Injured, exhausted or assaulted on the job? What the law and the agreement say.

A disease is an injury from employment if it is contracted in the course of the employment and "the employment contributed to a significant degree" to it (s 6(3)). In deciding that, account is taken of the duration and nature of the employment, the likelihood of the disease occurring anyway, hereditary factors, the worker's general health and activities outside work (s 6(4)).

1. The rule.
   1. If a worker suffers an injury by a prescribed disease, and the employment "in which the worker works at the time of suffering the injury, or in which the worker worked at any time before suffering the injury" is prescribed employment for that disease, "the injury is taken to be injury from that employment unless the employer proves that the injury was not from that employment" (s 10(2)).
   2. Post-traumatic stress disorder is a prescribed disease (Regulations Sch 1 item 37).
2. Who is covered. The prescribed employment for PTSD is (r 10(2)):
   1. "employment as a paramedic", meaning an individual registered under the National Law in the paramedicine profession (r 10(1));
   2. "employment as an ambulance officer";
   3. "employment as an ambulance emergency communications officer", meaning an individual whose primary duties include receiving calls for emergency ambulance attendance and giving instructions and advice, including first aid advice, before an ambulance arrives (r 10(1));
   4. Crown firefighters, and DFES communications systems officers. Paragraphs (a) to (c) are not limited to employment by the State. They cover St John staff and staff of any other ambulance employer.
3. The conditions (r 10(3)). The presumption applies only if:
   1. a psychiatrist diagnoses PTSD "in accordance with the diagnostic criteria in DSM-5" (r 10(3)(a)); and
   2. for paramedics, ambulance officers and ambulance emergency communications officers, the first diagnosis of PTSD, by anyone, was on or after 1 February 2022 (r 10(3)(b)). These conditions apply "Despite regulation 8", so the general 1 July 2024 start date for the other presumptions does not apply to PTSD.
4. Past employment counts. Because s 10(2) reaches employment in which the worker "worked at any time before", a former paramedic now working elsewhere can rely on it.
5. It is rebuttable. The employer can rebut it by proving the injury was not suffered in the course of the employment, or that the employment did not contribute to a significant degree (s 10(2), note).
6. The open point: patient transport staff.
   1. "Ambulance officer" is not defined in the Regulations or the Act. Whether patient transport officers, mental health transport officers and medics are "ambulance officers" for r 10(2)(b) has not been decided in any decision found for this guide.
   2. A worker outside the prescribed classes can still claim by proving that the employment contributed to a significant degree (s 6(3)).

A psychological or psychiatric disorder "is not an injury from employment if it results wholly or predominantly from" administrative action that is not "unreasonable and harsh on the part of the employer", or from the expectation of such action (s 7(2)). Administrative action includes a performance appraisal, suspension, disciplinary action and anything done in connection with dismissal, demotion or a failure to obtain a promotion or transfer (s 7(1)).

How s 7 operates against the s 10 presumption, for example where a paramedic's PTSD claim follows a disciplinary process, has not been decided on the material read for this guide.

1. COVID-19 is presumed work-related for "employment as an ambulance officer" (r 9(2)(c)), where a medical practitioner diagnoses COVID-19 on the basis of a NATA-accredited test result, the diagnosis day is on or after 16 February 2020, and the worker was in prescribed employment on that day (r 9(3)–(5)).
2. There is no occupation-based cancer presumption for paramedics or ambulance officers: the presumption in s 11 for listed cancers is for firefighters only. Schedule 1 to the Regulations presumes some cancers to be work-related for any worker after a stated period of exposure to a listed substance or ionising radiation (Sch 1 items 15–36).

The steps under the 2023 Act:

