Today’s correspondent is concerned about a policy shift within South Australian Ambulance Service (SAAS) as it relates to

… the safety and welfare of its staff—particularly solo responder paramedics.

In South Australia, for many years, solo responder paramedics have been deployed to rapidly attend high-priority, lights-and-sirens Category 2 cases. Historically, these officers were not dispatched to incidents involving drug or alcohol intoxication, or to mental health-related cases, due to the inherent risks associated with working alone. Ambulance dispatch protocols explicitly excluded solo responders from such case types.

However, in recent months, this safety directive has been removed from policy and procedure. Dispatchers are now permitted to allocate solo responder paramedics to any type of incident, including those involving highly intoxicated individuals, persons under the influence of illicit substances, and potentially volatile mental health situations. Under the new approach, the attending paramedic is expected to make an on-the-spot “dynamic risk assessment” upon receiving the job and may decline to attend if they deem it unsafe.

This policy shift has raised significant concern among operational staff. Many believe that paramedics may still feel pressured to respond, even in potentially dangerous circumstances, creating a foreseeable risk of assault or other harm. Management has responded to these concerns by stating that attendance decisions rest entirely with the individual paramedic, who is responsible for applying their risk assessment at the time of dispatch.

The change has reportedly been driven by increased workload pressures. Dispatch management has advised that, regardless of potential dangers, if a job is classified as a priority case and no other ambulance crews are available, solo responders will be tasked. It has been suggested that dispatchers themselves could face personal liability if they fail to send a responder to a priority call and an adverse outcome occurs.

My question is whether this change in practice represents a failure on the part of the Ambulance Service to adequately discharge its duty of care to solo responder paramedics, given the clear and foreseeable risks associated with sending them alone to potentially dangerous incidents, even if management has stated the choice is for them to make.

Additionally, in relation to the above, I seek clarification on whether dispatchers could, in fact, be held personally liable if they received a case that was clearly inappropriate for a solo paramedic to attend—such as an incident involving an intoxicated or drug-affected patient with no police present—and chose to hold the case until a full crew was available.

Furthermore, if a solo paramedic were dispatched to one of these higher-risk cases (that they would not previously have been allocated to), and felt compelled to attend for any reason, but subsequently suffered an assault or injury, to what extent could the Ambulance Service be held liable? I also question whether there could be implications for workers’ compensation approval in such a scenario—particularly if the Service argued that the individual was at fault for not declining the case despite obvious safety concerns.

The simple answers are ‘no’, ‘it depends on what you mean by ‘personally liable’’ and ‘no’.  But let’s look at them in more detail.

Duty of care

The duty a person conducting a business or undertaking (a PCBU) owes to its staff is a duty to take steps to ensure the safety of its workers that are ‘reasonably practicable’.  The Work Health and Safety Act 2012 (SA) s 18 says:

“reasonably practicable”, in relation to a duty to ensure health and safety, means that which is, or was at a particular time, reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters including—

(a) the likelihood of the hazard or the risk concerned occurring; and

(b) the degree of harm that might result from the hazard or the risk; and

(c) what the person concerned knows, or ought reasonably to know, about—

(i) the hazard or the risk; and

(ii) ways of eliminating or minimising the risk; and

(d) the availability and suitability of ways to eliminate or minimise the risk; and

(e) after assessing the extent of the risk and the available ways of eliminating or minimising the risk, the cost associated with available ways of eliminating or minimising the risk, including whether the cost is grossly disproportionate to the risk.

At common law there is also a duty to take reasonable care for the safety of staff. The Civil Liability Act 1936 (SA) s 32(2) says:

In determining whether a reasonable person would have taken precautions against a risk of harm, the court is to consider the following (amongst other relevant things):

(a) the probability that the harm would occur if precautions were not taken;

(b) the likely seriousness of the harm;

(c) the burden of taking precautions to avoid the risk of harm;

(d) the social utility of the activity that creates the risk of harm.

There are ‘inherent risks associated with working alone’ so one way to avoid them is to not have single responders.  Equally there are inherent risks in paramedic work, paramedics work in uncontrolled environments, they may have to access patients in difficult and dangerous places, patients may be aggressive for all sorts of reasons including as a side effect of the very condition that means they need ambulance care. The easy way to avoid those risks is not send a paramedic to any case. That will ensure their safety but you can immediately see that is not practicable.  The likelihood of injury is relatively low – most paramedics go to most jobs without getting hurt – and there are many other things that can be done and are done to mitigate the risk.  Electric stretchers to reduce back injury, PPE to minimise all sorts of risk, training etc. 

Most injuries are probably minor but no doubt some are catastrophic. 

