Case for National Registration for Paramedics

1. The Facts

  • There are currently approximately 13,000 paramedics working in Australia
    • Largest employers are State/Territory emergency ambulance services and the Australian Defence Force
    • 18 per cent of paramedics work in the private sector (2011 Australian Census) with one third of these operating in private sector services contracted to the WA and NT governments
    • 122 private sector employers of paramedic staff were identified in 2012
  • Paramedics undertake significantly complex clinical interventions in a very diverse range of emergency and primary care settings away from direct supervision
  • Paramedic education has shifted largely from in-service and VET training conducted by State/Territory Emergency Ambulance Services to the university sector with undergraduate and postgraduate degrees
  • Paramedics are currently not registered as healthcare professionals in any State/Territory in Australia unlike the situation in many overseas locations e.g. United Kingdom, Ireland, Canada & South Africa
  • State/Territory regulation of the Paramedic profession currently either does not exist at all or exists via a series of inconsistent legislative frameworks and/or codes

2. Protection of the public

Risks to the public under the current system

  • In most States/Territories anyone can call themselves a Paramedic;
    • The pubic have no way of knowing what level of training the person claiming to be a Paramedic has with 33 per cent of paramedics surveyed by PA in 2012 (n=3289) claiming to have personal knowledge of unqualified individuals operating as a paramedic
    • No continuing professional development (CPD) standards or other regulatory requirements exist for ensuring that a paramedic’s training is clinically current
    • There are currently no compulsory or nationally consistent checks on probity and criminal history as a condition of paramedic practice
  • In most States/Territories Paramedics are not subject to specific legislative prohibition to protect against professional misconduct such as;
    • practice under the influence of drugs or alcohol
    • a mental or physical health problem which will affect their work
    • assault or inappropriate sexual behaviour involving patients
  • In most States/Territories there is no centralised source of information available where findings in relation to substantiated complaints about a paramedic are published;
    • Complaints and problems relating to paramedics are predominantly dealt with by individual organisations engaging the paramedic
    • A paramedic who is sacked by one employer for clinical or corporate misconduct can move relatively easily to another employer as sharing of this information is inconsistent, employer dependent and subject to privacy laws
  • Increasing student demand has seen increasing numbers of university Paramedicine courses in the market. This raises concerns regarding the potential variability in the baseline education of paramedics;
    • Currently no compulsory national accreditation standards or system exists for paramedic entry level education and training
    • Only 10 out of 22 university Paramedicine courses are fully accredited under the voluntary accreditation system administered by the Council of Ambulance Authorities (http://www.caa.net.au/paramedic-education/accredited-courses)

What can go wrong?

  • Individuals claiming to be a Paramedic may not be suitably qualified or experienced to provide safe and effective health care to the public leading to poor or inappropriate clinical outcomes
  • Paramedics can make errors of clinical judgment, act beyond the scope of their training and provide care below an acceptable standard
    • Paramedics work autonomously in wide variety of professionally demanding emergency clinical settings away from hospitals and clinics and are often involved in making very time critical decisions for patients in difficult or hazardous circumstances
    • When clinical practice errors occur these can be far more hazardous for the public than many of the risks identified for the other health professions currently registered under the National Registration & Accreditation Scheme (NRAS)
    • Paramedics administer a variety of scheduled drugs by invasive techniques and undertake advanced medical procedures in the field. They also in many States/Territories decide whether patients should go to hospital or stay at home without seeking additional medical opinion.
  • In most States/Territories, Paramedics who may be subject to an employer investigation for professional or clinical misconduct simply have to resign their employment for the matter to be closed
  • Where an employer may place sanctions on a paramedic in cases of established misconduct, these may be over-ridden by the findings of an industrial commission or court and do not carry across other agencies engaging the same paramedic
  • A paramedic with a child protection or other professionally relevant criminal conviction can be employed as or continue to practice as a paramedic in many States/Territories

How often do things go wrong with paramedics?

  • Due to the current lack of a nationally consistent and publically accessible complaint system for paramedics no national data is available on the practice of Australian paramedics
    • 55 per cent of paramedics surveyed by PA in 2012 (n=3289) indicated that they personally knew of instances of actual harm to a patient associated with the practice of another paramedic, with 9 per cent of these indicated to have resulted in a death
    • In the UK where paramedics are subject to national registration they feature in the middle of the rankings for exposure in the complaints processes
    • UK paramedics receive 1.1 complaints per 100 practitioners, the highest rate for the 15 professions registered with the Health and Care Professions Council (excludes dentists, doctors, nurses and pharmacists)
    • The comparable rate for doctors in the UK is 9.3 complaints per 100 practitioners

3. Workforce mobility

  • Paramedics provide a national resource pool that can be called upon to assist at short notice in times of disaster or major emergency either within or outside of Australia;
    • Inconsistencies with jurisdictional mutual recognition, practitioner regulation and controlled substances legislation often mean highly skilled paramedics are unable to operate to their full capacity when deployed out of their home state
  • There is currently a national, and an emerging international, market for paramedic skills across both government and private sectors;
    • 6 per cent of paramedics had moved across State and Territory boundaries in the five years before the 2011 census.
    • 23 per cent of paramedics surveyed by PA in 2012 (n=3289) had worked in more than one State or Territory in their lifetime.
  • 57 per cent of 122 private sector employers operate across State and Territory boundaries
  • There is currently no national regulatory system to support this mobility and make this safe for the public;
    • Each engaging organisation has to assess and establish the standing and credentials of paramedics who want to work for them
    • It may be easier for employers under time or workforce pressure not to check in too much detail than it is to do a more thorough check
    • In cases of overseas trained paramedics it may be very difficult for engaging organisations to establish the quality & reliability of a Paramedic educational qualification
  • The public may be the ones impacted upon with a real cost in terms of their health and safety

4. The benefits from national registration of paramedics are greater than for many of the other health professions already registered under the National Scheme because the risks to the public are higher.

National registration and its benefits will come with some costs

  • State and Territory governments will have to amend legislation
  • Along with the Commonwealth, State and Territory governments will have to meet the costs of the establishment of the new National Paramedic Board before registration commences
  • The cost for implementing this for one profession may be lower than the $945,000 governments provided for the introduction of registration for four new professions in 2012
  • Paramedics will have to meet the ongoing costs of the registration system through registration fees
  • Paramedics will have to meet the compliance costs of registration requirements

5. There is overwhelming support for national registration in the paramedic profession across Australia

  • In a survey conducted by PA in 2012, 87 per cent of the 3841 paramedic and student respondents supported the inclusion of Paramedics in the NRAS
  • There is additional strong support for this from the following organisations:
    • Paramedics Australasia (https://www.paramedics.org/)
    • National Council of Ambulance Unions (http://www.ambulanceactive.com.au/)
    • Council of Ambulance Authorities (http://www.caa.net.au/)
    • Private Paramedicine Australia (http://www.privateparamedicine.com.au/)

6. National Registration of paramedics would provide the same level of public protection and support for workforce mobility as for other health professions such as medicine and nursing

What National registration would provide.
Protection for the Public:

  • Only people who meet approved and nationally consistent educational and practitioner standards would be able to call themselves a paramedic
  • Paramedics with fitness-to-practice issues would not be able to move freely from job to job without anyone knowing
  • Checks on qualifications, clinical currency, probity and criminal history would be a condition of practice
  • Compulsory and independent accreditation of paramedic training and education programs
  • Regulation which covers all paramedics wherever they choose to work
  • Regulation which covers all employers of paramedics