C2005/3279, Transcript of Proceedings [2005] AIRCTrans 2148 (17 October 2005)

TRANSCRIPT OF PROCEEDINGS

---

Workplace Relations Act 1996 13038-1

COMMISSIONER FOGGO

C2005/3279

METROPOLITAN AMBULANCE SERVICE
AND
LIQUOR, HOSPITALITY AND MISCELLANEOUS UNION
s.170LW - Application for settlement of dispute (certification of agreement)
(C2005/3279)

MELBOURNE

10.04AM, TUESDAY, 04 OCTOBER 2005

Continued from 3/10/2005

PN547

THE COMMISSIONER: Good morning. Before we start, there was an issue that was raised late yesterday. The application before me has been properly filed pursuant to section 170LW. In those circumstances it is a dispute which arises from the ..... agreement. The dispute resolution clause of the agreement provides in very clear and unambiguous terms steps for resolving disputes which includes application to the Commission. Obviously in circumstances where the Commission has jurisdiction there is responsibility to proceed with the matter in accordance with the dispute resolution clause. Given that that is the case, I don't seek any view from the union in relation to the matter that was raised yesterday.

PN548

The proceedings will proceed, a decision will be made and an appeal may or may not arise and as far as the authority or jurisdiction of the Commission which falls from the Act and the dispute resolution clause that is the role of the Commission.

PN549

Mr McGhie, I don't think we were finished with you or your evidence.

<STEVEN MCGHIE, ON FORMER OATH [10.06AM]

PN550

THE COMMISSIONER: Here is a quick question for you, Ms Maclean, just to keep you on your toes. What does PCI stand for?

PN551

MS MACLEAN: Patient care record.

PN552

THE COMMISSIONER: Thank you. That's okay, at five past ten I've past my first test this morning. Don't get too smart; there will be many more throughout the day.

PN553

MS MACLEAN: Very good.

PN554

THE COMMISSIONER: Mr McGhie, you gave an affirmation yesterday and of course that remains, I don't think there is another need to swear you in.

<CROSS-EXAMINATION BY MS MACLEAN, CONTINUING [10.07AM]

PN555

MS MACLEAN: Mr McGhie, can I ask you to turn to your witness statement?
---Yes.

PN556

And in particular paragraph 11. We heard yesterday in evidence from Mr Young that in relation lets start firstly with fixed wing aircraft there are a number of possible crew permutations, do you recall him giving that evidence that on any given fixed wing flight there might be one flight paramedic, a flight paramedic with a MICA flight paramedic or perhaps two flight paramedics depending on the needs of the particular patients who are on that flight, do you recall him giving that evidence?---Yes.

PN557

Do I understand that it is the union's position that the entitlement to the allowance arises in respect of each shift or in respect of each flight?---Well, it is in respect of each shift, but I think what we have said is that we don't expect the allowance to be paid when there isn't a single officer crewing situation.

PN558

Mr McGhie, from a practical point of view, from an employer's point of view has to payroll and do all the record keeping as is appropriate, what is your position as to the applicability of the allowance is it payable per shift or is it payable per flight?---Well, it is payable per shift.

PN559

So regardless of whether the flight paramedic in the fixed wing aircraft, lets concentrate of that for the moment, during the course of the day works for, arguments sake, the majority of their shift in a crewing arrangement which involves them being on their own only once. The allowance would be payable for the entirety of the shift?---No, I don't think that is what we are claiming for. What we are saying is that in general it is payable per shift but obviously where there is a situation where there is two officers involved in the treating and transport of an Aero medical patient then we are saying that the allowance is not payable in that circumstance.

PN560

So you are saying are you now that the allowance would be payable per flight?
---No, it is payable on an hourly basis, it is calculated on a shift by shift basis and pro rata on an hourly basis greater then an eight hour shift that is the way the clause reads is my understanding.

PN561

Perhaps if we can just turn to the clause and I want you to explain as a matter of practicality how you would envisage the employer, MAS, complying with it so that it was not in breach of the clause and we end up in court. Do you have a copy of the clause there?---No, I don't.

