Australian Capital Territory

Emergencies Act 2004, section 62

APPLICATION FOR APPROVAL AS A PROVIDER
OF
AMBULANCE SERVICES
IN THE A.C.T.

  Applicant's name
  (Provider):		  Date of request:	….. / ….. / ……	
  Applicant's
  address:		
		
  Contact:	
  Work Phone:
	  Home Phone:
	 Facsimile:
	
  Term of   approval:	  From	…... / …… / …..	  To	…… / …… / ……	

APPLICATION IS MADE FOR APPROVAL AS A PROVIDER OF:

Ambulance Services that may include: (select services for which approval is sought)

	Provision of emergency medical treatment at static events within the Territory within a defined precinct not including ambulance patient transport from the event or outside the precinct of the event.

	Provision of emergency medical treatment at static events within the Territory within a precinct including ambulance patient transport from the event or outside the precinct of the event. 

	Provision of non-emergency patient transport services including the routine ambulance transport of patients to or from public or private hospitals, health establishments, nursing homes, place of residence or establishments providing outpatient services. 

A.   Definitions for this application:

Applicant – means the person applying, under section 61 of the Emergencies Act 2004, for approval as a Provider of services.

Ambulance Commander – means the ACTAS manager responsible for ambulance services at the scene of a major incident.

approval – means the approval granted to the Provider under section 62 of the Emergencies Act 2004 - if granted.

approved services – means the services to be provided under the approval.

ACTAS – means the ACT Ambulance Service.

clearly distinguishable – means, for clauses C13 and C14, that PPE, official clothing and official vehicles are marked, badged, labelled, coloured and presented in such a way that it is clearly evident that the PPE, official clothing and official vehicles are not those of ACTAS or the ESA.

Duty Manager – means the ACTAS manager on duty who is responsible for daily provision of ambulance services.

emergency ambulance services – means a response using an official vehicle to a pre-hospital emergency incident, provision of medical care and may include subsequent ambulance patient transport to hospital.

equipment – includes:
a)	medical apparatus; and
b)	machinery, fit-out or device fixed to an official vehicle.

ESA – means the ACT Emergency Services Authority established under section 7 of the Emergencies Act 2004 and, where the context permits or requires, includes any or all of the emergency services established under that Act.

ESA Contact Officer – is the person nominated in writing by the ESA to the Provider at the time the approval is granted, or at such later time as the ESA is able to nominate a contact officer.

event – includes any private function, public entertainment, public meeting or any other location where the Applicant provides the services for which approval is provided.

first aid – means the provision of help to an injured person before the arrival of a qualified ambulance officer or medical professional.

Medical Officer – means a doctor, registered within the Territory, who is working for the Provider.

medical treatment – may include:
a)	undertaking a medical examination and assessment;
b)	giving medical advice;
c)	giving first aid;
d)	undertaking a medical procedure; or
e)	administering a medication.

non-emergency patient transport – means the routine ambulance transport of patients to or from public or private hospitals, health establishments, nursing homes, place of residence or establishments providing outpatient services.

official clothing – includes any specifically coloured, marked or badged clothing directly employed in the performance of the functions of the Provider in accordance with the approval.

official vehicle – includes any specifically coloured, marked or badged vehicle directly employed in the performance of the functions of the Provider.

PPE – means personal protective equipment.

precinct – means a specific zone of operations associated with the provision of the approved services.

pre or post hospital care – includes any patient care or medical treatment that is provided outside a definitive care facility.

Provider – means the applicant for approval under section 62 of the Emergencies Act 2004, being the person or organisation that will conduct or manage the approved services and, where the context permits or requires, includes an employee, servant or agent of the Provider.

public entertainment – means an exhibition, performance, lecture, game or sport to which the public has access whether or not by payment.

Static event – means an event at which the approved services are being provided within a defined area or precinct.

B.   Particulars of the Provider and its activities:

1.	Details of the name/business name/incorporated body under which the Provider intends to operate are provided in Schedule A.

