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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

Second Reading

Adjourned debate on second reading.

(Continued from 16 October 2013.)

Dr McFETRIDGE (Morphett) (12:08): I indicate that I am the lead speaker for the opposition and I can tell the house the opposition is supporting this bill and we will be moving through all stages without any amendments. We dealt with the Health Practitioner Regulation National Law (South Australia) Bill on 25 May 2010 and at that stage there were a number of health professions that were included in the national law but one of those not included at that particular time was that of the paramedic profession in Australia.

Paramedics Australasia, back in 2010, sent me some information about their wishes and hopes for the future of paramedics and the recognition of them as true health professionals and a separate health professional, and they indicated to me at that stage that the Australian Health Ministers' Conference had given in-principle support for the national registration of paramedics, and this legislation is all about getting that national registration. It was pointed out back in 2010 that things do move slowly, and we know that. The lead agency was Western Australia at that time, with the objective of potentially including paramedics within the national registration scheme by 2014.

So, we are a little bit ahead of schedule there, but I would think that, in a lot of cases, we are a long way behind what could possibly have been achieved in the eyes of some members of this particular profession. In fact, Paramedics Australasia sent me a brochure of some six or seven pages entitled 'The Forgotten Health Profession', and in that brochure it talks about some of the things paramedics do. It states:

Today's paramedics deal with life and death issues and make routine clinical decisions on a daily basis, administer life-saving medications, and perform other clinical interventions such as CPR, defibrillation, intubation, cannulation, thoracentesis, etc. often without...[knowing] a patient's medical or social history. Paramedics regularly triage, assess and clinically manage unconscious, incoherent or combative patients, sometimes in multi-casualty situations.

I know that when I have been to road accidents with the CFS, the ambulances turn up and the paramedics are there. They are able to undertake many interventions now that do save the life of those victims of the car crashes, and that is just one small part of their role—and it is an absolutely vital role. The number of roles paramedics can undertake is quite large, and I will read some of the paramedic role descriptions from Paramedics Australasia. I should say that it is a highly qualified profession, and paramedics have to undergo extensive training to be recognised as a paramedic for, say, the South Australian Ambulance Service.

Part of the point of this legislation, I should point out, is that currently anybody can call themselves a paramedic; you do not have to have all of the qualifications one would think would be mandatory. Fortunately, the legislation that is now being put in place can not only protect the profession but also protect the patients of paramedics. We now know that a degree in paramedics or health sciences or its equivalent is a basic prerequisite.

The Australian Defence Force, we should point out, employs paramedics. They train their own medics in the Diploma of Paramedic Science (Ambulance) and the Diploma of Nursing, which is a required registration for a division 2 nurse with the Australian Health Practitioners Regulation Authority. The ADF also trains its medics in the usual areas of military training in combat because they are going to have to be out there in all sorts of areas of combat.

So, it is not just paramedics out on the roads providing, as we think, early lifesaving intervention for road accident victims, which is the most easily recognised one, or perhaps it could be at the footy, treating people collapsing with a heart attack and things like that, but there is this other area in the ADF—and we salute them for their bravery going out into places such as Afghanistan, Iraq and all the other places where they serve. They are supporting our troops there, and they are highly skilled and highly trained, and they are able to undertake many interventions that a first aider could not undertake, and certainly we mere mortals who are untrained in this area would not be able to do.

I should say that, Sunday a week ago, I did do my first aid refresher with St John's doing the training there. The chap who undertook the training is a former paramedic with the British Navy, and he had a lot of experience. Some of the war stories he was able to tell us about from the Falklands were really quite alarming to say the least. Without the training they had as paramedics, many soldiers would have died on the ships that were hit by Exocet missiles during the Falklands war. I have digressed slightly, but the scope of practice of paramedics is in the military, but the one we recognise most is in the civilian fields, and the one that springs to mind for everybody would be in the road crash area—but it is broader than that.

When there is an incident, an accident, an episode of illness, the paramedics are able to apply their skills, and I will go through some of these skills again. Life saving and life supporting skills such as the use of a range of medications both S4s and S8s. The S4s are prescription only drugs and the S8s are the controlled drugs like morphine and pethidine, the other opiate drugs and some of the anaesthetic drugs. They are drugs you need to know; you need to have studied pharmacology to understand how the drugs work so that you can use them without harming the patient.

Paramedics also undertake not only the monitoring and use of ECGs but also the interpretation of an ECG. An ECG is not just a squiggle on a line, you have to know which of the patterns the ECG leads are giving the readout on and then interpret that particular pattern. It is not simple, for example to say that if it is going up and down the right way and is doing it every couple of seconds that the patient is okay. There may be serious issues going on with the heart function. If you do not know how to read an ECG, it seems no more than a squiggle on a line.