**** STEVEN MCGHIE XXN MS MACLEAN
PN562

Perhaps the Commissioner's associate can hand you a copy of the EBA. Do you have a copy of the allowance clause there?---Operational crewing allowance?

PN563

Yes?---6(c)?

PN564

Yes?---Yes.

PN565

Let's start at the start:

PN566

When an employee regardless of rank is required to undertake and perform operational stretcher duties as a single officer crew then that employee shall receive an allowance equal to 1.5 per cent of the weekly rates specified for the ambulance paramedic -

PN567

et cetera:

PN568

- for each shift.

PN569

?---Yes.

PN570

So the first qualification in that clause is that it is for each shift?---Yes.

PN571

Is it your position that to be entitled to the allowance an employee is required to be rostered alone only once during the course of that shift to receive the allowance?---No. To be entitled to the amounts the employee is rostered per shift as a single officer, but there are circumstances during the course of a shift where they may not be in a single officer situation such as depending on the patient's condition and the requirement of the crewing arrangements.

PN572

But the on-road ambulance paramedic is rostered per shift on their own, everyone is rostered on their own, they are teamed up during the course of their shift with a partner or attendant, are they not?---They are not rostered on their own, I don't understand what you are asking.

PN573

I don't understand what your answer was. Every individual turns up for work and they will complete a rostered shift?---Yes.

PN574

They will perform duties during the course of that day either on their own or as part of a team or as part of a crew, that is right isn't it?---What happens in rostering an ambulance is that people are rostered to a roster line, that roster line generally is paired up with another roster line that forms a crew, that is generally what happens. In the single officer branches they are rostered to a roster line which is only one officer and they are not paired with anyone else.

**** STEVEN MCGHIE XXN MS MACLEAN
PN575

And in that event do they receive a single officer crewing allowance?---Yes, they do.

PN576

At the Air Ambulance how does it work?---At Air Ambulance they are rostered to a line, a roster line, as a single officer, they are not paired up with anyone else unless there is a specific requirement for a case that requires two officers.

PN577

So what you are saying is, if I understand you correctly, and if I don't please say so, that a flight paramedic regardless of the work they do is entitled to the single officer crewing allowance regardless of the resource allocation that they might form part of for a particular shift they should get the allowance regardless?---Yes.

PN578

So if for the whole of their shift they work as part of a team of two or three they still get the single officer crewing allowance?---Yes.

PN579

Is your position the same with respect to the MICA flight paramedic in the helicopter?---Yes, it is.

PN580

Is your position also the same with respect to the MICA flight paramedic who performs duties on the fixed wing aircraft?---That's right.

PN581

And the MICA flight paramedic on the fixed wing aircraft would always be, this is right isn't it, part of a crew of at least one other paramedic, flight paramedic or MICA flight paramedic depending on the needs of the patient?---No.

PN582

You can envisage a situation where there would be a MICA flight paramedic on their own on the fixed wing aircraft?---I would say on most occasions.

PN583

What about in the situation where the MICA flight paramedic is part of a crew of say one flight paramedic plus the MICA flight paramedic, they should still get the allowance?---Well, if it is payable as per shift, yes.

PN584

So really Mr McGhie what you - - -

PN585

THE COMMISSIONER: I'm sorry, could you just ask that last question again, I didn't quite understand the answer.

PN586

MS MACLEAN: When the MICA flight paramedic is on the fixed wing aircraft and they are part of a crew which includes at least a flight paramedic then the MICA flight paramedic ought receive the single officer crewing allowance, that is your position?---Yes.

**** STEVEN MCGHIE XXN MS MACLEAN
PN587

THE COMMISSIONER: Can you just explain that to me, Mr McGhie?---Both officers are rostered as single officer, they actually have two separate rosters and if there is a requirement for the MICA flight paramedic to work in tandem he is still deemed as a single officer for a specific case they are working together and as per the clause it says it is payable per shift, but on most occasions the MICA flight paramedic would work in a single capacity.

