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Legal and Constitutional Affairs References Committee
National registration system for paramedics

ACKER, Mr Joe, Vice-President, Paramedics Australasia

HARTLEY, Dr Peter, President, Paramedics Australasia

REUS, Mr Darren, President, Australian Paramedics Association Queensland

SAMUEL, Mr Amir, Vice-President, Australian Paramedics Association of Victoria

SMITH, Ms Robyn, Executive Officer, Paramedics Australasia


CHAIR: I now welcome representatives from the Australian Paramedics Association Queensland, the Australian Paramedics Association of Victoria and Paramedics Australasia. Thank you very much for coming in and talking with us today. The committee has received submissions from Australian Paramedics Association Queensland and Paramedics Australasia as submissions 8 and 9 respectively. Before we commence, does either organisation wish to make any additions or amendments to their submissions?

Dr Hartley : No additions or amendments to the submission are required.

CHAIR: I now invite you to make a brief opening statement before we go to questions.

Dr Hartley : I am happy to make a statement on behalf of Paramedics Australasia to open up proceedings. I appear here before the Senate committee today in the capacity as the President of Paramedics Australasia, the peak industry body representing the full diversity of paramedics practising across Australia and New Zealand. Paramedics Australasia is pleased to be a contributor and a participant in this Senate inquiry into the establishment of a national registration scheme for Australian paramedics to improve and ensure patient and community safety. We are pleased for the opportunity to have our views placed on public record and considered as part of the process of informing the development of legislation or government policies and programs. Paramedics Australasia is also pleased to be a key stakeholder and member of the recently formed national registration reference group formed by DHHS Victoria, the lead agency tasked to progress the policy framework and the implementation of national registration for the health ministers advisory group.

Paramedics Australasia holds a unique position as a professional organisation with the greatest jurisdictional reach and depth of membership of Australian paramedics. Not only do we represent this comprehensive geographical reach and representation, but also PA membership comprises of paramedics employed in ambulance services; defence, private and academic settings; along with a strong nationwide student cohort. Our activities include continuing professional development, publication of the peer reviewed Australasian Journal of Paramedicine, holding scientific conferences and symposia, sponsoring and fostering evidence-based research and leadership and advocacy in professional matters. We provide an Australasian platform for the development and promulgation of policies and service standards that will enhance the quality of patient care.

For over 10 years now, Paramedics Australasia has advocated for national registration of Australian paramedics as the only system that will safeguard patient and community safety. This position reflects the vast majority of our membership, equating to over 4,000 paramedics, with members based in every state and territory in Australia as well as New Zealand. Our 2012 survey of 3,841 members shows that 87 per cent supported the inclusion of paramedics in a national registration and accreditation scheme.

The paramedic industry and practice in Australia is not limited to state and territory ambulance services. In fact, paramedics provide complex and high-risk clinical services in a range of sectors, including emergency response, primary care in the mining and offshore oil and gas industries, support for major sponsoring and entertainment events, in-house medical services in hotels and casinos, international air medical retrievals, combat medic roles in defence forces and private interfacility patient transport services. In addition to these activities, paramedics are engaged in non-clinical roles to support the advancement of the profession, including clinical education, research, administration, management, university academia, professional advocacy and clinical governance.

The diversity of the paramedic workforce has not only expanded to a wide range of sectors and environments; it has also advanced the clinical service provided to the community. In locations across Australia, paramedics are also frequently consulting with specialist physicians, pharmacists, nurses, social workers and mental health specialists as members of the healthcare team to achieve clinical pathways for patients who have called an ambulance but who may be better served by referral to another health profession, instead of being taken to an overburdened emergency department.

Paramedicine has emerged as a profession that is flexible and adaptable, and it is positioned to contribute even more to the support of health systems across Australia and in the future. Including paramedicine in a national registration and accreditation scheme helps ensure patients receive safe, competent and professional health care now and in the future.