1. Make the claim. A claim is made when you give your employer a completed claim form in the approved form and a certificate of capacity (s 25(2)), within 12 months after the injury occurs (s 25(1)). A late or defective claim is not invalid if the failure results from mistake, absence from the State or another reasonable cause, or would not prejudice the employer's defence (s 25(5)).
2. The employer passes it on. An insured employer must give the claim to its insurer within 7 days (s 26(1)). If it does not, you may give the claim to the insurer yourself (s 27).
3. The liability decision. Within 14 days after receiving the claim, the insurer must give you and the employer a liability decision notice accepting liability, accepting it with one or more liability questions, or not accepting it (s 28(1)–(2)). For an incapacity claim the notice must also say whether income compensation is accepted (s 28(3)).
4. A deferred decision. If a decision cannot be made, the insurer may instead give a deferred decision notice within the 14 days (s 28(4)). It must then decide before the deemed liability acceptance day set by the regulations; if it does not, it is taken to have accepted liability, including for income compensation in an incapacity claim (s 29(1), (3)).
5. A dispute. If liability is not accepted, an arbitrator may, on your application, hear and determine the question (s 30(1)).
6. Sick leave while you wait. Under the paramedics' agreement, if you are injured at work and have personal/carer's leave, you are paid sick leave until the claim is approved, and the leave is re-credited to the extent of the approved compensation (cl 40.6(d)).
7. Your job during incapacity. For 12 months from the day you first have an incapacity for work, the employer must provide your pre-injury position, or a suitable position if that is not reasonably practicable or you cannot do it (s 166(1)–(2)). It must not dismiss you solely or mainly because you are incapacitated, and must give you at least 28 days' notice in the approved form before dismissing you for any reason (s 168(2)–(4)).
8. Common law. Court proceedings for damages against the employer need an assessed permanent whole of person impairment of at least 15% and a registered election (s 421(1)).

Ordinary hours are "an average of thirty-eight (38) per week plus reasonable additional hours specific to each roster", and the maximum rostered shift is 13 hours (cl 23.1(a)–(b)). The National Employment Standards limit is 38 hours a week plus reasonable additional hours (FW Act s 62).

1. St John may require reasonable overtime, and an employee may refuse overtime that would result in unreasonable hours (cl 29.2(a)–(b)).
2. Both sides must take into account (cl 29.2(c)):
   1. any risk to the employee's health and safety;
   2. the dispatch priority of the case;
   3. whether other resources could avoid or reduce the overtime;
   4. personal circumstances, including family responsibilities;
   5. "the needs of the organisation to provide pre-hospital care in an emergency setting";
   6. notice the employee has given of unavailability;
   7. any other relevant matter.
3. An employee who considers overtime unreasonable must say so to the manager as soon as reasonably practicable, but the discussion "must not delay the Employee responding to a priority one (1) or priority zero (0)" case (cl 29.2(e)–(f)).
4. St John's overtime process is to rest on the "overriding principle" that employees should wherever possible be released at rostered shift end, with release preference to those who gave notice, then those who did not opt in (cl 29.2(h)).

1. Downgraded and ramped cases. Where a case was reasonable at dispatch but is downgraded after clinical assessment by the crew and is one "which is ramped on arrival at hospital", St John must "take reasonable steps to reduce the overtime" (cl 29.2(g)).
2. Takeover crews. "A crew shall be deployed to a hospital as a priority two (2) in order to take over a crew that is ramped at a hospital at the end of their shift", and the takeover crew may be diverted only for a priority 0 or 1 job (cl 29.3(a)(iii)).
3. Interns at a ramp. Where a paramedic intern works as a single officer and is deployed to a ramp, the intern "will only be permitted to support a Standard Crew Formation" (cl 32.1(d)(ii)).

The agreement sets no staffing numbers, response-time targets or limits on time spent ramped.

1. In the last 15 minutes of a shift there is a mandatory out-of-service period, broken only for a priority 0 or 1 job; and no interfacility transfer over 35 kilometres is tasked in the last 90 minutes unless it is priority 1 (cl 29.3(a)(i)–(ii)).
2. Time worked more than two hours past the end of shift is paid at 250% (cl 29.3(a)(v)). Other overtime is double time (cl 29.1(a)).
3. Where overtime is necessary it is to be arranged, wherever reasonably practicable, to leave a minimum break of 11 hours between consecutive 11-hour shifts, 10 hours between 13-hour shifts and 10.5 hours between 12-hour shifts (cl 29.1(e)). If St John directs work that cuts into the break, the employee is released until the break is had without loss of pay, or is paid double time until released if directed to resume (cl 29.1(f)).
4. On shifts of ten hours or more there is one uninterrupted 30-minute paid crib break, with a Broken Crib Break Allowance if it is interrupted or not given within the five-hour span across the middle of the shift, and a low acuity priority 4 job is not allocated until the break is taken (cl 28(a)–(e)).

"The parties recognise that fatigue is an issue of primary concern". The listed contributing factors are shift length, start and finish times, breaks within and between shifts, the amount of overtime "especially shift extension overtime", workload management and personal responsibility (cl 29.6(a)).

The joint consultative committee meets on fatigue issues and may recommend changes; a change to the agreement needs a formal variation; and a fatigue dispute goes to the cl 11 dispute procedure (cl 29.6(b)–(e)).