PN588

If they are working together why is that different to a road crew where there are two lines, roster lines, and you team up with someone? Why isn't that a team situation, the one we have just been talking about, where you have a MICA flight paramedic and a flight paramedic working together?---It isn't different, but as per the clause it says being rostered per the shift and paying per the shift so it isn't different and that is what happens in the rural services where assistance is provided to the single officer they still receive a single officer crewing allowance even though they may have someone recalled in, a community officer maybe used or someone else maybe used, a back up crew or something like that, they still pay that allowance.

PN589

Yes, thank you.

PN590

MS MACLEAN: Mr McGhie, can I suggest this to you that nowhere in clause 6(c) does it refer to being rostered as a single officer. What it says is, well, first of all perhaps you can have a look at the clause and tell me if you agree with that?---No, it doesn't say rostered, no.

PN591

What is says is that they are required to undertake and perform certain duties not they are rostered in a particular fashion, would you agree with that?---That's right.

PN592

So on one view the clause operates by reference to what sort of work the person is doing?---Yes.

PN593

You mentioned a moment ago in answer to a question from the Commission the rural services and you make reference in your witness statement to the position in the rural ambulance service, don't you?---Yes.

PN594

It is the case is it not that in the rural ambulance services there are perhaps not so now but there were a number of what we have referred to as one man stations?
---No, no, there is no one man stations in Rural Ambulance Victoria.

**** STEVEN MCGHIE XXN MS MACLEAN
PN595

Not any more, but there used to be?---There used to be.

PN596

That is the question that I am asking you, there were, but there aren't now one man stations within the Rural Ambulance Services?---There is no one man stations in the fact that there is only one person that staffs that branch. There are single officer branches, that is a different thing again.

PN597

They still exist?---They still exist, yes.

PN598

And the people in those stations would routinely turn out and respond to cases on their own and as you said earlier there might be an ambulance community officer or another crew come from another station to back them up if needed?---They would respond on a daily basis and they would have support as you have said community officers, other crews, maybe a recalled officer.

PN599

And in the Metropolitan Ambulance Service that situation no longer obtains, there are no more single officer branches in the metropolitan system?---No, only air ambulance.

PN600

And in the rural ambulance service the single offer crewing allowance forms part of the rolling rate, doesn't it?---It does now, yes.

PN601

THE COMMISSIONER: Forms part of the?

PN602

MS MACLEAN: Rolled in rate. The mysteries of the rolled in rate, Commissioner, are beyond me but I am told that Mr McGhie is one of the two people in Victoria who understands how it is calculated so we are very fortunate to have him here today. I don't know who the other person is but it is certainly not me.

PN603

The position is, Mr McGhie, that in the rural ambulance service the single officer crewing allowance is in the rolled in rate and they have still one man branches in the sense that they are single officer responding branches?---That's right.

PN604

And you say in paragraph 16 of your statement why that was done and that was by decision of the Commission in July of 1997, single officer crewing allowance was calculated based on the rostered hours at a single officer branch which provided a total figure for all of those branches, so it was put in can I suggest to you as recognition that the rural ambulance service still operated single officer crewing arrangements and it was appropriate in those circumstances to include it in the rolled in rate, is that your understanding?---No, no, it was put in - it was agreed between the parties following the decision in the Commission, agreed between the five regional ambulance services at the time in the union that the on-call branches single officer crewing branches were not contributing enough penalties to be included into the rolled in rate to add penalties to the rolled in rate and it was agreed between the parties that one avenue to allow those branches to contribute some time of penalty to the calculation of the rolled in rate was to agree on the single officer crewing allowance being included in the calculation.

**** STEVEN MCGHIE XXN MS MACLEAN
PN605

And it was referable to the single officer branches, wasn't it?---Yes, only referable to the single officer branches, yes.