2.	The services for which the Applicant seeks approval are set out in Schedule B.  The Applicant must provide sufficient detail of the proposed scope and extent of ambulance services that approval is sought for within each area of ambulance services.

3.	Details about the personnel employed or used by the Applicant, demonstrating its capability to deliver approved services in accordance with Australian or industry standards relevant to those services, are set out in Schedule C.

4.	Details of PPE and official clothing to be used by the Applicant are set out in Schedule D.

5.	Details of official vehicles and equipment to be used by the Applicant are set out in Schedule E.

6.	Particulars of clinical governance structures & arrangements associated with the provision of ambulance services are set out in Schedule F.

7.	Details of the Applicant’s arrangements for structure and communications, including chain of command, are set out in Attachment 1.

C.   General Conditions:

1.	The Applicant acknowledges that, if an approval is granted, it will be subject to the General Conditions specified below and any Special Conditions imposed by the Minister.

2.	The Provider may make written application to the Minister to amend an approval for services previously approved.  The Minister may, after consulting with the ESA, amend the approval.

3.	The approval may be revoked without notice if the Provider fails to comply with any of the conditions of the approval.

Notes: 1.	It is an offence under section 63(1) of the Emergencies Act 2004 to provide ambulance, services without approval under section 62 of the Act.
 2.	It is an offence under section 63(2) of the Act, if an approval has been granted under section 62, to provide services that are not approved.

4.	The Provider must ensure that all employees, servants and agents of the Provider agree to be bound by, and comply with, the terms of the approval.

5.	The Provider must at all times conduct any approved services in accordance with the approval.

6.	The Provider must cooperate with ACTAS in the provision of the approved services, including cooperative patient care, patient handover and other activities that may be related to the services being provided.

7.	Should an incident occur that involves multiple casualties, the Provider must comply with the directions of ACTAS Ambulance Commander, both in providing the approved services and in assisting ACTAS crews in medical treatment and patient care.

8.	All Medical Officers present at an incident must make their presence known to ACTAS Officers.  Although Medical Officers are ultimately responsible for medical care, Medical Officers must consult with ACTAS Paramedics regarding issues of medical treatment and transport, particularly in relation to criticality of injuries and transport of patients.

9.	The Provider must appoint, and submit to ACTAS details of, a person in the employment of the Provider to be its Clinical Quality Assurance Contact.  Any dispute about patient care or clinical governance arising from an incident involving ACTAS and the Provider must be forwarded to ACTAS Chief Officer for review and resolution.  A meeting between ACTAS and the Clinical Quality Assurance Contact will be organised to discuss issues under dispute, and to resolve any disagreement relating to patient care.

10.	The Provider must at all times comply with all Australian and industry standards relevant to the provision of the approved services.  This includes the requirements that:

a)	all persons performing functions on behalf of the Provider must be appropriately qualified and experienced to provide the approved service.  Any medical officer contracted to the Provider must be registered within the Territory; and
b)	the Provider must ensure that its employees, servants and agents comply with all legislation relevant to the services to be provided.

11.	The Provider must furnish details of relevant training or education, certifications and levels of clinical practice and experience at that level of practice, for all people engaged as employees, servants or agents of the Provider.  The list must be in the form set out in Schedule C.

12.	The Provider must ensure that the PPE and official clothing specified in Schedule D, or as otherwise required by the approval, are available, and used, at all times by persons performing the approved functions of the Provider.

13.	Only the PPE, official clothing, official vehicles and equipment specified in Schedule D and Schedule E, or otherwise required by the approval, may be used in the performance of the approved functions.  Any official clothing or PPE worn by an employee, servant or agent of the Provider must clearly identify the wearer as an employee, servant or agent of the Provider and must be clearly distinguishable from official clothing or PPE worn by employees of ACTAS and the ESA.

14.	Any official vehicle used by the Provider must be clearly marked to identify the vehicle as belonging to the Provider and must be clearly distinguishable from official vehicles used by ACTAS and the ESA.  If approved, audible or visual warning devices fitted to an official vehicle may only be operated in accordance with the Australian Road Rules and any other conditions imposed by the Minister.  Visual warning devices fitted to an official vehicle must not be off a red, blue or green colour.