The other area that we see a lot of is mental health crisis intervention. One paramedic said to me that we are trying to get beyond the capsicum and cargo nets, and I think that the minister actually went out with ambulance drivers and witnessed first-hand mental health patients having to be restrained. It is great that we have people with high levels of training so that they can intervene in an acceptable way with people who are very ill—in this case, mentally ill.

Management of patients across their life span including obstetrical emergencies: obviously we went through legislation in this place recently to regulate the role of midwives to make sure that the people who are calling themselves midwives are trained adequately and the services they are delivering are not going beyond the scope of their training. We all have expertise in various areas but you need to know the consequences of your actions, and this is what paramedics are being trained to do.

The use of stretchers and other patient movement devices is something that you do not really think about too much, but I can tell you first-hand that when a horse landed on top of me and broke my leg, I was in the middle of a paddock. When the ambulance officers were carrying me out, one of them tripped and nearly dropped me on a barbed wire fence, and that is why I gave up horse work. Not really. Anyway, they have to carry patients and some of those patients are now are getting larger. You see the bariatric ambulance service out there having to carry very large patients.

I read a story where a very large patient in Victoria was taken to the veterinary school there because the equipment in the human hospital was not large enough or robust enough to allow that patient to be put through a CT scanner, so they used the horse one at Werribee Veterinary School. Having to carry heavy patients is another occupational hazard for paramedics, and I assume they are doing it all with the professional expertise and consideration of the patients that we would expect.

Emergency driving, emergency management, triage, extrication, and basic rescue are all parts of the other roles that paramedics are involved in. I was first on the scene of a very serious road accident between Meadows and Kangarilla a couple of months ago. I assisted the CFS. We cut the top off the car. The patient had a broken leg, a fractured femur, and was in quite a bad way. We had to get in behind the patient. The paramedics and the doctors who arrived through the MAC helicopter stabilised this patient, they were able to get him out of the car and then airlift him to the hospital. It was pretty good to see the way they coordinated themselves, the way they treated the patient and were able to deliver him to Flinders Medical Centre for further treatment. I understand that he did have several weeks of quite intensive treatment.

Intensive care paramedics is another area that paramedics can continue with and do postgraduate training on. Other areas are retrieval paramedics, first responder paramedics and a number of other areas that paramedics can branch out to, so there are areas of speciality and expertise within the whole of this particular profession. Let's hope that it is not a forgotten profession now and not the forgotten profession that was put to me back in 2010.

It has taken a little while to get to this stage. It is a good thing that we are not only giving the paramedics the recognition they deserve but also protecting the patients who are being treated by paramedics. They are not only working for government ambulance services; we have a number of private ambulance services appearing around Australia. Certainly, the privately-employed paramedics also need to have the same levels of skill, expertise and training and, in this case, registration that we would expect of any government employee.

I support the legislation. A number of my colleagues want to contribute. I think that they also appreciate the role of all the employees of the South Australian Ambulance Service and particularly the highly-qualified, highly-trained and expert paramedics we have in our ambulance service. I should say that my nephew James, who is in the MFS but also works in the ambulance service, has told me firsthand some of the things they have to undergo, and it just reinforces the degree of respect I have for our paramedics and the ambulance service in South Australia. With that, I support the bill.

Mr VAN HOLST PELLEKAAN (Stuart) (12:21): I will make a fairly brief contribution following the member for Morphett, our spokesperson on health issues in this house. First of all, let me just say that, if somebody is in an emergency situation, they are grateful to get whatever medical and other support they can get, whether it is from a highly-trained doctor who happens to be there or from just a private person who might happen to have the skills. Of course, in that situation, you are very pleased to get whatever capable medical help is available at the time.

What this bill is really about, though, is far more to do with government services and services to industry. I think it is actually very important that we are able to clearly define and establish in our state exactly what a paramedic is. I am pleased to note that the Council of Ambulance Authorities, St John Ambulance, the Ambulance Employees Association and Paramedics Australasia all support this move as well, so good on the government for bringing it forward.

Where this really comes into play is in regard to employment and/or correct classification of volunteers. The reason that is very important is obviously that you need to know who you are bringing on board to deliver if necessary particular skills and particular support. I think this will become increasingly important as, hopefully, mining, oil and gas industries continue to grow throughout our state.