In almost every state and territory in the Commonwealth, the minimum qualification to become a paramedic with public ambulance services is at a bachelor's degree level. This level of qualification is a relatively new phenomenon. The level of qualification now, as has been the case with so many health professionals before us, has resulted in a segment of the current workforce holding pre-existing sub-degree qualifications, inclusive of diplomas and advanced diplomas, as their highest qualification level. In some sectors of the industry, such as mining and event services, the entry qualification has been at a certificate or diploma level. Therefore, the word 'paramedic' is not clearly defined and could mean a university graduate with a wide scope of practice or a certificate holder with a limited skill set.

A major issue for consideration is that in some states and territories the title 'paramedic' is not protected, essentially permitting anyone to refer to themselves as a paramedic should they desire to do so. It is Paramedics Australasia's view that the Australian public deserves to know who is treating them when they call for an ambulance or seek care from a paramedic. Today, there is no standard definition of what a paramedic is or to what level they have been trained, with potential for members of the public to be misled.

When paramedicine is included in a national registration and accreditation scheme, a benchmark will be established to define what a paramedic is and what qualification they must hold. All future paramedics will have to meet the new standard to be registered under that scheme. Existing paramedics entering the scheme will have to demonstrate that they hold the required qualification and provide a level of care that meets the benchmark, thus making them worthy of holding the protected title of 'paramedic'. A process to grandparent these existing paramedics into the scheme by recognising their skills and experience will be critical to ensure a suitable workforce exists to provide services to the community. It is equally important to ensure that any grandparenting is undertaken and managed in a way that does not dilute the professional title of 'paramedic' or compromise the standard of care that underpins the safe and high-level clinical care provided by everyone using the title 'paramedic'.

It is likely that some people providing out-of-hospital services today may not meet grandparenting standards to retain the title of 'paramedic'. It is Paramedics Australasia's view that these sectors of the current workforce will still be able to provide clinical services within a strong governance framework—however, not at the same level as paramedics. Nor would they be able to use the title 'paramedic'.

On behalf of Paramedics Australasia, I would like to thank the Senate committee for this opportunity to present the evidence I have delivered today in support of our submission and to have this evidence noted on the public record. I now welcome any questions the committee may have.

Mr Reus : Thank you very much for looking into this matter. We do support bringing in registration for paramedics. We would mirror a lot of what people have been saying. We believe that we are bringing prehospital care to a good level through support and continued clinical improvement through quality improvement in a holistic approach where, if we bring the right care to the right people before they get to hospital, we actually reduce the cost to the public through reduced stays in hospital—in cardiac matters, trauma and other things like that. Paramedic registration will bring a skills equity across the country. There is quite a gap between what paramedics have as skill sets across the states. There are different levels of paramedic, of course, but I am referring to just the general advanced care level. It would bring mobility between the states for paramedics to have recognition of their level as they go across.

As far as I know from Queensland, there is a lot of trepidation from on-road staff about registration. They are seeing it as a double-edged sword. Some are fearful they are going to lose their qualification and their job. Some are thinking that the costs associated with being registered will be prohibitive and will affect their family life. Other issues include the clinical investigation of complaints. It probably will be a better system under registration—including from a disciplinary point of view. I think a lot of employers will still prefer to keep the discipline side of things. We also agree that we require it to protect the title of 'paramedic'. There are too many people who are using the title 'paramedic' with nothing but a first-stage certificate. That is also, of course, to protect the public so that they can know what their expectations are of the paramedic treating them.

Mr Samuel : I am here supporting Mr Reus's submission, and I would like to add to a few things we heard before and maybe make some clarification. Firstly, we have not discussed today that each state actually acts under state laws. Some of these laws go back to the eighties, and we think the paramedic profession has evolved greatly since then and the legislation has not kept up with it. A national law as discussed in the submissions might bring everyone to the same level and paramedics will be able to practice in the same way.

