The decision in Cox v State of New South Wales trading as Ambulance Service of NSW [2025] NSWSC 1556 was handed down on 17 December 2025 but slipped under my radar.  I thank the respondent (ie the person responding to the application) Ms Cox, for bringing this decision to my attention. 

This decision was an ‘interlocutory’ decision that is a decision made before any final decision and dealing with matters of procedure rather than the substantive claim.   That means Ms Cox is the respondent here as she is responding to an application filed by the Ambulance Service, but she is the plaintiff, ie the person claiming damages, in the substantive case. 

The case is a claim for damages for alleged negligence in the way the ambulance service responded to Ms Cox.  Ms Cox (at [1]) ‘… has been employed as a paramedic since 2000. She alleges in her statement of claim filed in September 2025 that she has sustained a serious psychological injury as a result of a traumatic event that occurred on 9 December 2015. She claims work injury damages pursuant to Part 5 Division 3 of the Worker’s Compensation Act 1987 (NSW) (“WC Act”) arising from the State’s breach of duty of care’.

The traumatic event is described at [5]:

While on duty in the ambulance with her work partner at a service station, a man shot and killed another man and then approached the ambulance and pointed the gun at Ms Cox. She ducked for cover fearing she was going to be shot. Ms Cox and her partner then attended to the man who had been shot but he died. A short time later she heard further gunshots and was later informed the shooter had shot himself nearby.

We are told ([6]-[8]) that:

Ms Cox returned to work a few days later but ceased work in March 2016 and has not worked since.

She has alleged continuing her duties exposed her to returning to the scene of the trauma and that she was not provided with adequate counselling and support and psychological treatment, was not adequately supervised or assessed, and that the system of return to work and or psychological assessment and support was inadequate.

A statement of particulars filed alleges extensive psychiatric injuries and disabilities including physical manifestations of those injuries as well as complete destruction of her earning capacity.

The case was commenced in the NSW Supreme Court but the Ambulance Service sought to have it sent for hearing in the District Court.   The maximum damages that can be awarded by the District Court is $1.25million (District Court Act 1973 (NSW) ss 4 (definition of ‘jurisdictional limit’ and 44(1)(a)).   The applicant argued that the case was correctly in the Supreme Court as the damages are likely to exceed the District Court’s jurisdiction. She also argued ‘that the case involves complex legal issues or issues of public importance’ and so should be heard in the Supreme Court ([3]).  It is that second claim, the legal issues of public importance, that will make this case of interest to readers of this blog.

What sets this case apart from the ‘usual’ is that the traumatic event was a singular event (rather than the effect of compound events) and that the incident was the offender pointing a gun at her, rather than ‘a “call-out” to attend or to treat the persons involved’ ([17]).

The defendant argued that the case did not raise any significant legal issues. They said (at [18]) ‘Questions of assessment of the duty of care owed by an employer to persons engaged in dangerous or difficult or distressing occupations are all within law that is settled. There is nothing complex about causation in this case’.

Counsel for Ms Cox argued (at [22]):

Unlike most of the authorities in this area, this claim is based on a single isolated incident as the triggering event. The assessment of the risk of psychological injury to Ms Cox which determined the response and level of care to be provided to her was advanced based on a system that treated the event as “otherwise than in the course of duty”, and “unlikely to recur”. This makes even more central the legal issue of the nature and scope of the duty of care owed to ambulance officers, (and, more generally, first responders), to incidents that are arguably outside the usual scope of incidents expected.

Further counsel for Ms Cox argued (at [23]) ‘there are conflicting authorities between the High Court and State appellate courts in the area of accumulated trauma and isolated traumatic incidents’.   She said (at [24]) that ‘… there is tension between the approaches of the Courts of Appeal in Briggs [NSW] and Hegarty [Queensland] and the question of the importance of autonomy and privacy when dealing with psychiatric or psychological injury …’

Finally (at [29]): 

In terms of general public importance, Ms Rabsch [counsel for Ms Cox] submitted that clarification of the scope of duty of care of employers of emergency workers is of itself a matter of general public importance. The role of standard operating procedures and their adequacy and validity in dealing with one-off traumatic events of this type is also a matter of general public importance for the huge number of first responders who are exposed to traumatic events inside their normal work events, but also who no doubt feel that they should and do respond to random violent events where a person is injured or in peril. There are more than 40,000 first responders in NSW alone and their function in the community is well recognised as valuable and vitally important work.