PN606

And at no time during those discussions or subsequently was it suggested to MAS that the single officer crewing allowance ought to be referable to the air wing, there was no attention given to the air wing at that time or later, was there?---No, that is true because there was no need because in MAS generally speaking their rosters consisted of 10 14 rostering and it wasn't about an issue of having the small on-call branches that only contributed one weekend penalty into the calculation, it was some other type of additional item to add to the calculation so there was no reason for it.

PN607

And it was also the case and it certainly wasn't the view of the union at that time that the single officer crewing allowance was payable?---Well, I don't necessarily agree with that.

PN608

Was it or wasn't it?---Sorry?

PN609

Was it or wasn't it?---Was what?

PN610

Was it the view of the union at any time prior to last year that the allowance was payable, I thought we discussed this yesterday?---It hadn't been raised with us as an issue by our members and I don't think it was an issue that was certainly on the tips of our tongues for many years as you have said and it wasn't something that we pursued, no.

PN611

And the way that you see it operating now is as a general wage increase for MICA flight paramedics and flight paramedics regardless of the work that they actually do on a day-to-day basis, that is the way you put the allowance forward now?
---As a general wage increase?

PN612

Yes?---I see it as an entitlement they are entitled to because they work on their own.

PN613

Well, you see it as an entitlement don't you whether they work on their own or not?---Yes.

PN614

So it is not a question is it, Mr McGhie, of them working on their own, it is an entitlement that all the employees at the air wing, you say, ought to receive?---If they are rostered on their own, yes I do, and I see it the same as what occurs in RAV.

**** STEVEN MCGHIE XXN MS MACLEAN
PN615

The inclusion in the rolled in rate, is that something you are going to press?---No, no, we never sought to, MAS had the rolled in rate for near on 30 years, I mean, RAVs formula has only existed since 1995, '96.

PN616

And the single officer crewing allowance forms no part of the role in rated MAS, does it?---No.

PN617

What about the MICA single responder on the road?---What about it?

PN618

Shouldn't they get the allowance too on that view?---We have never sought - - -

PN619

MS FORBATH: Commissioner, I object, I understood that we were going to deal with the on-road situation another time otherwise I would have questioned Mr Mark Rogers and I certainly would have asked Mr McGhie some questions about this matter as well.

PN620

MS MACLEAN: Commissioner, there is no grievance in relation to the MICA single responder, it is specifically excluded from the union's - - -

PN621

THE COMMISSIONER: Yes, I thought it was too.

PN622

MS MACLEAN: You will see in the union's submission that they make specific reference to that and so there is no claim in relation to that, so what I am trying to explore with Mr McGhie is why on his view of the allowance's applicability, why that is to be excluded.

PN623

THE COMMISSIONER: Yes.

PN624

MS MACLEAN: Why should they miss out Mr McGhie?---I don't work in a stretcher ambulance vehicle.

PN625

But they are rostered on their own?---They are rostered on their own.

PN626

So the person in a MICA single responder doesn't receive it because they are not performing stretcher duties, is that right?---They are not working in an operational stretcher capacity and that is working in an operational stretcher ambulance, they can assist other crews in a stretcher vehicle if they need to take their patient on to the hospital in transport by back up crew but primarily their duties are in a sedan or a wagon, station wagon, and they don't have stretcher carrying capacity.

**** STEVEN MCGHIE XXN MS MACLEAN
PN627

The flight paramedic, for instance, if they are in a crew with another flight paramedic they may have no operational stretcher duties, as you put it, but the fact that they are in a stretcher vehicle will do, they may not touch the stretcher, perform any loading, unloading, that maybe done by others in the crew that they are working in on that particular shift, but the vehicle is the key is it?---No, the vehicle is not the key, but that is one of the factors in regard to providing this allowance, an entitlement to this allowance.

PN628

The type of vehicle?---Yes.

PN629

Can you take me back to the clause and just show me how you form that conclusion?---It says:

PN630

Perform operational stretcher duties.

