Medical Edge Medics

Meeting Chaired By
Lee Waller.

Meeting Conducted
12:30 – 13:30.

Committee Attendee’s
John Thomas, Mike Hardwick, Lee Waller, Callan McClure, Dave Higgins, Conrad Fairhead, Andrew Kerfoot, Lindsey MacDougall, Dave Bryant, Rick Candy, Chris Smith, and Aaron Pittaway.

Committee Apologies
Shane Gray, Paul Davies and Jesse George.

Previous Minutes Accepted By
This was the first meeting of the AEAWA Ambulance Services Committee.

Meeting Agenda
This Special Meeting was scheduled due to multiple emails and calls received from employees of other Ambulance/Transport Services within Western Australia

In essence, these employees have asked if they would receive a discount for their Professional Indemnity Insurance, required by AHPRA, and being able to access ShopRite for member discounts. Various discussions took place regarding the potentiality of other Ambulance Service employees joining the Association.

Can they Join they AEAWA?
In short yes, the can. At a previous AEAWA Annual General Meeting, the membership was asked if the Committee explored the option to expand into other areas, and other Ambulance Services, could we as a committee, get that approved. The membership voted in favor for that to occur.

What does the Association need to do to make this happen?
As the membership have voted for this expansion, the committee would need to do the following.
1. Open another bank account for membership payments to be separate from St John WA member payments.
2. Design advertising (flyers etc) to get the word out to all those working across the various Ambulance Services.
3. Add an area to the AEAWA database so they may join.
4. Add a separate tab to the AEAWA website.
5. Develop an Ambulance Services portfolio and assign that to an AEAWA Executive member. At this meeting it was voted AEA Secretary Lee Waller would be appointed into this position.
6. Advertise for office staff to assist in this extra workload.

What benefits can these members access?
Currently members within St John WA have access to the following benefits.
• ShopRite
• Professional Indemnity Insurance
• Journey Cover
• Salary Continuance
• Organisational Support through [email protected]

The only identified issue was the Salary Continuance due to the fact that the AEAWA had 1,300 members under one employer (St John WA). This was the reason the costings for this benefit was able to be achieved.

It would be unlikely the AEAWA would receive these numbers from a singular organisation, to be able to supply that benefit to its Ambulance Services membership. That being said, this benefit will always be reviewed at any upcoming meeting, in case circumstances change.

All other benefits, members would receive. The AEAWA would just set up a different email account through the server for these members [email protected]

Could the AEAWA take on Delegates from these Other Ambulance Services?
Yes, that actually would assist greatly. Delegates are working in those various, specific environments. They understand the issues, and how things could change to make workplace improvements. Any AEAWA member will have the choice to become a delegate.

Meeting Concluded
13:30.

Specifically, my question relates to registered paramedics providing medications (S4s/S8s) to patients and the patient’s right to refuse transport / further clinical monitoring – or a paramedics responsibility with providing this form of treatment with the knowledge that this patient will likely refuse transport after treatment is provided.

This question comes from the general consensus among many clinicians and both university educators being that we (paramedics) should not provide medications or refuse to administer medications if the patient is likely going to decline transport to hospital. In general this refers more specifically to comfort care such as antiemetic or analgesia type medication management, opposed to life saving medication such as adrenaline.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

Today’s question relates to working overtime for Ambulance Victoria (AV).  The question below is heavily edited to reduce the length but get to what I understand is the gist of the issue.

My correspondent works in ambulance communication.  The comms team is turn between the need to respond ambulances and the need to assist on road paramedics to finish on time. The Ambulance Victoria Enterprise Agreement 2020 provides that crews are required to work ‘reasonable overtime’ but I’m told there is no policy directive from AV as to how this is to be managed.  I’m told that road crews are worried about their careers if they refuse overtime, and comms members are worried about their careers if they take staff ‘off line’ before the end of the shift so that they can finish on time, particularly when they have asked to finish on-time to meet family commitments.

In a nutshell, the communications group are worried about being dragged through the wringer for failing to follow the EA, the crews have had enough with the service for not following the EA and the Union is perpetually fighting the service for not following the EA.