There was a question before from Senator Bilyk about non-paramedic practice. I came from overseas 12 years ago as a paramedic. For various reasons, I could not work in the emergency service and I went to work in the non-emergency area in Victoria. The company used the name 'Paramedic Services Victoria'. None of the work done was what we know as paramedic work. We were more ambulance attendants and patient transport officers. That name is an example to show you how it used to be. I do not think the company still uses that name today—I think it has changed since, but I am not quite sure about that.

Regarding the change in government support in Victoria, during the last elections in Victoria paramedics were very involved in supporting one side of the political debate. As a result, Labor, who came into the parliament in Victoria, made a big promise to assist the state based ambulance service and developed a plan, which is on the ministry website, for how to change things in Victoria. But, again, it is all state based, and I think here we are talking about how to bring this to a national level.

Another thing is training. We have seen, as paramedics who have been on the road for quite some time, gap students who qualified as paramedics in some universities and came across. They have a gap year. They are still do training with the service. You can see the differences between universities and their qualifications and the competency of the gap students. By doing this registration it will require universities across the board to have the same level of education, which at the moment is not the case.

With regard to practice, we talked before about being able to practice in different states without too many changes or training; just familiarisation of the workplace. I will give you an example. A paramedic from Victoria who was a clinical instructor and a lecturer in a university in Victoria decided to move his family to north New South Wales. He could not get a job there and ended up in the Queensland Ambulance Service. He went to the whole process, which included quite a few weeks of out-of-pocket costs and everything. He was then accepted, but 18 months later he moved to New South Wales and had to go all the way from the bottom to do the same again. It just should not be like that.

The other thing I would like to comment on today is public versus private. I will give an example. I come from Israel. In Israel, the title 'paramedic' is advanced life support. You might have heard of MICA paramedics in Australia, which is the most advanced life support. Israel is a very small place, so they are all regulated under the national service, but there is the need to have a private service for emergencies. Just like you have public and private hospitals for medical, they have membership. People pay. People who are chronically ill and would like to have the best service will pay more to have that service. That means that every ambulance would have the most advanced life support once they make the call. That is just one example of how private emergency can work alongside the public one.

On research and development, once we decide to register paramedics and show that we protect the title of 'paramedic' to the highest level that we could wish for, paramedics will feel that they can contribute themselves by doing more research and more development. It will also require them to keep up to standard. That is what we want. We want the highest standards for everyone, basically; it does not matter where you are.

In Victoria we have what we call the EMR program. The fire brigade are the first responders. The ambulance service is training them to be first responders to cardiac arrest, basically. The question again is: are we going to call firefighters paramedics? In America, some of them are. On the other hand, you have ambulance community officers in the countryside and they are all volunteers, but they are under the emergency services in the state. There is the question of what you want to call them. So you have to have not just the registration of 'paramedic' as a title but all the other ones so that everyone will know what level they are, like you have in America: EMT, basic life support, advanced life support, critical care and so on.

The last thing is cost. That is something that needs more work. I think it would be good for everyone.

Mr Acker : I would repeat exactly what Dr Hartley said. I am happy to answer questions.

CHAIR: Mr Reus, in your submission you say that AHPRA would be the most logical body to—

Mr Reus : It is already present and it is already operating four other professions. I believe it has got the basis behind it. It would probably be the cheaper option too, although it still has to set up a national board. Whether they have to do state boards—if states are going to be a bit recalcitrant in coming on board with it, they are going to have to have their own. If they will not go for one set of skills right across the nation, they might have to have their own set of skills per state, in which case they might have to have their own board. I am not sure how all of that will work but I believe that, seeing as it is already present, that is probably the place for it to be.

CHAIR: Does everyone agree with that or have a different idea?

Dr Hartley : Paramedics Australia's view would be that AHPRA would certainly make the most reasonable approach as the national regulatory authority. It is established, it is very focused on the health professions and has a very comprehensive understanding of health and the health workforce. It would make perfect sense for it to sit within that jurisdiction.