PN631

Yes?---And operational stretcher duties are a range of things and that is, you know, triaging, treatment, loading and unloading of a patient onto a stretcher and transporting the patient to the hospital and there is a whole range of duties that is involved in that. The situation with the single responders is that they don't have one aspect of that in regard to the type of vehicle that they use and that is they don't have a stretcher carrying capacity. Their role in the stretcher capacity is to assist other crews and to transport that patient on if required with another crew.

PN632

You take a very expansive view at paragraph 19 of your statement, don't you, of operational stretcher duties, you say it is more than loading and unloading, it involves all the things that you have just gone through, triage treatment et cetera?
---That is right.

PN633

The crew person in the helicopter is not an employee of MAS, you know that don't you?---That's right, they are not an employee of MAS.

PN634

And you know that they undertake training and various certifications to be able to not only perform their aviation role but also to be of assistance to the MICA flight paramedic in flight and in other places?---I believe they undertake some training, yes.

PN635

Is the training of the crew person something that the union considers to be appropriate in that assistant role?---I suppose the concerns of the union has is whether there is - the fundamental training is probably appropriate, it is an issue of whether there is appropriate ongoing training and reaccreditation of that person.

**** STEVEN MCGHIE XXN MS MACLEAN
PN636

Is that a matter that you have taken up with MAS?---Not at this stage, no.

PN637

That is going to be something for later too, is it?---Well, it could be.

PN638

The crew person, can I suggest to you, is a very important part of the team that goes out to respond on the helicopter to what are, I think, is accepted very sick people?---Well, I think the crew person is a very important part on the helicopter, but not so much for the sick people, more so for the helicopter getting off the ground and actually responding to where they have got to respond to. A crew person's primary job is to assist the pilot.

PN639

And you know don't you, you would with discussions with your members, you would know that the crew person also plays a role in the treatment of patients in terms of being an assistant to the MICA flight paramedic, drawing up drugs, providing fluid pushes, things of that kind?---Takes a role in assisting the paramedic, yes.

PN640

So they are an extra pair of hands of the paramedic when they are actually treating a patient should that be required?---Yes, they can be, yes.

PN641

And they get in the back of the helicopter during flight if need be?---Well, I am not aware of that.

PN642

Is the union's position that there ought to be two MICA flight paramedics rostered per flight in the helicopter?---Well that would be our ideal position and that is what we would like to see but we know that physically it would probably be impossible due to the size and the nature of the vehicle itself and that has been an historical situation hence the documentation that you handed up to me earlier in the questioning and yesterday but, you know, we are well aware that ideally we would love to have - our position is to have two paramedics per case, that is our position, and that is the position we have put to the government but we know it is difficult within the helicopter.

PN643

And this is something that you have discussed with your members as to whether that would be their preference or not?---No, not at this stage.

PN644

You are proposing to do that, are you?---Not at this stage, no, we are not.

PN645

THE COMMISSIONER: Did you say the ideal position is two MICA flight paramedics or flight paramedics?---Well, it would depend on the skill sets required for the type of patient depending on the time criticalness of the patient. Obviously, in the helicopter ideally you are talking two MICA flight paramedics and obviously there would be a skill set mix depending on the type of patient for fixed wing.

**** STEVEN MCGHIE XXN MS MACLEAN
PN646

MS MACLEAN: Give the discussion we had earlier, Mr McGhie, no matter what on a flight to flight basis if your ideal position was adopted and you had various different skill sets being applied during the course of a shift no matter what the flight paramedics and MICA flight paramedics would still receive the single officer crewing allowance on your view, wouldn't they?---No. We don't claim for single officer crewing allowance where two officers are rostered together as per their normal day-to-day duties, and if there were two paramedic or MICA flight paramedics rostered together to work in the rotary wing or the fixed wing, we wouldn't be seeking the single officer crewing allowance.

PN647

And you would advocate for that position whether it was needed for patient care or not?---Advocate for the position of two people?

PN648

Yes?---Well, we are not advocating for that at the moment in regard directly to air ambulance, but that is our position in regard to all on-road situations and obviously ideally in the air wing situation that would be our position, but we know there is difficulty due to the size of the vehicles that they are working in.