The VAU’s recommendation is that an AV employee contacts the Regional Manager under 45.1(d) relevant manager (NOT a comms person) and requests on time to finish due to personal circumstances as early as practicable, as outlined in the above screen shot. The Regional management team have pushed back and said that this is a resourcing decision and should be left for the communications team to facilitate. It has been pushed up from every angle, H&S, Union, through the comms group, through the roadies and the response from AV is just a holding pattern of ‘awaiting legal advice’ and ‘statistics’ i.e. how would this affect the service’s ability to respond to core business.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

I recently attended a case in which a corrections inmate had self-harmed by putting a foreign object into their abdomen. Our local hospital is usually our go to with patients that are also inmates at a corrections facility. In this particular case the patient refused transport to this particular hospital. The patient then stated he would be happy to be transported as long as it was to a different facility which was an extra 10-minute drive away.

My question is regarding the autonomy rights of inmates. It is my understanding they have normal autonomy and therefore can refuse to be transported or treated by paramedics. Can the patient although refuse transport to one facility but accept treatment to another?

If this is the case, is it providing appropriate care to do so? Or is that an organisation issue for the company that provides the ambulance services.

Of course, given that this was self-harm there was also the argument of the Mental Health Act and its input. I feel that it was safer to take this patient to the hospital 10 minutes further away, keeping him calm and compliant, rather than having to provide sedation to facilitate transport to the closer facility against their will. I understand this is contrary to your previously stated opinions on the NSW MH Act. I would love to hear your thoughts on this case.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

Now that paramedics are a registered health profession, I’ve had the same conversation with quite a few colleagues who, like me, envision fully autonomous paramedic practitioners becoming a reality in Australia.  Those conversations usually revolve around the question ‘what next?’ in terms of expanding the capabilities of the profession.  As far as we can see there are four major legal hurdles: (1) the ability to bill directly to Medicare, (2) the ability to prescribe medications, (3) the ability to refer to medical specialists, and (4) a ‘drug license’ (for lack of a better term) that allows us to autonomously take authority for medications, i.e. paramedics taking ketamine out of a pharmacy under their own authority for their medical kit in a trekking expedition they’ve been hired to take care of.  I recognise that some paramedics in some parts of the country can do some of these things, but I don’t believe there are paramedics anywhere in Australia that can do them all.

My question for you, from your perspective in law, is this: do you think these are all necessary, and do you think that in sum these four would be sufficient, or do you believe that there are other major steps that we need to take to become fully autonomous medical professionals?

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

Currently working on a film set with another individual who has been representing themselves as a paramedic – both through being paid to be one and wearing clothing with the title paramedic displayed. I had known of this individual previously through others as a Paramedic working for many years prior to registration. This person at time of writing however is not registered and I have good authority to believe he has not lodged in accordance with the provisions contained within the Act.

There have been a number of occasions at which I have been concerned about the fact that this individual is a.) holding themselves out to be a paramedic and b.) providing treatment that would fall reasonably within a paramedic’s scope of practice but superior to that of a First Aider.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

… is regarding a medical team (mixed discipline Paramedics, Diploma holding medics and sometimes Nurses) for an event. Within that team legally who bears the burden or overall responsibility for patient outcomes in the eyes of the coroner and any other applicable medico-legal issues for that team.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

At a point of my life where, due to illness, I could die anytime, anywhere. I do not want to get resuscitated and plan to put a DNR order in place. My question is, how would anyone know about this order if they find me laying somewhere? how would the ambulance know? would they not start resuscitation before trying to find out who I am and if I may have such an order in place?

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

I am a paramedic working for the Queensland Ambulance Service (QAS). When we attend a patient we are required to complete an electronic ambulance report form (aERF). This document contains patient details, our assessment findings, and subsequent management including medication administered and interventions performed. It includes past medical history, current medications, and importantly allergies.

The transition of a patient from our care, to that of the hospital includes the following the steps: providing verbal handover at triage, verbal bedside handover, then delivery of our printed records to the bedside. The electronic version is stored and may be downloaded for clinical governance purposes. This documentation may also be requested by external organisations including the police, the Office of the Coroner, OHO, and the patient.

Due to “operational demands” it has become an increasing occurrence that paramedics are being dispatched to other cases prior to their immediate completion of the eARF. In regions of high workload it may be many hours, and several other cases, before this documentation is completed. This means hospitals do not receive immediate, and sometimes never, documentation relating to the prior care of the patient. It also means that there are likely to be inaccuracies and potential omissions from the documentation.

As treating paramedics, what are our legal obligations when it comes to completing and providing timely documentation on a patient we have verbally handed over to hospital staff?  Without considering internal QAS policy on this matter, would a paramedic have a legal stance to refuse an order to attend a new case based on their belief they needed to complete important elements of their care of their current patient (such as medications administered and allergies)?

