Regulation of Paramedicine

Medicine regulation began around the start of the century.
The Frankenstein Chronicles on Netflix portrays early medicine regulation, referencing the Anatomy Act (likely 1819).

Australia has a national regulation scheme, unique among countries like the UK, South Africa, and Ireland.
The US and Canada use state or province-based schemes, which are more complex.
Australia transitioned to a national scheme about 10-12 years ago, previously having state-based regulations (e.g., Medical Board of New South Wales).

As professions evolve, practitioners become more autonomous necessitating accountability.
Paramedics today practice with more autonomy compared to 30 years ago when practice was heavily protocol-driven.
Critical thinking is now essential, requiring professionals to justify actions beyond protocol adherence.
Regulation protects the public by ensuring practitioners are competent, qualified, and adhere to standards.
It sets clear boundaries for who can be considered part of the profession, addressing the pre-2018 issue where anyone could claim the title of "paramedic."
Self-regulation empowers the profession to set its standards, evolve, and improve, ensuring standards are set by peers, not external bodies.

Enabled by the Health Practitioners National Law, a state law due to constitutional requirements.
A model piece of legislation was adopted by each state to participate.
Each profession has a national board (e.g., Paramedicine Board of Australia) responsible for setting standards and disciplinary hearings.
AHPRA (Australian Health Professional Regulation Agency) is the government bureaucracy supporting these boards, handling registration, audits, and investigations.
The board decides on registration applications based on set standards, while AHPRA manages the administrative processes.
Queensland and New South Wales have co-regulatory schemes where complaints are managed within the state.
New South Wales has the Paramedicine Council of New South Wales, which handles complaints about paramedics and students.

Entry requires meeting qualification criteria (approved or accepted qualification) and being a fit and proper person (character, criminal history).
Ongoing requirements include:
- Maintaining a clean criminal history.
- Demonstrating appropriate language skills.
- Completing 30 hours of Continuing Professional Development (CPD) annually, with 8 hours being interactive.
- Maintaining a reflective journal (ACP offers an online platform).
- Meeting recency of practice: 450 hours in 3 years, or 150 hours per year.
- Recency of practice includes any activity using paramedic skills and knowledge.
- Holding professional indemnity arrangements.
- Grandfathering standard (for those without a university degree) is phasing out.

Mobility: Facilitates movement of health practitioners across the country, addressing workforce shortages and enabling locum positions.
Uniform Standards: Ensures consistent standards for paramedics nationwide.
Efficiency: Streamlines administrative processes, staggering registration renewals.
Collaboration: Boards collaborate to advance health professions.
National Register: Publicly accessible register of health practitioners with registration details and complaint history.

Student Registration: Managed by the university, required for placements, but not on the public register.
General Registration: Standard for all paramedics.
Specialist Registration: Exists in some professions (e.g., medicine); may be introduced in paramedicine in the future.
Provisional Registration: Only applies to medicine and pharmacy.
Annual Renewal: Registration must be renewed annually and is listed on the public register, including any conditions.

Declare any relevant changes.
Meet CPD requirements.
Maintain professional indemnity.
Adhere to mandatory notification requirements.
Registration standards and codes define appropriate practice and can be used in disciplinary proceedings.

Voluntary Notification: Anyone can report concerns about a health practitioner's performance, conduct, or health.
Mandatory Notification: Required in cases of:
- Practicing while intoxicated.
- Engaging in sexual misconduct.
- Placing the public at risk through physical or mental impairment.
- Placing the public at risk through substantial departure from accepted practice.
Universities must make mandatory notifications for students in certain circumstances.
Support is offered to students facing challenges before resorting to mandatory notifications.
A high standard is required for mandatory notifications, focusing on significant risks to public safety.
In the UK, paramedics and social workers are the most reported professions, with most complaints being conduct-related rather than clinical.
Paramedicine has a high-risk profile due to unstable environments, invasive procedures, vulnerable patients, and time-critical situations.

Registration: Granted by the Paramedicine Board and AHPRA; the right to practice using a specific title; requires qualification and meeting the fit and proper person test.
Qualification: Holding a university degree, is a baseline for getting registered.
Fit and Proper Person Test: Assessment of criminal history and complaints.
Credentialing: Setting a scope of practice within an organization; primarily employer-driven. For example, New South Wales Ambulance credentials paramedics as P1 Paramedics, which determines their scope in that organization only.
Internship: Additional training required by ambulance services after registration to perform the role of an ambulance paramedic.
Credentials earned in one state or organization may not automatically transfer to another.