15.	The Provider acknowledges that it is not an “emergency service” for the purposes of the Emergencies Act 2004.  Therefore, the Provider:

a)	must not represent to any person that it is an emergency service for the purposes of that Act, or that it is empowered to do any thing that is not expressly permitted by the approval; and
b)	must not perform, in an emergency or otherwise, the functions of an emergency service, except as expressly permitted by the approval, or as directed by the ESA or any of its emergency services.

16.	The Provider must not display details, logos or symbols of any sponsor of the Provider, which would bring into disrepute the good name of either the ESA or the Provider.  There should be no association with the following products or services unless a positive, socially responsible theme or health message is to be promoted:

a)	tobacco;
b)	alcohol;
c)	the sex industry; or
d)	sponsors who could involve the ESA or the Provider in controversy or expose either party to adverse criticism.

17.	The Provider must at all times maintain the clinical governance arrangements as approved and set out in Schedule F.

18.	The provider must, maintain an accurate record of any first aid or medical treatment provided to any person by the Provider.  Any record created in the provision of the approved services is to be maintained by the Provider in accordance with the Health Records (Privacy and Access) Act 1997.  The Provider must supply a copy of the proposed form of record with this application.

19.	The Provider must develop a Provider’s Code of Conduct, which is agreed to by all of its employees, servants and agents, and is complied with at all times.  The Provider’s Code of Conduct must meet the minimum requirements set out in Attachment 2 and must be furnished with this application.

20.	
The Provider hereby releases and indemnifies the ESA, its employees, servants and agents from and against all damages, costs, expenses, loss or damage which they may incur or sustain and all actions, proceedings, claims and demands whatsoever which may be brought or made against them by any person, in respect of or by reason of or arising from:

a)	the provision, by or on behalf of the Provider, of the approved services;
b)	any negligence or other wrongful act or omission of the Provider or its employees, servants or agents, or of any other persons for whose acts or omissions the Provider is vicariously liable;
c)	any negligence or other wrongful act or omission of the Provider’s visitors, invitees or licensees;
d)	death, injury, loss of or damage to the Provider or its other employees, agents, sub-contractors, invitees, licensees or visitors; or
e)	any breach by the Provider of the approval.

21.	The Provider will maintain a Public Liability policy of insurance of not less than $10,000,000 that notes the ESA as an interested party, and covers the Provider and the ESA in respect of any claim arising from or related to the provision of the approved services.

22.	If the Provider is providing first aid or medical treatment, the Provider will maintain a Medical Liability and Indemnity policy of insurance of not less than $20,000,000, which notes the ESA as an interested party and covers the Provider and the ESA in respect of any claim arising from or related to the provision of the approved services.

23.	The ESA may require the Provider to provide proof that the policies of insurance required by the approval have been effected and maintained.  The Minister may terminate the approval if the Provider does not comply with this clause.

24.	In the event of any dispute between the Provider and the ESA in relation to the administration of the approval, the Provider must initially contact the ESA Contact Officer.

_______________________

The Provider declares that the information given in this application and its schedules and attachments is true and complete.

Signature/s			…………………………………………………………………………

If a company or delegate
of a body corporate,
capacity/authority		………………………………………………………………………….

Date:				………………………………….

SCHEDULE A

DETAILS OF APPLICANT (complete as applicable)

Name of applicant:	……………………………………………………………..

Trading as:		……………………………………………………………..

Address for
correspondence/service:	…………….……………………………………….

Places registered:
(States, Territories)	…………………….……………………………………….

Contact person:	…………………….……………………………………….

	 address:	…………………….……………………………………….

	    phone:	(w)   ……………………………  (mob.)   …………………………..