My concerns come from the findings of Coroner David O’Connell in the inquest into the death of Marcia Joyce Loveday (28 October 2013). The coroner seems to indicate his trust on the attending paramedic’s word based on their eARF completed prior to the paramedic’s knowledge a clinical incident had occurred. If we provide a verbal handover it seems we have no supporting evidence unless we also provide timely paperwork.

Without going into specifics, I am also aware of a situation where a hospital in our region placed a high degree of blame onto not identifying a rupturing Aortic Aneurysm on what they claimed was an insufficient verbal handover from the treating paramedic. My understanding is the paramedic’s documentation was used to support their version of events.

I appreciate if you are able to provide some clarity on this. I am concerned that operational needs or KPI’s, are overtaking the reason for our existence of providing a high standard of clinical care.

To read the full article please click here.

Australian Emergency Law
Discussion on the law that applies to or affects Australia’s emergency services and emergency management, by Michael Eburn, PhD, Australian Lawyer.
Email: [email protected]

https://australianemergencylaw.com/

Survey Status – Currently Active click here.
Survey Data Collected – 25/08/2024- 12/12/2024
Number of Participants – TBA
Survey Results – TBA

Yes, as a financial member of the AEAWA (the fortnightly fees you pay the Association), your Professional Indemnity Insurance required by AHPRA for your registration are paid in full by us.

AHPRA will periodically audit you as a Paramedic to ensure you meet the requirements for registration and that you are covered under a Professional Indemnity Insurance Policy. This is the box you tick each year when re-registering to work as a Paramedic. The AEAWA have been in constant contact with AHPRA and can assist you with this process, now we have streamlined the paperwork.

If you have been audited, you will need to find your AHPRA Paramedic Registration Number which will look something like this PARA0001107777. Email [email protected] and please place in the subject line AHPRA Audit and your Registration number, as we may receive up to 80 of these requests a week and this makes it easier to track.

Once received you will be emailed the approved AHPRA/AEAWA template signed on your behalf by the AEAWA Secretary to certify to AHPRA that you have Professional Indemnity Insurance through your AEAWA membership, which in turn will satisfy the insurance component of your registration.

Any further questions or issues you have with AHPRA please contact the AEAWA or one of our Delegates.

Please contact an AEAWA delegate for more information, or email [email protected]

If the matter is urgent, contact a delegate from the AEAWA website www.aeawa.com.au. If the matter is non-urgent, or you have a general enquiry, suggestion or feedback, please email [email protected]. We try to respond to all emails within 24 hours.

Complaints, perceived wrongdoing, and performance concerns are handled through the Code of Conduct Policy, which covers both the Performance Management process, and the (generally more serious) Misconduct Management process. If you are approached in relation to matters which could possibly result in disciplinary action, please speak with a delegate before making any formal statement or responding to any allegations.

Remember that anything you say (even in what appears to be an informal chat) can be used in further proceedings. It’s best to try and ascertain the nature of the complaint before addressing any points raised. At any stage you can advise management that you wish to respond in writing. This will give you time to reflect and consider your response carefully. It is however advisable to email your response to the AEAWA before you send it through to your employer, as feedback can be provided by a committee member before it is finalised. At any stage you can request a support person.

AEAWA delegates are highly experienced in performance management and misconduct management cases and will help guide you through the process. The golden rules of going into a performance meeting:

• Never assume it is just a ‘friendly chat’
• Know your rights (which we will explore further in the article)
• Hope for the best and plan for the worst
• Don’t be afraid to exercise your rights

You should contact the AEAWA as soon as you suspect there might be a problem with your employment or disciplinary action may be taken against you. The AEAWA will not take any action without your authorisation. If you are called to attend a meeting, you can request to be provided with an agenda to assist with your preparation.

If you are provided with detailed information/allegations prior to the meeting, your delegate can assist you to prepare for the meeting. Make sure you seek the AEAWA’s industrial advice before submitting any written materials. As an AEAWA member we encourage you to take a delegate with you to the meeting.

You should be informed:

• what the meeting is about?
• who will be at the meeting?
• where and when the meeting will be held?
• whether there are any documents relevant to the matters to be discussed at the meeting. If so, you should request a copy of those documents.

You can request that this information is provided to you in writing. If the meeting is part of an investigation (especially if you are the subject of the investigation), you can also request:

• the terms of reference for the investigation, including information about the investigator’s role
• a copy of the policies and guidelines to be followed in conducting the investigation
• a copy of the policies and guidelines alleged to have been breached.

You should immediately request to be accompanied at the meeting (in person, via a phone or on Teams/Zoom) by an AEAWA delegate as your support person. You should ask what the meeting is about and who will be attending.