I know a little bit about this purely by association with my brother who is a paramedic. He lives in Bathurst in New South Wales, but he works primarily in the north-west of Western Australia. He went through great difficulty, in fact, getting an interstate transfer. Before Bathurst, he was living in Broken Hill and he was a professional ambulance officer in Broken Hill. He moved to Western Australia to be with his then fiancée, now wife, and had an awkward time transferring from state to state as an ambulance officer.

Then within Western Australia he stepped up to become a paramedic. He still works on even time on and off in Western Australia as a paramedic but, given that he is often two weeks on and two weeks off, or three weeks on and three weeks off, even now as a qualified paramedic in Western Australia, he is not entitled to work as an ambulance officer on his days off in Bathurst and that district where there is a shortage. They are crying out for people exactly like him, and he is at home with his family with free time.

The reason I mention that is that, clearly, if we could get these descriptions, definitions, qualifications and certifications really well established within states, then states would far more easily be able to draw on skills that exist interstate. Let's hope that as mining, oil and gas grow, particularly in the more remote parts of South Australia, we will be able to encourage people from other states to come and live here and work here, but it will not be possible to do that if we do not have our act together really well and really clearly about exactly who it is we are trying to employ.

For example, the type of work my brother does is very often offshore. I remember one job he did on a pipe-laying vessel, where there had to be medical support available 24 hours a day. One GP and one paramedic were required to be on that vessel, and one of them had to be on duty with the other as backup support 24 hours a day, typically for a month at a time. If you cannot identify within your own state exactly what a paramedic is and who is entitled to perform that function, the company struggles to know exactly who they are required to employ.

That is just one example of why it is really important that we get this sorted out within South Australia—because, as I said before, we will not be able to draw upon the resources that exist outside our state and, ideally, bring them into our state to contribute to the growth of our state and its economy if we do not have this really well sorted out.

We support this for many reasons, not the least of which, of course, is to ensure that a volunteer, a government employee or an industry employee is in situ and ready to provide support so that you know you are getting the support you deserve at the time, and also, of course, to provide the ability for people to move interstate. If you cannot do those things because you do not have not the right definition, we are really just holding ourselves back. So, for that and many other reasons I support the member for Morphett and the opposition's position to support the government on this matter.

Mr WHETSTONE (Chaffey) (12:26): I, too, rise to support this bill to protect the title of our paramedics here in South Australia. As the member for Morphett and the member for Stuart have said, the paramedic profession in Australia is currently not regulated, despite consistent calls for it to be included as part of our national registration and accreditation scheme for health professions. As it stands, with no regulation, essentially any person may call themselves a paramedic and undertake duties and responsibilities generally associated with paramedic practice. Even without the necessary education or training, people can call themselves a paramedic, and this is certainly concerning.

That said, our ambulance service is comprised of both career and volunteer paramedics, and it is paramount that those people, who are providing a vital service, whether it be in a professional or volunteer capacity, be supported and protected under this bill. It will be an offence for any person to take or use the title of paramedic unless they hold the appropriate qualification.

Over my quite long career in sport, particularly in competitive waterskiing, I had to gain certain certificates to perform CPR and also support assistants if there were falls during the waterskiing; obviously, the disciplines can be quite different in some cases. Particularly in lake racing, there is very rough water; there are always many laps, and skiers can fall off many times during a race, particularly in some of the waterways in Europe, where they are basically concrete channels and the water becomes very rough and very peaky.

I have very vivid memories particularly of river racing and of when a skier has fallen—and at high speeds it is usually not a good outcome. I have had to support skiers, perform CPR on skiers, and nurture skiers who have fallen and hurt themselves extremely badly. I would not call myself a paramedic, but I would say that it is a volunteer support that is there to help until the professional medical help does get there. It has been of huge concern that people be there to assist. They do not have to be a recognised paramedic but they have to be there to basically fill the gap until the professional gets there.

I would like to touch on paramedics in Chaffey, and particularly in Riverland towns, which are largely serviced by career paramedics. Regional communities like Morgan, which falls in Stuart, and Swan Reach, Pinnaroo and Lameroo are supported by volunteers, and there have been many calls for volunteers from South Australian ambulance services due to shortages.

Some of those services have tried to incentivise volunteers to provide benefits by way of free training in lifesaving treatments and general medical support but, sadly, in 2007 the South Australian Ambulance Service said volunteer numbers were down to such an extent that some ambulance cars even had to be left unstaffed, and this is not the kind of situation we want to see.

Ambulances sometimes have to be called in from other areas during an emergency and, while there are shortages, we must not use volunteers without necessary education and training to provide the level of care expected. Without the generous people who volunteer their time in small country communities to be a part of their local ambulance services, many country towns would not have this service.

