedics.

Section 157F says:

(1) A doctor or health practitioner may examine a person subject to an emergency examination authority to decide the person’s treatment and care needs.

(2) Also, a doctor or authorised mental health practitioner may examine the person to decide whether to make a recommendation for assessment for the person under the Mental Health Act 2016.

If the result of the examination is that there is no ‘recommendation for assessment for the person under the Mental Health Act 2016’, then arrangements must be made to return the person ‘to a place reasonably requested by the person’ (s 157P).

Chapter 4A of the Public Health Act, entitled ‘Health of persons with major disturbance in mental capacity’ was inserted into the Public Health Act by the Mental Health Act 2016 (Qld) and then amended by the Mental Health Amendment Act 2017 (Qld). Anyone familiar with paramedic registration will see that both those Acts were passed before paramedic registration came into effect on 1 December 2018. 

The Public Health Act refers to ambulance officers that is (s 157A and Ambulance Services Act 1991 (Qld) schedule 1) ‘an ambulance officer appointed under section 13 and an honorary ambulance officer appointed under section 14’. 

The Public Health Act also refers to ‘A doctor or health practitioner …’ (see for example s 157F).  The term ‘doctor’ is not defined but one would expect that everyone would accept it means a registered medical practitioner (and not, for example, a lawyer with a PhD). The term ‘health practitioner’ means (s 157A) ‘a person registered under the Health Practitioner Regulation National Law, or another person who provides health services, including, for example, a social worker.’  Paramedics are registered under the Health Practitioner Regulation National Law, so a paramedic appointed to QAS under s 13 of the Ambulance Services Act is both an ‘ambulance officer’ and a ‘health practitioner’ (and to add confusion they are also an ‘authorised person’ (s 157A)).  Given the legislation was written before 1 December 2018 it may not have been intended to put paramedics into two categories, but that is the effect of the current law.

Section 157F(1) says ‘A doctor or health practitioner may examine a person subject to an emergency examination authority to decide the person’s treatment and care needs’.  Given that a ‘health practitioner’ includes a paramedic and a nurse the section can be understood to say ‘A doctor, or nurse or paramedic may examine …’  But that literal interpretation cannot be correct– it cannot be any doctor, nurse or paramedic. If paramedics have delivered a patient to a hospital, and the hospital has decided to detain someone, then it cannot be the case that another paramedic could go in and examine the patient and determine what their treatment needs are and that they do, or don’t need, an assessment under the Mental Health Act. Nor could it be the case that any passing doctor or nurse could make those decisions. Section 157F is talking about what is to happen once a person is detained at a hospital, so it has to be read as a ‘doctor or health practitioner’ who is a member of staff at that facility.

Even that is too broad.  If paramedics have brought a patient to hospital, the triage nurse has decided to exercise the power under s 157E and detain the person, then it cannot be the case that the most junior nurse on staff can stop, talk to the patient and make an assessment under s 157F.  It must be a doctor, or nurse, or paramedic who is not only on the staff of the facility but who is authorised by the facility to make that decision.   We should, therefore, read s 157E as if it says ‘‘A doctor or health practitioner [employed by the hospital and authorised to make a decision under s 157F] may examine a person …’

The question

With that background I can rephrase the question. I think I’m being asked:

Let’s say a patient is assessed to be at immediate risk of serious harm, the risk appears to be the result of a major disturbance in the person’s mental capacity and the paramedic is of the view that the person requires urgent examination, or treatment and care, for the disturbance.  The person is then detained by the paramedics and transported to a public hospital where they are triaged and ramped with paramedics.

The paramedics now feel that the patient is no longer at risk of harm, is no longer demonstrating a major disturbance in their mental capacity or no longer requires urgent examination. 

Can they release the patient?

There are (at least) two possibilities here.

First

The first is that the patient, having been triaged and ramped, is not yet being detained by the hospital under an EEA. The paramedics must give an EEA to the staff at the hospital, and that means the staff ‘may’ detain the person, but if they have not yet got past triage that may not have happened.  Let us assume that the paramedics have given the details to the triage nurse orally, but have not handed over any paperwork so no EEA has been given to the hospital staff.

At this point the patient is being detained by the paramedics under s 157B. It has to be the case that paramedics can revisit their treatment decisions in light of new information (and see Mental Health Act (NSW) ss 20 and 22 and changing circumstances (June 4, 2020). Let us conduct a thought experiment.  Assume the patient is in the community and paramedics assess them and form the view that detention under s 157B is justified.  Before going any further, a person identifies themselves as a mental health professional and a member of the person’s treatment team – perhaps they are an on-call crisis responder who was also called by concerned family. This person may convince the paramedics that in fact the patient is not ‘at immediate risk of serious harm’. Or that an urgent examination is not required as the person already has a diagnosis, there is a treatment plan in place and the carer now on scene will manage the patient in accordance with that plan.

Even if the paramedics had determined to detain the patient under s 157B, they must now be allowed to change their mind when they determine the conditions under the section are not, or are no longer, established.

What difference does it make once the patient is ‘on the ramp’?  I would suggest none, the same scenario may apply there, where the person’s treating team attend the hospital and persuade the ambulance officers that the person’s ongoing detention is not required.