Once at the meeting ‘just listen’, do not answer any questions, explaining that you were given inadequate notice and insufficient time for preparation. You should take a copy of any letter handed to you but not comment about it.

You can and should seek advice from the AEAWA even if advised that the matter is confidential. You should however refrain from speaking with anyone else other than a delegate from your industrial body.

Generally, yes. Management can ask you to attend a meeting to discuss matters related to your employment. If you do not agree, management can direct you to attend a meeting. Such a direction is likely to be lawful and reasonable. If you do not comply, you could be subject to further disciplinary action.

You are not obliged to attend a meeting at the time requested by your employer if it is not possible for you to attend at that time (for example, you are sick, your AEAWA delegate or support person is unavailable, or you will not have enough time to review relevant documents). In this case, consult with your delegate to request a reasonable adjournment of the meeting time. In some cases, it might be better to respond in writing to matters rather than attend a meeting to verbally respond to those matters.

Yes. You will be allowed to bring a support person with you to any meetings with management. The vast majority of our members bring their AEAWA delegate as such a person. In addition, it is illegal for an employer to take adverse action against an AEAWA member who seeks ‘to be represented by an industrial association’ under the Fair Work Act 2009.

Adverse action can include dismissal, discrimination, demotion, suspension, issuing warnings, and commencing disciplinary processes. Adequate notice of the meeting should be provided so members can arrange for a delegate to be present to assist them and represent their interests in accordance with the law. Furthermore, the meeting should be scheduled at a time when the representative is able to attend. Non-members do not have the right to representation, only to be offered a ‘support person’.

Delegates will not be available as a ‘support person’ to assist non-members.

The AEAWA understands that members often want the advice and representation of a lawyer during an investigation, but only on rare occasions is a lawyer of value to your case. While the AEAWA have access to an expert legal team, the provisions of the Fair Work Act allow for a ‘support person’ to be present at meetings.

Many lawyers will in fact decline to act as a support person. In addition, lawyers typically represent multiple clients and therefore they are unfamiliar with the specific policies, procedures, and standing orders operated by your employer.

The are also unfamiliar with conventions and routines of our work, and ‘standard practice’ of our employment. It is also historically the case that where employees have attempted to bring a lawyer to a meeting, to act as a support person, the meeting is terminated or ‘cut short’ and rescheduled. Fortunately your AEAWA delegate will be very familiar with the relevant employment law, the Fair Work Act, the current EBA, your employers Code of Conduct, the Standard Operating Procedures and other policies relevant to your case, as well as the local protocol and historical conventions of WA ambulance work.

In addition, your delegates have well over a century of combined experience representing countless Industrial Paramedics, Paramedics, Ambulance Officers, Transport Officers, and Communications Officers. We know the best arguments to make a strong case to protect our members.

The value of this knowledge cannot be underestimated. Lawyers tend to be of most value in cases where termination of employment has occurred, and where an unfair dismissal appeal will be lodged with the Fair Work Commission, or in cases involving very complex legal issues.

AEAWA can engage a lawyer where required to help advise on such cases, but there is generally a ceiling on the expenses covered. Speak to an AEAWA delegate for more details.

The role of a support person or delegate is prescribed in law according to the Fair Work Act 2009. They:

• DO provide emotional support and reassurance for employee
• DO observe the proceedings, assist with clarifying the process and take notes
• DO quietly prompt or give advice to the employee, including requesting a break if needed
• DO respect and maintain confidentiality at all times Your AEAWA delegate, as a representative of an industrial body to which you are a member, has a role to support their member’s interests, including actively ensuring that natural justice and procedural fairness has been afforded to their member.

This may involve asking clarifying questions and, on occasion, advocating to ensure that procedural fairness has been afforded to their member.

It is generally unlawful for an employer to force an employee to answer questions. An employee may choose which, if any, questions to answer. In any meeting where dismissal is a possible outcome, employees should consider their responses carefully, take the opportunity for an adjournment to take advice from their AEAWA delegate if required, and answer truthfully if the member decides to answer the question. Employees should also appreciate that a refusal or failure to answer a fair and relevant question may result in the employer making its decision without the benefit of any answer.

The FWC investigation in the Patrick Stevedores case (Francis v Patrick Stevedores Holdings Pty Ltd [2014] FWC 7775) resulted in Deputy President Sams stating that employees have a duty to be “open, frank and honest” with their employer about serious issues in the workplace. Therefore, uncooperative employees may be opening themselves up to further disciplinary action – and there have been cases in the past where a dismissal has been upheld where employees were uncooperative and dishonest in investigations (Telstra v Streeter [2008] AIRCFB 15).