CHAIR: When you talk about the modelling, you talk about the UK system—have you had a look at that?

Mr Reus : A while ago, Queensland had a big recruiting drive in the UK, which is, obviously—they are now taking our paramedics. We had a big recruit. I have got a lot of paramedic friends and colleagues in Queensland who have talked about their system. I have only looked into it briefly, but they said it has been quite successful. There have been shortcomings, but I think that might have a lot to do with some of their clinical abilities and their actual authorities to perform certain tasks. Other than that, it has been very successful, as best as I can gather.

CHAIR: How long has a national register been spoken about in your circles?

Dr Hartley : From PA's perspective, we have been working on this and advocating for this for well over a decade.

Mr Samuel : I have been a paramedic in Victoria for 10 years, and ever since I have been a paramedic—

Mr Reus : Queensland is the same. Queensland has been setting up our yearly or biannual certificate of practice along the lines of what we would expect for registration, with CQI points—which are clinical quality improvement points—continued professional development, doing certificate practice exams and things like that. It is very similar. Queensland Ambulance Service—while I cannot speak for the commissioner or the department, they have been supportive and leaning towards registration for many years now.

CHAIR: We have heard from previous witnesses about liability and that there is a bit of uncertainty. Have you got any ideas on how we would deal with that area?

Mr Reus : I have to go with what Associate Professor Eburn said earlier. He did respond to my submission in relation to that. He is a lot more learned than I am, so I would have to take on board what he had to say about that. The vicarious liability—I know that that is the case, but Queensland Ambulance Service have overtly said they will cover that aspect of it anyway. I think they might be aware of the vicarious liability.

Dr Hartley : Similarly, we would be supporting what Professor Eburn has indicated in his submission: that professional liability and personal liability will fall under the umbrella of the existing employee. The complexity around this is the areas that are transparent. There would be areas around the state based services. We would know that their workforce would be covered by the umbrella of their own liability coverage. It is more the independent, smaller services within the private sector that are not as transparent, and that is an unknown quantity.

Mr Acker : On the question about the UK, in addition to being the vice president of Paramedics Australasian, I am also a paramedic academic at Charles Sturt University. Last year I took 26 students to the UK on a study tour to learn about paramedic services and how they are delivered. HCPC has been registering paramedics forever 15 years, and the perspective from the paramedics is that it has been a very good thing. Not only has it made them more accountable; it has made them more mobile and able to move into other areas of health care. It is not uncommon for UK paramedics to be working in general practice with physicians in prisons and other public areas as well as hospitals. It has created a large, mobile workforce all over the UK and internationally.

The other thing that we noted was that there are multiple levels of prehospital care providers in the UK. Only the paramedics are registered. All of the other ones are not registered, but the public knows who they are. They are technicians. They typically drive the ambulances and assist the paramedics, but in all cases the paramedic who is registered and accountable is responsible for patient care. In my opinion, that makes for a healthcare system that is a lot safer. It is transparent, the public knows who is who, and the paramedics who are providing services are accountable to HCPC to provide high-quality services.

They are also accountable for their own professional development, meaning that they go out and seek education. Currently in Australia there is no requirement for paramedics to do any continuing professional development or education, except for what their employer requires them to do. That is different when it is in a registered environment.

CHAIR: How does the public access that information in the UK and places like that?

Mr Acker : The UK is like other registered services. I am a Canadian and I am still registered in Alberta, which is where I am registered as a paramedic. The public can go onto the website at any time—which is, in my case, the Alberta College of Paramedics; in the UK it is the Health and Care Professions Council—put in my name, and my registration status will come up. So, the public can access any paramedic's status: whether I have been suspended, whether there is discipline against me or whether I am current. It is completely transparent. And we believe, as Paramedics Australasia, that is essentially important. I currently work in New South Wales as an intensive care paramedic. But if I did something wrong here, I could simply go across the border to Queensland, and if I did not disclose that I was a paramedic in New South Wales, nobody would know that I had lost my certificate to practice. There is no national register and there is no way for services to know who is registered and who is competent.

