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HEALTH AND MEDICAL ASPECTS WHEN IS A PARAMEDIC NOT A PARAMEDIC? Emergency Response Best Practice 2011 To date, the word “paramedic” has been ill-defined. Anyone with basic ambulance service training, or a 7-10 day “EMT” or “Industrial Medic” course on top of a first aid certificate could claim to be a paramedic, because there was no accepted definition and corresponding level of qualification. However, in 2010, the Emergency Services Registry of Australasia (www.esra.com.au) was created to provide a reliable and consistent framework to credential paramedics and other rescue personnel. For the first time, certification was linked not only to qualifications but also to experience. The basic qualification to be designated a Paramedic (ESRA Level IV) is a Certificate IV in Health Care (Ambulance), a minimum one year’s full time tertiary study level, which then needs to be followed by clinical placement within a hospital or ambulance service and meaningful, “real-world” experience. Advanced Life Support and Intensive Care Paramedics (corresponding to ESRA Levels V and VI) require a minimum three years of study at the Diploma, Advanced Diploma or Bachelor of Science level and then clinical experience. So, freshly armed with a qualification and a brace of years in a state ambulance service, your Level IV Paramedic is ready to go…………or are they?? Once outside the confines of the ambulance service or health department, they are no longer able to utilise the legal and approved protocols and procedures of those organisations. They are effectively “outliers”, marooned in a no-man’s land without clinical oversight, assistance from superiors or legal coverage for their actions. They cannot give medications, as without a poisons permit (different in each state jurisdiction and in the offshore environment), it is illegal to purchase, provide, store, carry and/or administer drugs. This even includes non-prescription and basic over-the-counter drugs, let alone complex antibiotic, analgesics (most especially narcotics like morphine) or intravenous fluids. Only within an effective clinical governance model, comprising oversight, poisons licensing and legislative responsibility can a paramedic practice in their chosen profession. Effectively, this means they must be employed by an organisation that provides all of these elements, in exactly the same way as a state or territory ambulance service or health department. 78 AUSTRALASIAN MINE SAFETY JOURNAL There are no “solo paramedics”……..they must remain part of a continuum of care, commencing with a Medical Director, clinical governance model, ongoing education, case- review, legally compliant medical record-keeping, up-link to assistance, insurance coverage, professional development and support. Companies that contract medical staff directly without approved clinical governance expose themselves to significant risk. Best practice in emergency response is enabled only after management accepts that given these real risks, the highest standard of holistic response must be afforded to and implemented across all operations. Where best practice emergency response systems have been implemented, it is also generally the case that overall costs for maintaining these capabilities are lowered. Additionally, management are protected from OHS and legislative standpoints and production is quarantined from threat. For the last 50 years, mines emergency response and rescue has been evolving and coming to terms with the expectations of our modern age. Televised real-life rescues, reality television shows, “larger than life” film and TV productions and community expectation that “city-style” services be available in remote areas and offshore, fuel the need for mine management to be 100% certain that they can respond appropriately. The long-anticipated OHS Harmonisation threatens more scrutiny, fines and conceivably individual criminal prosecution and jail-time. Everyone from the board room down to the boiler room, including managers, need to critically review the standard and capability of emergency response in place and ask hard questions like these. Questions to ask your current paramedics or paramedical service company: • What clinical protocols and procedures do you operate under? • What pharmaceutical protocols and procedures do you operate under? • What is your tertiary qualification and when was it obtained? • Have you been recertified to this level since and, if so, by what organisation? • What is your ESRA paramedic level? • What clinical governance is provided for you? • Who holds your poisons permit? • When did you last undergo a recertification? • What professional development activities do you participate in, and who approves or audits these? • Who is your Medical Director? • What malpractice or professional indemnity insurance do you carry? • Who do you call for help? Professional paramedics can only exist within a professional organisation, medically governed and working within a robust clinical governance framework.