In any unfair dismissal matter, the Fair Work Commission is required to consider ‘whether the person was given an opportunity to respond to any reason related to the capacity or conduct of the person’.

The employer is then entitled to make a decision based upon all relevant information before it. Your AEAWA delegate will be able to advise you on how to answer questions. If you do not wish to answer a question for a particular reason (for example, you have not reviewed the relevant documents), you should explain why you cannot answer the question and explain when you will be in a position to answer the question (for example, after reviewing the relevant information). You do have the right to refuse to answer the same question which is needlessly repeated. Employers are not entitled to treat disciplinary meetings as cross examination.

If the investigator has already asked a question and you have fully answered the question to your best ability, then that is sufficient. It is not acceptable for the employer to approach the meeting as an interrogation. If the matter may potentially have criminal or other serious consequences for you (for example, AHPRA registration issues), you should consult with your AEAWA delegate before answering. You may be able to claim privilege against self-incrimination. You can also adjourn a meeting and leave at any time should the situation become too stressful. An employee cannot be detained in an enclosed space unless they are under arrest. Your AEAWA delegate will help support and guide you if this becomes necessary.

Write out your version of events and refer to it during the meeting if you need to. Consider whether you should provide a written response to your employer in addition to a verbal response during the meeting. Your written response will often clarify matters and shorten the time taken in the meeting. Ask your AEAWA delegate to review your version of events to ensure your interests are protected. Consider what other processes may be happening in relation to the same issues (for example, criminal proceedings or an AHPRA board investigation).

You should ensure your responses in all areas are consistent and considered. Review the Code of Conduct, the Enterprise Bargaining Agreement and any relevant policies to understand the process you are involved in and what to expect. Your employer cannot generally require you to answer questions during a meeting. Your employer is required to give you an opportunity to respond to a matter before it makes a decision about your employment. You will generally have 7 days to respond. If you choose not to respond, your employer may make a decision having regard only to the information available.

Yes. Your employer may have more than one person present at the meeting. It is common for one or more representatives from Employee Relations to attend a meeting with a uniformed manager.

• You can choose to respond in writing to questions should you prefer, discuss with your AEAWA delegate what is best for your situation.
• If you don’t know the answer, say you don’t know. Don’t guess the answer.
• Keep your answers short and concise (for example, say ‘yes’ or ‘no’ and go no further).
• Do not volunteer information.
• Be accurate.
• Do not exaggerate.
• If you are unsure how best to answer, request a short break to consult with your AEAWA delegate.
• State the basis for your comments if relevant (for example, ‘I observed …’ or ‘I heard …’ or ‘Paramedic X told me that …’ or ‘I measured the heart rate by x and recorded it to be y’).
• Do not agree with something unless you know it to be true from your own direct observations.
• Do not speculate (for example, ‘He may have done that because …’). If asked to speculate, it is OK to say you don’t know.
• If you think there is a record relevant to what you are being asked, request a copy of it (for example, time sheets, clinical records, call data). You should not answer the question without first reviewing any records.
• If you need to review a patient’s record to refresh your memory about why you made a clinical decision, then request the time and opportunity to do so – somewhere quiet without interruption or pressure.

• Try not to get angry or emotional during the meeting. Request a break if you feel yourself getting angry or emotional.
• Make appropriate considered concessions.
• You can take notes during the meeting if you wish.
• You can ask questions about the process (for example, what will be the next step? When will a decision be made? What are the possible outcomes of the process?).

• Speak with your AEAWA delegate who will advise of the likely next steps.
• As soon as possible after the meeting, make a note of the matters discussed during the meeting.
• Follow up on any matters you promised to address during the meeting (for example, you may have promised a further response once you had reviewed relevant records).
• You can ask for a copy of the notes taken by the interviewer during the meeting to enable you to review them and amend where you don’t agree they are an accurate reflection of events. In general, the interviewer is not required to provide you with a copy of their notes, but they may choose to provide them.
• You can ask what information, if any, will be placed on your personnel file.
• You may provide a written response to issues discussed during the meeting and ask for it to be placed on your personnel file. Your AEAWA delegate will assist in drafting a response.
• You may wish to send an email to the interviewer confirming the matters discussed during the meeting, particularly if the interviewer made verbal concessions during the meeting.

Please contact an AEAWA delegate for more information, or email [email protected]