PN649

Regardless of whether the person during the course of a shift actually works alone or not you say there is an entitlement to the allowance?---As it currently stands, yes.

PN650

And that is your claim?---Yes.

PN651

I having nothing further, Mr McGhie, if the Commission pleases.

PN652

THE COMMISSIONER: Thank you. Ms Forbath?

PN653

MS FORBATH: I have to call in one of the other witnesses, Mr Colin Carthy, he is waiting outside.

PN654

THE COMMISSIONER: Is there any re-examination?

PN655

MS FORBATH: No, sorry.

PN656

THE COMMISSIONER: You can step down, thank you, Mr McGhie.

<THE WITNESS WITHDREW [10.34AM]
<COLIN GIFFORD CARTHY, SWORN [10.35AM]
<EXAMINATION-IN-CHIEF BY MS FORBATH

PN657

MS FORBATH: Thank you, Mr Carthy, can you just state again for the record your name and address?---Colin Gifford Carthy, (address supplied).

PN658

Did you prepare a witness statement for this matter before the Commission?---I did.

PN659

Do you have that statement in front of you?---I do.

PN660

Is there anything you want to change in that statement?---No.

PN661

I tender that.

EXHIBIT #A4 WITNESS STATEMENT OF COLIN GIFFORD CARTHY

PN662

MS FORBATH: Mr Carthy, do you have a copy of Mr Young's witness statement?---I do.

PN663

Can I take you to paragraph 8? Mr Young states at paragraph 8 that the crewman assists the MICA flight paramedic with a number of matters and included in that list is the words "including medical procedures", do you agree with that statement or not?---No.

PN664

Why not?---The crewman receives sort of very basic training in practical measures only under direct supervision by the flight paramedic or MICA flight paramedic for simple manual things like getting some equipment out of a box or getting some gear out of the helicopter, opening some equipment up, but only under direct supervision, they don't assist with any medical assessment or management of the patient, they don't assist with treating the patient, all procedures relating to the patient are the direct responsibility of the MICA flight paramedic. The crewman does not make any decisions on what treatment or what equipment is used, those decisions are just to the MICA flight paramedic. We direct them, we say, "I want a cervical collar" you tell them what size you want and they will get it for you and then you put it on, they don't actually put it on. Hands on they will only do things that you actively tell them to so they don't have any responsibility for any treatment or management of the patient at all.

PN665

How often has the crewman assisted you in the back of the helicopter?---In the back of the helicopter in seven years I can only recall once. Once I had two patients, or two children, on board and this was on our workload back-up helicopter which we have now which was our primary helicopter, there is very limited room in it, and I had two children, patients, sort of top to tail on a stretcher and I monitored both patients and the crewman I just had him sitting up the front with one of the children just holding his hand to sort of reassure him a bit, but all treatment and monitoring was done by me.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN666

How often has the crewman assisted you at a scene on land?---On land, well, medically no assistance at all, I mean, they assist you as in if you ask them to get equipment or to carry the cases or you tell them what equipment you want taken to a scene or into a hospital then they do that, but in assessing patients or treating the patients or making - managing decisions or doing any of the paperwork, that is my job, I do that.

PN667

Can I take you to paragraph 10? Have a look at the sentence, about halfway down the page that starts with the words:

PN668

This is similar to the assistance provided with on-road paramedic services in MAS.