We know that at the hospital, even if the patient has not been admitted, the hospital does owe a duty of care to the patient (see SA Coroner makes recommendations with respect to ambulance ramping (August 1, 2025)) so it would be prudent to talk to the hospital staff and see if they are happy with the decision, but fundamentally at this point it is the paramedics who are detaining the patient and if they feel the conditions for their detention no longer apply, they cannot justify ongoing detention against the patient’s wishes.   Depriving people of their liberty is a very serious thing and can only be justified when permitted by law.  A paramedic can only be duty bound to detain a person when the conditions set out in that law are met (Stuart v Kirkland-Veenstra [2009] HCA 15).  If the conditions in s 157B are not met, then detention by paramedics cannot be justified.

Second

The second scenario is that the patient is being detained by the hospital.  Assume that the EEA has been completed and handed to the triage nurse and the nurse, acting with the authority delegated to them by the hospital, has made the decision to detain the person under s 157E.  Now the decision to detain the person is not the paramedic’s decision, it’s the hospital’s decision.

Can the paramedic rescind the EEA?  I cannot see how.  At this point the person is being detained by the hospital. The hospital having considered the information in the EEA has taken the view that the person should be detained for the purpose of the examination. That decision is made on the basis of the paramedic’s observations and opinions at the time the EEA was written, not now.

Again, let us consider a thought experiment. The paramedics have dropped the patient off and left the hospital.  Back at their station (they should be so lucky) the community mental health team contact them to find out what happened to their patient and where is the person now?  In discussion (as in the example above) the paramedics form the view that the patient is being cared for in the community and detention is not justified – the person is not in fact ‘at immediate risk of serious harm’ or does not require an urgent examination.  But the paramedics could not go back to the hospital and say ‘we’ve changed our mind’; they would instead say to the community health team ‘we took them to xyz hospital, you’ll have to contact them …’ 

Further, as argued above, the paramedics could not go back to the hospital and have another conversation with the person and say ‘as a health professional I’ve examined the person, and they don’t need a mental health assessment’.  Having handed the patient to the facility, and the facility having made the decision to detain the person, then it is the facility’s decision on what to do next.  The EEA is evidence of what happened, and the paramedics state of mind, at the time it was written but the question of whether detention should continue is a matter for the hospital, not the paramedics.

Finally, this scenario shows why the paramedics could not revoke the EEA. Having written it and given it to the hospital staff, they no longer have it.  The document is now on the patient record. The paramedics cannot go and remove it or put in another one as they are not in control of the patient’s record.  Equally if a paramedic wrote on a patient care record that the patient was hypertensive, the fact that they are no longer hypertensive would not justify changing the record that shows that they were hypertensive.  And just because they’re not now does not mean that they don’t need an examination to work out why they were and if there is some underlying cause that needs to be addressed.

If the patient is with paramedics on the ramp, but the hospital has made the decision to detain the person, then what justification is there for the paramedics to continue the detention? Section 157N(2) says:

The person in charge of the public sector health service facility, and anyone lawfully helping the person in charge, may exercise the power to detain the person in the facility with the help, and using the force, that is necessary and reasonable in the circumstances.

If a triage nurse has received the EEA, made a decision under s 157E but then said to the paramedics, “but we haven’t got a bed yet, this person will have to wait with you until we can clear some space” then the paramedics are continuing the detention on behalf of the facility, that is they are ‘lawfully helping the person in charge’ but that does not give them the power to substitute their own decision for the decision of a person in charge. In the same way if paramedics bring a patient in for resuscitation and remain in the room assisting whilst the ED specialists work, they can assist but it is not up to them to say ‘actually that’s the wrong thing to do, we’ll do this instead’.  At that point they are now assisting others but they are not the decision maker.  Certainly, as health professionals if they disagree with the decision they should be able to question it ‘What about …?’ ‘are you sure …?’ ‘have you seen this ….?’ ‘have you considered …?’ ‘do you think …?’ etc.  Equally in the circumstances they may, and should bring new information to the attention of the hospital decision makers (the doctor, the triage nurse) and certainly they should report (as they should with anyone on the ramp) if the patients circumstances or conditions change, but at this point the decision to detain is the hospital’s, and not the paramedic’s.

We can note too that if the hospital has decided to detain the person under s 157E and the person leaves, the person in charge of the hospital can authorise an ‘authorised person’ (which includes an ambulance officer) to collect the person and bring them back (s 157H).  That authorisation can remain in force for three days (s 157I).  It means that if an ambulance officer has transported the patient to hospital, the hospital has decided to detain them, but before they are admitted, the paramedic decides the criteria in s 157B are no longer met so he or she will let the person go, then the hospital can authorise their re-detention by the very same ambulance officers (s 157J)!

Conclusion

The question I was asked was ‘… if the crew that wrote the EEA could then revoke it?’ My answer to that question is ‘no’.  The EEA reflects the paramedics observations and belief at the time, not necessarily their thoughts now.  If the hospital has, on receipt of the EEA, decided to exercise its powers under s 157E then the ongoing detention is a matter for the hospital, not the paramedics.

Prior however, to the hospital exercising their discretion under s 157E, a paramedic acting under s 157B has to be able to change his or her mind and discontinue the patient’s detention if the paramedic is of the view that detention under s 157B is not, or is no longer, justified. But that’s not relevant once a decision has been made under s 157E.

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.