Discussion

Without having all the facts and evidence I infer that Ms Rabsch’s argument about the fact that this was a single incident rather than will go to the ambulance services response (see [22] and quoted, above]. There will, I infer be issues about whether this event was in the course of Ms Cox’s duties.  On the issue of whether the event was likely to recur one might infer that is unlikely that someone will again point a gun at her, but what is likely is that she will be again ‘on the road’ and often asked to pass the very area where it happened and to attend to scenes of violence and perhaps active shooters.  So, again I infer, that there will be an issue of what is the duty of the defendant when they are not responsible for the traumatic event. 

As for the conflicting authorities (at [23] and [24] and quoted above) I have previously discussed the case of Hegarty v Queensland Ambulance Service [2007] QCA 366 (see Negligence claims relating to PTSD (May 14, 2018)).  In that case Keane JA of the Queensland Court of Appeal in Hegarty v Queensland Ambulance Service [2007] QCA 366.  Keane JA (as he then was, he’s now a judge on the High Court of Australia) said:

[43] The area of debate in the present case concerned the extent to which the defendant was duty-bound to ensure that its superior officers should intervene with individual ambulance officers in relation to possible signs of deterioration in their mental health. The private and personal nature of psychological illness, and the consequential difficulties which attend the discharge of an employee’s duty in this respect, must be acknowledged as important considerations. The dignity of employees, and their entitlement to be free of harassment and intimidation, are also relevant to the content of the duty asserted by the plaintiff. Issues of some complexity arise in relation to when and how intervention by an employer to prevent mental illness should occur, and the likelihood that such intervention would be successful in ameliorating the plaintiff’s problems…

[45] … The resolution of this issue is fraught with difficulties peculiar to cases of psychiatric injury. In cases of apprehended psychiatric injury, unlike cases concerned with the amelioration of physical risk in the workplace, important values of human dignity, autonomy and privacy are involved in the formulation of a reasonable system of identification of psychiatric problems which may warrant an employer’s intervention in the making of a decision to intervene. The employee may not welcome intrusion by a supervisor, which suggests that the employee is manifesting signs of psychiatric problems to the extent that help should be sought, especially if those problems are having no adverse effect upon the employee’s performance of his or her duties at work.

[46] Employees may well regard such an intrusion as an invasion of privacy. Employees may rightly regard such an intrusion as a gross impertinence by a fellow employee, even one who is in a supervisory position. An employee is known to be at risk of psychiatric injury, prospects of promotion may be adversely affected and questions may arise as to the entitlement, or even obligation, of the employer to terminate the employment. Employees who are ambitious, and eager for promotion, and whose signs of dysfunction might equally be signs of frustrated ambition, might rightly be deeply resentful of suggestions which reflect an adverse assessment of the employee’s ability or performance and prospects of promotion. Such employees can be expected to pursue such remedies as may be available for their grievance over the intrusion. Dissatisfaction or resentments of this kind may give rise to industrial relations issues for the employer, as well as defamation issues for other employees. A conclusion that an employee has acted unreasonably in failing to recommend psychological assessment and treatment cannot be made without recognising that the employer’s decision must be made in a social, economic and legal context which includes these considerations.

One can infer that in this case there will be further arguments on the extent of an employer’s duty to not only ensure that psychological supports are available but that an employee actually takes advantage of them (and for a discussion of a number of the authorities, see QAS not negligent in management of paramedic’s PTSD (December 12, 2018) andStatement of the law relating to PTSD claims by police and emergency services personnel (November 16, 2025)).  

The argument at [29] (quoted above) speaks for itself.  A finding by a superior court on the ‘duty of care of employers of emergency workers’ and the ‘role of standard operating procedures and their adequacy and validity in dealing with one-off traumatic events …  inside their normal work events, but also who no doubt feel that they should and do respond to random violent events where a person is injured or in peril’ will be important for all emergency workers.  Given the apparent conflict between the state courts it may become the vehicle for an appeal to the High Court of Australia (via the NSW Court of Appeal) for a nationally binding decision.

Decision

The Court agreed with Ms Cox and refused the application to send the matter to the District Court for finalisation. Her Honour Lonergan J said:

I am persuaded by the submissions of Ms Rabsch. For the reasons she has cogently outlined in her written and oral submissions, this proceeding is one that entails complex legal issues, particularly regarding the content of the duty of care, as well as issues of general public importance, being the processes by which first responders are treated by the law in this state, particularly in circumstances of finding themselves responding to a random incident of violence, when they are ”off-duty” or were not formally called on to assist.

Conclusion

The case has a long way to go.  Like many cases it might settle.  It may be resolved by a single judge and end there in which case it does not create a binding precedent but may still deliver a persuasive judgment on the law.  Depending on the outcome, the parties resources and their commitment it might end up in the Court of Appeal or the High Court of Australia in which case a significant precedent will be set. 

We will keep our eye out for other judgments as the matter progresses through the system and report further if there are legal developments of general application.

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.