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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
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HEALTH PRACTITIONER REGULATION NATIONAL LAW (SOUTH AUSTRALIA) (PROTECTION OF TITLE—PARAMEDICS) AMENDMENT BILL

Introduction and First Reading

The Hon. J.J. SNELLING (Playford—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for Defence Industries, Minister for Veterans' Affairs) (12:06): Obtained leave and introduced a bill for an act to amend the Health Practitioner Regulation National Law (South Australia) Act 2010. Read a first time.

Second Reading

The Hon. J.J. SNELLING (Playford—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for Defence Industries, Minister for Veterans' Affairs) (12:06): I move:

That this bill be now read a second time.

Paramedics are those health practitioners that provide rapid response and emergency medical assessment, treatment or care in a pre-hospital or community environment. Paramedic practice has changed in its focus from a model of 'treat and transport' to a more contemporary healthcare model of 'assess, treat and appropriately refer'. This change in practice places a greater responsibility on the practitioner and poses an increased risk of harm to the public.

The relationship between people treated by a paramedic and the practitioner is one taken on trust. A patient may be unconscious or not competent to make an informed decision when being treated, so consent to treatment is not always possible. The patient may not understand the clinical interventions that the paramedic needs to undertake to treat them, and in many cases, save their life. These factors underscore the role of trust that the patient places in the paramedic—trust in the paramedic's competence to practise and trust in the paramedic's decision-making processes about the clinical interventions and their referral for care.

Paramedic practice is not currently regulated in Australia. This is despite a call for the profession to be included as part of the National Registration and Accreditation Scheme for health professions from reports in New South Wales, Victoria and Western Australia.

In February 2010 the Standing Council on Health sought advice on options for the regulation of paramedic practice, including the inclusion of the profession in the National Scheme. The Australian Health Ministers' Advisory Council (AHMAC) is still preparing advice on options for the consideration of Health Ministers. Should AHMAC recommend to the Standing Council on Health that paramedics should be incorporated into the National Scheme, it is likely to be another two years from the time that the decision is made before regulation would begin.

This is based on the experience of those health professions that were incorporated into the National Scheme in 2012 and represents the time to establish accreditation authorities and develop registration standards for the profession. I seek leave to have the remainder of the second reading explanation inserted in Hansard without my reading it.

Leave granted.

In the absence of regulation any person may call themself a paramedic and undertake the duties and responsibilities generally associated with paramedic practice regardless of whether they hold the necessary education and training to provide the level of care expected.

This Bill takes a step towards the regulation of paramedic practice by protecting the title of paramedic. Under this Bill it will be an offence for any person to take or use the title of 'paramedic' unless they hold the appropriate qualifications to perform the role of the paramedic.

The Council of Ambulance Authorities has established an accreditation scheme for education courses in Australia to ensure that graduates meet the requisite education and training standards for employment as a paramedic in Australia and New Zealand. These qualifications will form the basis of the qualifications that will entitle a person to take the title of 'paramedic'. Most paramedics employed in Australia hold a tertiary qualification and have completed an internship program.

Paramedics Australasia, the national professional association of paramedics, has estimated that there are currently approximately 12,800 paramedics in Australia. The paramedic profession has almost doubled in size since 2006. Most paramedics are employed in government related ambulance services and the Australian Defence Forces. In general these employment sectors have strong employment and governance practices, which ensure that only those persons suitable to be paramedics are employed as such.

However, the employment picture for paramedics is changing, with paramedics increasingly being employed in the private sector in diverse areas such as private ambulance services, private industry (including mining) and the events sector. Paramedics Australasia estimates that the private sector employs 36 per cent of the total paramedic workforce.

In addition, there has been a large growth in the labour market for the casual employment of paramedics in a large range of employers including private first aid providers and private industrial and resource services.

Within this expanding private employment sector there is no assurance that these employers apply the same standards in the development of clinical protocols and guidelines to manage the practices of their paramedic employees. This highlights the potential risk that may occur to the public from persons that do not hold the appropriate qualifications and training.