There is great social utility in sending paramedics to people who ask for them.  That is recognised in the amount governments pay to provide all manner of health services – that there is an ambulance service to attend patients and a hospital to take them too reflects a policy decision that these services are core functions of government to be provided in the public interest.  Even though keeping every paramedic in their station for their entire shift may reduce the risk of injury, it is not ‘reasonably practical’ nor an exercise in ‘reasonable care’.

Attending people who are ‘highly intoxicated individuals, persons under the influence of illicit substances, [or] potentially volatile mental health situations’ may represent an increased risk but not everyone who has that diagnosis is a threat, and until a paramedic gets there you cannot be sure that the person for whom the ambulance has been called is any of those things.  A ‘highly intoxicated person’ may be so intoxicated as to be unconscious and at risk of dying.  A person in a mental health crisis may be depressed and sullen.  Until the ambulance services has ‘eyes on the ground’ they cannot really know what the risk is.

And if there are workload pressures matched with demand pressures then it may be reasonable to send a single officer.  If they can intervene that’s good for the patient and if they chose not to the patient is no worse off than if they hadn’t been dispatched at all.

The concept of ‘duty of care’ under both the Work Health and Safety legislation and the common law is not a simple ‘ there is a line that must not be crossed and if you do this you are in breach’.  The response has to be ‘reasonable’.  Whilst it’s not a rule of law I think a good rule of thumb is, at least as a starting point, if the potential defendant can identify reasons for a decision that goes a long way to showing the decision was ‘reasonable’.    And there can be many ‘reasonable’ decisions; that is there may be more than one way to deal with a risk and the fact that some people think option A is the better choice, and others prefer option B does not mean that they could both be reasonable. The decision maker can chose the one they prefer and a court won’t find that decision unreasonable just because others might have made a different, also reasonable decision.

If SAAS chooses not to dispatch single officers that may be a reasonable response so a patient who misses out on care could not sue; but equally sending them may be a reasonable response – and people may disagree on that even though they assess the risk the same.  One cannot say therefore whether the decision to assign single officers to all jobs is a breach of duty.  If the question arose the issue would be whether the decision to assign a single officer to the particular job was a reasonable decision or not.  And, as I’ve said, the starting point would be to identify the service’s reasons.  And if they can show they have taken into account the factors listed in the legislation, above, then that would go a long way to show that their decision is reasonable even if someone else thinks that had they been the decision maker, they would have made a different decision.

Conclusion 1

It cannot be said that the ‘change in practice represents a failure on the part of the Ambulance Service to adequately discharge its duty of care to solo responder paramedics’.   That question can only be answered if a paramedic gets injured and sues, or the work health inspector decides to prosecute, and the real issue will be whether the decision to respond that paramedic to that job was reasonable.

Personal liability

If by ‘personal liability’ you mean liable to pay damages to a patient who does not receive care because the controller refused to allocate a job to a single officer paramedic contrary to the SAAS policy, the answer is ‘no’.  The controller is not working on their own account.  They are an employee of the SAAS. The failure to assign the job is a failure by the SAAS.  Any liability (if there was any) would fall to the SAAS.  

The aim of compensation is not ensure that the plaintiff gets compensated, not to punish the defendant.  No plaintiff wants to sue a controller who has no assets, and an employer is vicariously liable for the negligence of their employee to ensure that there is a defendant with pockets deep enough to pay the damages.  The defendant would be the SAAS.

If by ‘personal liability’ you mean subject to some unpleasant outcome, then presumably a controller could be disciplined if they failed to apply the policies of their employer.  They are employed to implement the policies of their employer and if they are not prepared to do that (subject to rules about industrial action, WHS stop work measures, the obligation to obey lawful orders etc) then one can imagine they may be disciplined and that could include dismissal.

Conclusion 2

A controller could not be personally liable to pay damages to an aggrieved patient if they failed to allocate a single responder.  They may be subject to internal discipline if they fail to apply the policies they are employed to apply.

Workers compensation

The employer, in this case the SAAS, is always liable for injuries received at work. It follows that ‘if a solo paramedic were dispatched to one of these higher-risk cases (that they would not previously have been allocated to), and felt compelled to attend for any reason, but subsequently suffered an assault or injury’ the Ambulance Service would be liable to pay workers compensation and assist in the return to work (Return to Work Act 2014 (SA)).

Workers compensation is a no fault scheme. A worker is deemed to be acting in connection with their employment even if they are ‘acting without, or in contravention of, instructions from the employer’ (Return to Work Act 2014 (SA) s 8(1)(b)). It is only ‘serious and wilful misconduct on the part of the worker’ that can disqualify them from workers compensation and benefits (s 8(2)(b)(i)). Not ‘declining the case despite obvious safety concerns’ would not be serious nor wilful misconduct.  It might be an error of judgement.

Conclusion 3

If a paramedic is injured the ambulance service will be liable for workers compensation. A decision to attend will not disqualify the paramedic from a claim even if others think the decision was unreasonable.

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.