CHAIR: I note in Australian Paramedics Association Queensland's submission you talk about the fact that the onus is pretty much on the individual for training, and you suggest paid leave to increase their skills.

Mr Reus : Not necessarily paid leave. I know with nursing they have a couple of professional development days, which is on work time. Probably two days a year is not going to be sufficient for self-education, but it certainly helps, and it is quite often done under the umbrella of the employer's professional development: what they expect of you, changes in work practices and all of those things that go towards your professional development. So it is not necessarily two weeks of leave or anything like that.

CHAIR: Overseas, do they have to pay their own costs? Or is that something the government does?

Mr Acker : It is a combination. Ambulance services are entitled to provide any education they think is necessary, and typically things that are important for health and safety of their workforce—the use of equipment and those sorts of things—are provided by the ambulance services. But it is the responsibility of the registered professional to get their own: to first of all identify their own learning gaps, which is important, and then to seek their own education. This has created quite a cottage industry of education providers, whether it is a two-day workshop or whether it is a postgraduate or a university course, which has provided practitioners with a really wide range of educational opportunities. But it is their responsibility to get the time and pay for it, and we believe that that is an important part of professional registration and being a professional. It is not unlike doctors, nurses, physiotherapists, pharmacists and other registered health professionals. They are responsible for their education.

Senator PERIS: What is a career pathway for a young Australian child going to high school? We heard earlier that we are world leaders here in Australia in paramedics' education and the United Kingdom is grabbing our students. What are the pay levels? I know that you have raised concerns in here. Registered nurses or even, for example, Aboriginal health workers have tiers. Does that not exist in the paramedics industry?

Mr Reus : It does not in Queensland. There are certain pay levels for your skill levels. A lot of it, unfortunately, relies on penalties for extra money. So, we in Queensland—certainly now that Victoria has got a substantial pay rise—are the lowest paid in the country. But the career path that you were talking about is now university, of course, where there are just way more students than there are going to be vacancies. I am not sure; Mr Acker can actually qualify that a lot more than I can. I know that Queensland alone is only taking 150-ish paramedics on board a year on attrition and increase, and I know that we alone have 1,000-something students in Queensland.

Mr Acker : The career pathway for paramedics is actually very good. It has been put into evidence before that we are the best in the world, and I would agree with that. Paramedics, as a degree, has existed since 1994 in this country, which was the first in the world, and that is pretty remarkable and that is pretty impressive, and that is why a lot of academics come from around the world to teach here. The importance of that is that it adds credibility to the workforce. The workforce comes from universities and is no longer purely vocational.

Unfortunately, as has been reported before, that is not necessarily true in all states. The New South Wales Ambulance Service are the only service that retains a vocational pathway. As a university academic, I graduate students who can apply for jobs, but at the same time the Ambulance Service can just recruit them from civilian life, so it is their prerogative, which has created an unfair competition. As a taxpayer as well, I think it seems a little unusual that the students are taking on HECS and using tax dollars to go through university, and then the Ambulance Service is paying, essentially, to train those individuals who come from the civilian world, so that creates an inequity.

The argument has been put forward that the vocational pathway needs to exist to target certain people in the population. For example, Indigenous paramedics are not represented across every state appropriately, which is unfortunate. Our university, though, has addressed that by creating an Indigenous pathway, so Indigenous students can come into the university—it is a partnership with the ambulance service—complete the degree in a supported pathway and get into the paramedic workforce. It does not have to be a vocational pathway to target the individuals that we want to be paramedics. There are partnerships, and there are opportunities to look at different ways of doing things. But essentially the career pathway is very, very good for paramedics.

