Paramedics employed by NSW Ambulance are represented by two trade unions – the Health Services Union (the HSU) and the Australian Paramedics Association (the APA).

In an Application for NSW Ambulance Safe Paramedic Crewing Award [2022] NSWIRComm 1037 (27 May 2022) the HSU, supported by the APA, asked the Industrial Relations Commission to make an award that would have ensured “that paramedics are assigned to a dual crew and that any NSW Ambulance vehicle that is capable of patient transport is staffed by a dual crew when dispatched to incidents” ([2]). At [25] the Commission said:

"The HSU’s case for the making of the Proposed Award rest on two broad premises. These are that single paramedic responses, first, expose paramedics to significant additional workplace health and safety risks, and second, result in patients receiving a sub-optimal level of care and treatment."

The Commission (made up of Chief Commissioner Constant, Commissioner Sloan and Commissioner Webster) declined to make the award as sought, or any relevant award. They determined that NSW Ambulance genuinely wanted to avoid single response paramedics ([56]) except those in designated single response roles, that is (at [11]) Extended Care Paramedics, members of the Special Operations Team, Paramedic Specialist Motorcycle Responders, members of the Immediate Care Unit, Duty Operations Managers, Paramedic Educators and Clinical Training Officers. The Ambulance Service, in conjunction with the unions had implemented a Work Instruction to minimise single crewing (see [58]). Even so “Despite the steps taken by NSW Ambulance, there was generally no controversy that it is not possible for NSW Ambulance to guarantee against a paramedic being “single” at work” ([67]). Given that reality, the Commission said (at [71], emphasis added):

"In circumstances where paramedics will from time to time be on duty “single”, the question which next arises is whether NSW Ambulance should be prohibited from dispatching them to respond single to an incident. For this would be the effect of the Proposed Award."

Paramedic safety

As for paramedic safety it was agreed that paramedics were safer when r****esponding in pairs but the risk was not reduced to zero. The Ambulance Service (at [76]):

"… contended that a number of the risks identified by the HSU’s and the APA’s witnesses were present whether or not a paramedic was responding single or as a member of a dual crew. This included travelling under lights and sirens, particularly when the second paramedic is attending to a patient in the rear of the ambulance, and the risk of occupational violence. NSW Ambulance contended that the presence of a second person “has some potential to reduce risk of harm associated with patient and bystander violence, [but] this is not guaranteed and cannot be relied on as a safe system of work”.

Further, the Service confirmed that paramedics, whether working as a single responder or as part of a dual crew, always had the option to ‘stand off’ and wait for police or further ambulance back up if they felt a situation was unsafe ([77]-[78]).

The Commission (at [82]) was “satisfied that a single responder may be exposed, to an extent, to greater workplace health and safety risks than when they attend an incident as a member of a dual crew.”

Patient safety

"… the HSU contended that a single responder will not be able to deliver the same level of patient care as that which could be provided by a dual crew. This will extend to not being able to apply in full the relevant procedures or protocols, or to utilise all of the equipment that might otherwise be available to be used in aid of the patient. Further, the single responder will not have the advantage of checking clinical decisions, medications and the like with another paramedic ([85])."

The Ambulance Service recognised that it may be better to have two paramedics treat a patient but that was not always possible eg where the number of patient’s exceeded the number of paramedics on scene. Paramedics are trained, it was argued, to apply principles of care and to adjust that care depending on the circumstances. The “key premise underpinning NSW Ambulance’s opposition to the Proposed Award” was that

"… from the perspective of patient care, there will be instances where time is of the essence and where the prompt attendance of a single responder will deliver a greater clinical benefit to the patient than waiting for a dual crew to arrive. That is, whatever compromises might be made from a clinical perspective are outweighed by the benefits of a timelier response."

It may be better to have two paramedics, but one is better than none.

One witness was cross-examined about his experience in a country town. He described situations where he had been called when off duty to respond as all the on-duty and on-call officers were already engaged. The witness was asked (at [97]):

"… to assume that one of the things that award, if it were made by the Commission would do, would be to prevent an officer being put in an ambulance single, to respond to an incident. Now if an incident occurred in Gilgandra when the on-duty or on-call crew were otherwise occupied and an emergency arose, would you be content with an award that would require you to remain in the station or at home single and the patient would have to wait for a backup crew to come from some further distance?"

The paramedics answer was “No I wouldn’t be comfortable.”

At [100]-[101] The Commission said:

"We do not accept that there is only “scant evidence” of the benefits of single paramedic responses or that the Commission “is in no position to find” that the benefits asserted by NSW Ambulance outweigh the risks of single paramedic responses. We are also not persuaded that that evidence ought to be dismissed as being opinions amounting to conjecture…

It is relevant to observe that the evidence of a number of the witnesses called by the HSU and the APA is corroborative of NSW Ambulance’s contentions as to the potential benefits of single paramedic responses. That is, while the incidents that they describe would have been challenging, if not harrowing, their intervention in some of the cases – albeit as a single responder – led to a better patient outcome than if NSW Ambulance had delayed dispatching them to the incident until a dual crew could respond."

Conclusion

The Commission concluded (at [105]) that:

"We are persuaded to accept the position put by NSW Ambulance, that in certain instances the benefits to the patient of the timely attendance of a single responder outweigh any additional risks to the paramedic, and justify any compromises to the treatment protocols that might otherwise be applied by a dual crew."

Given that conclusion it would be inappropriate to make an award that prohibited the dispatch of single officers in any circumstances. The Commission could have left the matter there and simply dismissed the application, but it did not. Rather it did make orders to amend the relevant employment award to require the Ambulance Service to apply the current work instruction to work toward minimising incidents of single crew response ([118]). The order of the Commission ([122]) was:

"The [Ambulance] Service will apply rostering practices intended to avoid single paramedic responses to the extent practicable. To that end it will apply the Work Instruction titled Clinical Operations – Dual Paramedic Crewing dated 12 June 2020, or as amended or replaced by the Service from time to time following consultation."

Conflict of interest disclosures

For the sake of complete transparency, I disclose:

One of the unions, the APA, is a sponsor of this blog; and One of the witnesses for the Ambulance Service was the Director Medical Services at NSW Ambulance, Dr Jason Bendall. Dr Bendall and I co-authored the paper ‘The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics’ (2010) 8(4) Australasian Journal of Paramedicine Article 4 (previously (2010) 8(4) Australian Journal of Emergency Primary Health Care, Article 990414). I consider Dr Bendall a personal friend. Neither of these connections influenced my report on this decision

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Reproduced with permission from Australian Emergency Law.

The College is a partner of Australian Emergency Law blog, created by Dr Michael Eburn. College members are invited to ask a legal question relating to emergency law and Michael Eburn will prepare a response which will be published in Rapid Response – monthly enewsletter for members. Questions can be asked anonymously. Email: qanda@paramedics.org