1) An independent authority would be established to register paramedics and ensure those registered are fit and competent. 2) Paramedic practice poses risks to patients because paramedics make clinical assessments, perform procedures, administer drugs, and make critical decisions autonomously. 3) Most stakeholders support a national registration scheme under the Australian Health Practitioner Regulation Agency model to protect the public through consistent standards and transparent complaint processes.

1. The national registration
of paramedics
@Arban70 Updated 16/05/2015

2. An independent authority is established to set up,
register and control:
̶ Who enters the profession – i.e. who gets on the register;
making sure that those who are registered are fit and
competent - entry
̶ Who stays on the register - ensure those on the register are
able to practice safely and maintain their competence -
monitoring
̶ Who is removed from the register - those shown to be
lacking ability or fitness to practice - removal
How does registration work ?
Registration involves transparency, objectivity and due process
entry
monitoring
removal

3. The overarching criteria – public safety & public interest
̶ does paramedic practice pose potential risk of harm?
̶ do patients take expertise on trust?
Paramedic practice involves risk – because practitioners:
̶ make clinical assessments
̶ perform invasive procedures
̶ administer powerful drugs
̶ make critical judgements and decisions
̶ operate autonomously within their Scope of Practice, and
̶ patients must accept practitioner competence on trust
Why paramedic regulation ?

4. Controls applied to practice, tasks, roles or entry
Restricted conduct – professional code
Defined areas or scope of practice
Transparent disciplinary & complaint processes
Maintenance of a transparent register
Public accountability through lay representation
* (For a summary of the functions of regulation see also Sir David Clementi
Review of the Regulatory Framework for Legal Services in UK - 2004)
Principles of good regulation*

5. Paramedic services sector poorly-defined & statistical data is
incomplete – there is no harmonised or formal regulatory
structure for paramedics or that captures all service providers
A snapshot of the sector shows (broad figures only)
▬ 120 + private and statutory employers across Australia
▬ 12000 + paramedics or related personnel (depends on definition)
▬ 900 ADF medics (approx.)
▬ 6000 + tertiary-level university degree students in Australia
▬ U/G and P/G educational programs & research activities
conducted by many universities (multi-campus as well)
▬ A myriad of inter-professional practice settings that cross borders
▬ A client base of 23.3 million Australians
Australian paramedic services

6. A national scope of practice
A national competencies framework
A national code of conduct
Transparent and independent complaint processes
Independent accreditation and educational processes
Objective & independent fitness to practice evaluation
Public accountability through lay representation
What is needed for paramedics

7. #1 - Relevance to healthcare
#2 - Risk of harm to health and safety of public
#3 – Adequacy of other regulatory mechanisms
#4 - Feasibility of regulation - distinctive practice
#5 - Ability to favour the public interest
#6 - Serve the public interest – access, equity
The AHMAC registration criteria*
* Paraphrased

8. The original regulatory proposals
1. Do nothing
2. Statutory code of conduct
3. Jurisdictional regulation (strengthen)
4. Registration under AHPRA / NRAS model
The consultation discussion paper prepared by the working group on behalf of
AHMAC highlighted the need for robust regulation & showed that paramedic
practice held more exposure to risk than many other registered professions.
The consultation paper and stakeholder submissions showed that robust
regulatory action is warranted to protect the public!

9. 34/35 consultation groups supported Option 4 registration
Several Health Ministers have declared support
Paramedic Societies / practitioners support registration
Paramedic students / educationalists support registration
National health advocacy groups support registration
Unions nationally support registration
Private Paramedicine Australia supports registration
ANZ (NZ provider Trust) supports registration
What do stakeholders think ?

10. No national protection of title – too many persons may be
dangerously underqualified & unregulated
The inherently high risks of paramedic practice
Service providers are not independently accredited
Some govt. providers compete & also regulate - thus
breaching Hilmer / competition policy / Conf. of Interest
The Clinical Practice Guidelines (CPG) vary across
jurisdictions – no national standard
No nationally consistent terminology or role descriptions
The public interest demands strong regulation
Why do anything ?

11. Need to fulfil same overall regulatory functions*
Inherent costs are the same to realise similar outcomes*
Paramedic practice risks require a proactive system
Controls need regulatory teeth and enforceable sanctions
Does not inform best practice or protect whistleblowers
No public stakeholder engagement
“There is no such thing as free regulation” - John Hutton 2005
Why not a Code-based model ?

12. Duplication of functions - not efficient
Does not display relative benefits over a national system
Does not facilitate single stop international comparisons
Does not facilitate mobility of practitioners
Must fulfil same overall regulatory functions*
May suffer from basic process, procedural & governance
weaknesses – including cross- jurisdictional issues
Currently poor public and practitioner engagement
“There is no such thing as free regulation” - John Hutton 2005
Why not a jurisdictional model ?

13. Satisfies best practice regulatory principles and creates a
consistent national regulatory framework
Established system - national boards – with broad
membership and operational transparency
̶ practitioner members
̶ community members (minimum number per Board)
Robust complaint procedures – one stop shop
Firm procedural & governance arrangements
Recognised system – transparent and accountable
Third party objective assessment – public engagement
Economies of scale and general application
Why the AHPRA / NRAS model ?

14. Over in New Zealand ...
Submission lodged in October 2011 for ILS & ALS
practitioners to be regulated under the HPCA Act
NZ Health Minister has proposed to address during 2015

15. The project on paramedic regulation is being undertaken by
a team based in the WA Health Department
Two states (Tasmania & SA) recently introduced legislation
protecting the title of ‘paramedic’ while NSW has proposed
state-based title protection (13 March – no details)
The Victorian Health Minister has said Victoria supports
national paramedic registration (22 March 2015)
Paramedic regulation was considered by Health Ministers at
the COAG Health Council meeting on 17 April – see the
COAG Communique here: http://bit.ly/1znVU45
Ministers also agreed to adopt a national Code of Conduct
for unregistered health workers - see: http://bit.ly/1yS81vA
What is the current status?

16. Monitor the information provided by the professional
societies and government agencies
Spread the registration message among colleagues
Talk to lawmakers, employers and educationalists to
explore the ramifications and implementation issues
Discuss the topic on Facebook, Twitter & LinkedIn and
attend available professional development opportunities
Learn more about professionalism by following relevant
social media sites such as http://on.fb.me/1Gcjlju
What might people do ?
Paramedic registration is
a national imperative!