Mr Samuel : To answer your question: a student will study for three years in university. Because, as I mentioned before, there are so many universities producing paramedics, they have to fight for many fewer spots, and they do not have many other opportunities to go with that degree. It is very, very hard for someone young like that to find somewhere else to practise what they just went and studied for three years.

The way it works clinically in Victoria is that you will be a GAP for one year. If you qualify you become a qualified paramedic. You will have a pay rise after that year, after you have qualified, then after three years and then another pay rise six years after that, and then it is pretty much the same unless you become more like a MICA paramedic, a flight MICA paramedic, or you go to management and so forth. There are other things in the organisation. But, from a clinical point of view, those are the tiers.

The other thing I want to tell you about is a practice that I think started in early 2000 in America. It is called a physician assistant. It is paramedics who are advanced life support paramedics, mostly what we call here MICA, who practise in places where it is hard to get doctors. They will be the medical authority in that area. Sometimes they will work shoulder to shoulder with doctors in emergency places or sometimes just in remote places, but it is not so much developed here. It started here. There are very few who I know who have been practising in Australia. It is not well known.

Dr Hartley : The physician's assistant model in Australia is complex and constrained due to legislative requirements; hence it never really progressed beyond a small cohort of students who completed the qualification and then dispersed. But I think one of the important factors to recall here is that, if we wind the clock back a decade or so, there was a very defined set of skills and workplaces that paramedics were operating within. But, as we have progressed through to today, the diversity of the paramedic workforce and the areas that they work within has become quite extreme. So it would be incorrect to focus too heavily on paramedic practitioners who are working within the state based ambulance services because in fact, when we look across nationally, there are a significant number of qualified paramedics and paramedics that have subdegree-level qualifications that are referred to as paramedics but are working in a whole range of work environments such as mining, community care centres, a whole range of out-of-hospital practice consultants et cetera. So we need to be mindful that that workforce exists.

CHAIR: Mr Reus, you talk about investigations in your submission. Could you talk to us a little bit about the process now and what possibly could be the way we do things if we have a national register.

Mr Reus : I can only speak for Queensland, of course. We have an audit trail on all of our report forms, and if something is amiss in an audit it is given a level between 1 and 4—or even 5, nowadays, where 5 is nonclinical but is something of gross importance. It then gets referred to the clinical support officer team and the senior clinical educators, and quite often the medical director gets involved, and then they put on them a sanction of some kind, usually. It is quite arbitrary, which is why I support the idea of having a professional clinical investigations team, which would have to come under the banner of the board, and perhaps then if there is some kind of issue or disagreement a tribunal, as such. I think that is very similar to what doctors do. Dr Hartley could probably tell whether it is still arbitrary.

Dr Hartley : It is very arbitrary, and the concerning part of that is that it completely lacks transparency.

Mr Reus : I think that is what the issue is with Queensland. Like I said, I can only speak for Queensland—I am not sure about Victoria or New South Wales—it comes down to one person's decision, and sometimes it can be personally driven, as well. So I think that the idea of it coming under a board makes it—certainly transparency is the big issue, as is protection for the public. If there is an issue it needs to be brought in, stopped and rectified.

Dr Hartley : There is certainly no process across the services for independent review of those, sort of, clinical errors that occur. As Mr Reus mentioned earlier, one of the complexities and difficulties around that is that ,whilst we would be advocating for cross-border transitions of paramedics to be made easier, the regulatory process and registration will be able to address and prevent practitioners from being able to move from state to state without declaring those clinical misdemeanours that have occurred.

CHAIR: Mr Samuel, is it the same in Victoria?

Mr Samuel : Much similar. There is an internal arbitration sort of process.

CHAIR: So what are we saying, that the paramedic is investigated and is not really involved with it, that someone goes in and investigates it and then the paramedic is just told the outcome?