Again, the South Australian Ambulance Service volunteers recruitment activity supports South Australia's Strategic Plan, Target 24, to maintain the level of volunteering in South Australia at about a 70 per cent participation or higher. The bill is supported by the Council of Ambulance Authorities and St John's Ambulance SA.

I would also like to touch on what is happening in my electorate of Chaffey when we are talking about looking at providing services within hospitals, particularly when we look at some of the HAC funds that have been held up, or have had criteria put on them. There are a lot of individuals who put countless hours into providing services in the regions, but in that volunteer capacity.

We are looking at providing better services at hospitals, and we see that the current government's health budget is depleted and cash-strapped and we have community fund raising. We have HAC funds sitting in an account that the government has put a clamp on, and that is a real concern. It needs to be recognised that paramedics in South Australia are of significant importance. They need to be recognised for the duty they do, but also the volunteers in their capacity to be a part of that. In saying that, I support the bill.

Mr PEGLER (Mount Gambier) (12:33): I rise to support this bill. Everybody I have spoken to in this industry certainly supports the bill and, basically, this bill will protect the title of paramedic. I was quite surprised that this was not even regulated at this stage, and I always assumed that the title of paramedic would have carried some registration and accreditation rules, so I certainly support that.

Paramedics, particularly in the country regions, perform a vital service, and more and more has been put on them as first responders. In my electorate, we have a first responder ambulance service at Port MacDonnell which does a tremendous job, and it means that those people who are injured or sick can receive attention straightaway rather than having to drive the half hour to Mount Gambier in the first place.

There is also a shift, particularly in Australia, where more and more paramedics are working in private industry. We will see much more of that within mining, etc., so I think this is a move in the right direction. There is no doubt there will be a national scheme that will address the registration and accreditation standards for paramedics, but that probably will not come about for at least a couple of years.

In passing this bill, we will make sure that the title of paramedic is protected, and I believe it will then protect our people in South Australia a lot more. Also, it gives those people who are paramedics a lot more kudos in what they actually do; they do such a vital service in our region.

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) (12:35): I would like to thank members for their contributions on this bill. The paramedic profession has highlighted that the two biggest risks related to paramedic practice are the lack of protection of the paramedic title and the lack of minimum education standards for paramedics. I am pleased to advise that this bill will address these two risks.

While discussions are still continuing at the national level on whether paramedicine should be regulated under the National Registration and Accreditation Scheme, the parliament can protect the public of South Australia by passing this legislation. Under the legislation, it will be an offence for a person to take the title 'paramedic' unless they hold a prescribed qualification that provides them with the necessary knowledge and skills to make complex and critical clinical judgment.

Since the introduction of the bill into the house, my department has provided detailed briefings to the following groups: the SA Ambulance Service; the IMS Ambulance Service; the defence, mining and events sectors; Paramedics Australasia; the Ambulance Employers Association; the Council of Ambulance Authorities; and the Royal Flying Doctors Service South Eastern Section. I am pleased to advise the house these groups are supportive of the government's policy intent behind the legislation. I note that Paramedics Australasia released an update to its members on 29 October that stated:

Paramedics Australasia is pleased to see the acknowledgement of the professional role of today’s paramedics and the risks involved in health care performed by paramedics. It agrees that the protection of title is a vital step in protecting the public from the possibility of being treated by untrained or under-trained persons...

Paramedics Australasia recognises the SA move as an overall positive transitionary measure and has provided in-principle support for the proposed legislation. At the same time, Paramedics Australasia believes that the long term need is for a national scheme to regulate the paramedic workforce—given that paramedics work in many settings across the nation, offshore and in the public, private & defence sectors.

I thank Paramedics Australasia for their support of the legislation. The government will continue to support the profession's inclusion in the national scheme, but this decision will ultimately be for the Standing Council on Health to take.

As Paramedics Australasia has noted, paramedics may work across a number of sectors (health, defence, mining and events). One of the matters raised by the shadow minister for health is the discrepancy in paramedic workforce numbers reported by Paramedics Australasia and the Council of Ambulance Authorities.

In my second reading speech, I referred to the data published by Paramedics Australasia which indicated that 36 per cent of paramedics were employed outside of state and territory government authorities. The Council of Ambulance Authorities, in their submission on the regulation of paramedics, indicated that the non-government sector only accounted for 1 or 2 per cent of total paramedic employment.

I understand that the shadow minister has since received a comprehensive briefing on the workforce numbers from Paramedics Australasia. For the benefit of other members: part of the problem is that there is no definitive source on the number of paramedics. Some labour force surveys will group ambulance officers with paramedics, while other surveys will record a person as a paramedic because that is how they describe their occupation, rather than whether they hold qualifications to be employed as a paramedic.