SCHEDULE B

SERVICES TO BE PROVIDED 

(Note: The Applicant must provide sufficient detail of the nature and scope of services under each sub heading for which approval is sought)

	Provision of emergency medical treatment at static events within the Territory, not including ambulance patient transport from the event or outside the defined precinct of the event

	

	

	

	

	

	

	

	

SERVICES TO BE PROVIDED (cont)

(Note: The Applicant must provide sufficient detail of the nature and scope of services under each sub heading for which approval is sought)

	Provision of emergency medical treatment at static events within the Territory, including ambulance patient transport from the event or outside the precinct of the event. 

	

	

	

	

	

	

	

	

	

SERVICES TO BE PROVIDED (cont)

(Note: The Applicant must provide sufficient detail of the nature and scope of services under each sub heading for which approval is sought)

	Provision of non-emergency patient transport services including the routine ambulance transport of patients to or from public or private hospitals, health establishments, nursing homes, place of residence or establishments providing outpatient services 

	

	

	

	

	

	

	

	

	

SERVICES TO BE PROVIDED (cont)

(Note: The Applicant must provide sufficient detail of the nature and scope of services under each sub heading for which approval is sought)

	Other – [include details of any other proposed services]

	

	

	

	

	

	

	

	

	

SCHEDULE C

PERSONNEL AND SKILLS / QUALIFICATIONS

(Note: This table should include details of relevant training or education, certifications and levels of clinical practice and experience at that level of practice for all personnel)

NAME	SKILLS AND QUALIFICATIONS	

	

	

	

	

	

	

	

	

	

	

	

SCHEDULE D

PPE AND OFFICIAL CLOTHING TO BE USED

TYPE OF PPE	Aust. / NZ STANDARD	

		

		

		

		

SCHEDULE E

OFFICIAL VEHICLES AND EQUIPMENT TO BE USED

Note: The Applicant must provide details of all official vehicles or equipment used in the provision of services.

TYPE OF VEHICLE (including registration no) OR
EQUIPMENT 	RELEVANT STANDARD COMPLIED WITH	

		

		

		

		

SCHEDULE F

CLINICAL GOVERNANCE 

Note: The Applicant must attach documented evidence of the clinical governance structures and arrangements for the provision of the services for which approval is sought including:

•	Currency of clinical practice for all personnel;

•	Details of Medical Advisor or Supervisor;

•	Authority for clinical practice, outlining levels of clinical practice;

•	Clinical Practice Protocols and Guidelines including any pharmacology;

•	Clinical quality management processes, clinical review program and contact point for clinical review.

ATTACHMENT 1

DETAILS OF THE PROVIDER’S STRUCTURE FOR COMMUNICATIONS, COORDINATION AND CHAIN OF COMMAND
REFERRED TO IN CLAUSE B7

(to be completed by the Provider – include communication strategy and contact numbers)

ATTACHMENT 2

PROVIDER’S CODE OF CONDUCT – CLAUSE C19

(The following minimum standards are provided to enable Applicants to develop their own Code of Conduct applicable to the approved services.  A copy of the Provider’s proposed Code of Conduct is to be furnished with the completed application)

MINIMUM STANDARDS FOR PROVIDER’S CODE OF CONDUCT

The Provider’s Code of Conduct should include the following obligations for the employees, servants and agents of the Provider.

•	no person acting on behalf of the Provider at an event is to operate on public roads other than in accordance with the Provider’s approval;

•	employees, servants and agents acting on behalf of the Provider must maintain a courteous and professional approach at all times, whether or not attending at an incident;

•	employees, servants and agents acting on behalf of the Provider must not consume, or be under the influence of, alcohol or other intoxicating substance whilst on duty or wearing official clothing or PPE;

•	employees, servants and agents acting on behalf of the Provider must follow the directions of any ACT Emergency Services Authority or ACT Ambulance Service officer whilst attending at an event for the Provider;

•	employees, servants and agents acting on behalf of the Provider must strive to cooperate with all civil authorities at all times;

•	employees, servants and agents acting on behalf of the Provider must perform their duties with diligence and care, having regard to public safety and morality; and

•	employees, servants and agents acting on behalf of the Provider will pursue any training relevant to the operations of the Provider if requested or directed to do so.