Mr Reus : It is quite often an interview. That is quite often where the Australian Paramedics Association becomes involved, because we get involved in supporting them through that process. If we find that they are maligned by the decision we have legal recourse. That is sort of how it works at the moment. Even under a board under AHPRA it would not change the fact that there could be legal recourse, but it certainly would be a lot more defined.

Mr Acker : My experience is more from overseas. At a registered college in Canada your conduct and competency are adjudicated by your peers. It is an arm's length group: it is not your employer it is a group of your peers. They listen to your case and you get to present yourself and then they make a decision. I think, most importantly, it is about conduct and competency. Competency is simple: it is whether you are able to provide the skills and care as a paramedic. Conduct is more difficult. That looks at the person who is doing bad things, whether it is something illegal or something that is just unprofessional. I think that is why it is more important to have a third party look at rather than the ambulance employers, because they can look at the conduct and competency more objectively.

Mr Samuel : The system in Victoria works where internally you have tiers of how severe is the incident that you caused and, as a result, you go up and up. But there is no cross-border information that comes across about that sort of thing.

Mr Acker : One of the important things is that, as was mentioned earlier by Associate Professor Eburn, there is no transparency in what is happening across the country. If you looked on HCPC, the actual findings of unskilled paramedics is public knowledge. It is posted on their website. As you will find in Australia, if a nurse does something wrong it is published in their newsletter. So it is very transparent; the public can pick that up anytime. As we said earlier, we do not know what is happening across the country within paramedicine. It is not public knowledge. It is hard to say that paramedics are doing anything that is risky or unprofessional, because nobody is telling anybody about it.

CHAIR: Do you think there is a lack of accountability in the industry?

Mr Acker : Paramedic practice allows for a lot of shadow errors and things to happen in the shadows. We largely work independently. My partner and I work by ourselves in the community, so what is happening is only witnessed by the two of us. There is a lack of accountability and there is a lot of lack of transparency. We need to raise the bar higher so we are all working to the same standards.

Mr Samuel : You will see it more in the private sector, where they are more money driven and transparency is harder to see. Correct me if I am wrong in Queensland, but the ambulance service in each state holds a great standard, being a public sector. They are a public provider. It would be harder in the private sector to find these errors in small places.

CHAIR: Mr Reus, in the conclusion of your submission it seems you are absolutely convinced that the establishment of this register will save lives.

Mr Reus : Putting education back onto paramedics, increasing their skill sets, increasing the drive—paramedics, generally, are very conscious of people and are very caring. But to get stronger we have to move forward through prehospital research,. This is the only way I can see it being done holistically around the country. I know Queensland has its own research section. We do lots of work. Paramedics Australasia are always calling for abstracts and anyone with information or research. It is wonderful to see. This is just going to bind it altogether.

CHAIR: Does anyone else have an opinion on that?

Mr Samuel : It is also to protect the title 'paramedic'. That is the main thing here. Not everyone can be called a paramedic, only those who have the standard.

CHAIR: Those who have the qualifications.

Dr Hartley : Across the Australian paramedic industry there is a whole range of issues that can be addressed, which will save lives. I am talking about resources and response times and all those sorts of things that occur that can be addressed in a whole different manner. Will regulation and registration saves lives? That translates back into raising the level of accountability and translates into transparency on how the industry deals with its workforce, in terms of clinical competence and professional conduct. That definitely translates into lives saved but also enhanced progression of the profession and greater confidence in the paramedic workforce and risk mitigation.

CHAIR: Do you have anything to add to that, Mr Acker?

Mr Acker : I would not add any more to that. I would just say that registration will allow Australia to continue to be the best in the world at providing prehospital health care. As we said earlier, we believe paramedics are an important part of health care not only in providing ambulance services—we believe paramedics can have a role in all parts of health care. Australia needs that in urban areas as well as in rural and remote areas.

CHAIR: Hear, hear! We have run out of time. Thank you very much, gentlemen.