Health Workforce Australia is currently undertaking an ambulance and paramedic workforce study, which will provide the first true indication of Australia's ambulance officer and paramedic workforce. Data from this study is likely to be released some time in 2014. In the absence of this study, I am told that the Paramedics Australasia data is more likely to reflect the employment profile of paramedics than that published by the Council of Ambulance Authorities.

The Paramedics Australasia data has been extrapolated from a number of sources. They acknowledge that these estimates are therefore subject to some error, but, given that the defence sector is the second largest employer of paramedics in Australia, it is clear that the figure of 1 or 2 per cent reported by the council is far too low. While industry groups have given in-principle support to the legislation before the house, there have been two issues of concern. The first is the definition of a paramedic. I would like to take the opportunity to advise the house that I intend to move an amendment to revise the definition.

With paramedics working across a number of sectors, the description of a paramedic varies slightly. While the definition in the tabled bill adequately described a paramedic employed by SA Ambulance Service, it does not necessarily translate to the role of a paramedic in the mining industry. My department has worked with the SA Ambulance Service and Paramedics Australasia to develop a definition that can apply across all sectors. I have been told that the negotiation of this definition was one of the key requirements for the opposition's support for the bill. I am pleased to inform the house that this definition has been accepted by Paramedics Australasia and the Ambulance Employees Association.

I would like to outline the policy intent behind the definition. The definition describes a paramedic as 'a health professional who provides emergency medical assessment, treatment and care in the pre-hospital, or out-of-hospital, environment'. I note that the paramedic profession would have preferred the term 'health practitioner' to be used. Under the Health Practitioner Regulation National Law, the term 'health practitioner' has a particular reference that limits its use to the 14 health professions that are regulated under the national registration and accreditation scheme. As paramedicine is not currently regulated under the national scheme, the term 'health practitioner' cannot be used in the definition.

As an alternate description, the term 'health professional' is used. The reference to 'health professional' is used to denote that a paramedic is governed by professional standards, and with this comes a high level of individual, community and practice accountability. This is to distinguish a paramedic from any other person who may provide assistance in an emergency. It is not intended for the use of 'health professional' in this context to link with any of the definitions in the Health Practitioner Regulation National Law, including 'health practitioner' or 'health profession'. The second issue of concern to interested parties is the content of the regulations which will prescribe the qualifications a person must hold to use the title of 'paramedic'. I am told there is some concern about what this list of qualifications may mean for some persons currently employed as paramedics.

The first point I would like to put on the public record is that it is not the intention of this legislation to result in any person currently employed as a paramedic to become ineligible when it is brought into effect. While public safety is paramount, I have confidence that the current employers of paramedics in this state have appropriate governance arrangements in place to ensure that they only employ those persons who have the necessary qualifications and training to provide the clinical interventions that may be required of them. My department will bring together the industry groups to identify those qualifications that the paramedic workforce in this state currently hold, and these groups will jointly consider which of these qualifications should be prescribed by regulation or whether it is more appropriate for an exemption to be provided.

I am aware that there has been some concern that regulations may prescribe only the undergraduate degree qualifications currently accredited by the Council of Ambulance Authorities. These courses were only ever considered to be a starting point. I acknowledge that there are many persons currently employed as paramedics who hold other qualifications, and that these persons are more than competent to provide paramedic services to the public.

I would like to thank all those persons from the industry groups for the time they have given to consider this legislation and support the government's position. In particular, I would like to acknowledge the work of Robert Morton and Karen Braunack from SA Ambulance Service, Richard Larsen from Paramedics Australasia, and Phil Palmer from the Ambulance Employees Association. Their advice on the legislation at various stages has been greatly appreciated.

I would like to also thank all the officers who have assisted in the development of this legislation: parliamentary counsel, Simon Gill, Sharon Norton and Richard Dennis, and from the department, Kathy Ahwan, who is in the chamber today to assist me. With that, I commend the bill to the house.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 3 passed.

Clause 4.

The Hon. J.J. SNELLING: I move:

Amendment No 1 [HealthAge–1]—

Page 3, lines 1 to 4 [clause 4, inserted section 120A(2)]—Delete subsection (2) and substitute:

(2) For the purposes of subsection (1)(b), a paramedic is a health professional who provides emergency medical assessment, treatment and care in the pre-hospital, or out-of-hospital, environment.

I have already outlined the reasons for moving the amendment in my second reading reply speech.

Amendment carried; clause as amended passed.

Title passed.

Bill reported with amendment.

Third 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) (12:44): I move:

That this bill be now read a third time.

Bill read a third time and passed.

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