Paramedics are often involved in care that is complex and highly invasive, such as the administration of intravenous fluids and drugs, and the management of severe trauma such as burns and spinal injuries. They may also be required to administer scheduled drugs. The situations faced by paramedics are often complex and challenging and require good judgement to minimise the substantial risk of causing harm to the public.

A survey undertaken by Paramedics Australasia in 2011 found that 56 per cent of respondents (1,721 paramedics) personally knew of an instance of actual harm or injury to a patient resulting from the practice of a paramedic. 17 per cent of these respondents (527 paramedics) indicated that this care had resulted in significant harm or death to the patient.

At this point it may assist Members to note the distinction between the role of the paramedic from an ambulance officer and volunteers. Ambulance officers and volunteers have completed a comprehensive program focused on the provision of pre-hospital emergency care. The fundamental difference between these levels of healthcare providers is the expansive and internationally accepted scope of practice of a paramedic.

Paramedics are required to respond to medical and trauma emergencies, assess and treat the patient and prepare them for transport to a hospital for ongoing care, if and as required. Paramedics are often required to make complex and critical clinical judgements without direct supervision, including, but not limited to, decisions to discharge at the scene or to refer the patient to alternative pathways of care.

The protection of the title 'paramedic' is commensurate with the degree of risk associated with paramedic practice due to the clinical interventions and the nature of the occupation in comparison to the practices of the ambulance officer or volunteer.

This Bill will ensure that the public in South Australia will be protected through the legislative protection of the title 'paramedic' and the regulation of minimum qualification requirements for employment as a paramedic. This will complement the current powers of the Health and Community Services Complaints Commissioner to investigate complaints against paramedics, and take action against them should their practice not be in accordance with generally accepted standards for the profession.

This Bill will provide protection for the public ahead of the work currently being undertaken at the national level for the regulation of the paramedic workforce. The decision of this Government to proceed with the protection of the title 'paramedic' will assist with the transition of South Australian paramedics into any future national regulatory scheme. It will not introduce a regulatory process that will be inconsistent with developments at the national level.

I note that the Tasmanian Government has also introduced a Bill into their Parliament to restrict the term 'paramedic' to the Tasmanian Ambulance Service. While the Tasmanian Bill does not protect the public in that State to the same level as that proposed in this Bill, it does highlight to Members that other jurisdictions are beginning to make their own decisions about the regulation of paramedic services now rather than waiting on any decision at the national level.

The inclusion of the paramedic profession in the National Registration and Accreditation Scheme has overwhelmingly been supported by industry groups at the national level. These industry groups identified the lack of protection of the 'paramedic' title and the lack of minimum education standards for paramedics as two of the biggest risks related to paramedic practice. This Bill seeks to address these two potential risks in this State ahead of any agreement that may occur at the national level for the regulation of the paramedic workforce.

I commend the Bill to Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal.

Part 2—Amendment of Health Practitioner Regulation National Law (South Australia) Act 2010

4—Amendment of Schedule 2—Health Practitioner Regulation National Law

This clause amends Schedule 2 by inserting a new section.

120A—Use of title 'paramedic'

The inserted section provides that the title 'paramedic', or any variation of 'paramedic' will be protected in South Australia. The section creates the offence of taking or using the title 'paramedic', where the person does not hold the qualifications prescribed by regulations made by the Governor for the purposes of this section. Similarly, a person who uses a title, name, word or description that, having regard to the circumstances in which it is taken or used, could be reasonably understood to indicate the person is a paramedic, where the person does not have the prescribed qualifications, will constitute an offence. The maximum penalty for either offence is a fine of $30,000. A definition of paramedic is inserted for the purposes of the section. The provision allows the Minister, by proclamation, to confer an exemption in relation to specified persons, classes of persons, specified circumstances or classes of circumstances. A person who contravenes or fails to comply with a condition of an exemption is guilty of an offence, the maximum penalty being a $30,000 fine.

Debate adjourned on motion of Dr McFetridge.

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