PN669

The question is how does the assistance of the crewman on the helicopter compare with a back-up ambulance crew in an on-road situation or a fellow paramedic who has been rostered to work with you in an on-road situation?---As I stated previously, the crewman has basic training in the manual techniques of doing things, but only under direct supervision, they don't take any role at all in making an assessment or treating patients and no responsibility for what happens with a patient. When you work on the road as a two person crew you are both equally responsible for what management and treatment happens to the patient. If I am in an ambulance and I am driving to hospital and I am in the front or the back I would consult with the person I am working with, we can discuss the treatments, we can discuss what management we are going to do, you can talk about what needs to be done to treat the patient. With the crewman you can't do that, you are totally isolated, your decisions are what you are going to do, and you may ask them to draw up a drug but you have to indicate what drug you need to be drawn up, how much of that drug into what syringe and everything too. The sole responsibility for the treatment of the patient is down to the MICA flight paramedic rather when you are working with another ambulance officer that responsibility is split particularly if you have more than one patient then you would split, you would work together as a cohesive unit and as a team. Same with other ambulance officers, you are trained similarly in the way you think and how you assess patients, assessing consciousness, assessing injuries, how to treat patients, you are taught along the same lines, whereas, police crewman, well, he has been a police officer for his career and then joined the air wing and done a very short training sort of hands on training just on the equipment so it no way compares at all with working with a crewman as to working with another ambulance officer.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN670

Paragraph 11 in Mr Young's statement that is a short statement about:

PN671

Most cases responded to by AAV rotary wing crews involve pick-up and transfer from a trauma scene where on-road ambulance paramedics are already in attendance or inter-hospital transfer where air transport is required because of the nature of the patient's injuries.

PN672

Is that an adequate statement about most of the cases that you respond to or not?
---I wouldn't say it was a adequate statement, it is true in a sense, although, the jobs we go to there are ambulance officers at the scene or ready to transfer you into a hospital, but it doesn't really paint a true picture of what happens is that the ambulance officers, whether they be MICA, qualified ambulance officers or volunteers or a CERT team or whoever is that is there isn't trained in aviation medicine, has no understanding of the requirements of what we need to do to prepare someone for flight, they have no concept of our protocols and guidelines, we have some separate guidelines the way we treat patients and the need for some early intervention in some of the cases that we do, the drugs and the procedures we use, and even if going into a hospital, a regional hospital or a large regional hospital, small ones, we get cases where we get sent where someone may need to be intubated in the hospital where there might be a GP or something on the scene and they are not willing to intubate that patient because they just don't feel confident in doing it so they will say, "Look, this patient needs to be intubated, we will wait for you to get here so you can do it" because we sort of have that skill set and training to do that, we are sort of trained up to a fairly high level, well, not a fairly high, a very high level, and so when we go to a scene quite often the ambulance officers at the scene their training is nowhere near as high as ours so they treat to what level they can, but we have different expectations of what treatment we do, so even though there maybe people there when we get there we are still singly, solely responsible for how well we treat that patient, the level of treatment that patient gets, how well they are packaged and prepared for flight, and then once in flight, whether it is fixed wing or rotary, you are still singly responsible for the assessments, interventions, their treatment in flight.

PN673

At paragraph 12 of Mr Young's statement, here Mr Young is describing what happens during most on-road MICA cases. Do you agree with that statement or not?---In a perfect world it would be nice to think that you could do everything that is required before you put someone in an aircraft and fly them off. In a lot of times that is not possible because of the nature of the injuries or the illness or what is wrong with the patient. Many times the patients we transfer are critically ill or injured, they are very unstable, they are requiring fairly high levels of intervention and in-flight flying has its own sort of - it's a very different world then transporting someone on the road. There is a lot of problems that can arise with in-flight, you have different temperature things, with altitude you have pressure problems, there is sort of G forces, there is a lot of things that happen in-flight so patients have to be constantly reassessed and it is very often that you have to make interventions in-flight which are also complicated by the problems that you have like noise, like, in the helicopter you can't listen to someone's chest to determine what is going on with their breathing so you have to use different observations, and so you are continually taking observations assessing the patient's condition, and trying to intervene early to correct them or improve them. A lot of patients are in pretty fairly dire straights when we transport them, and that is why they are being transported by us because they are time critical, and even with best efforts patients still do deteriorate, and we try to stabilise them as best we can and improve them.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN674

You responded fairly extensively to the second part of that paragraph, just taking you back to the first part of that paragraph where Mr Young describes what happens when there are two MICA paramedics working in an on-road situation. Does that correlate with your understanding about how you work with another MICA paramedic on road?---At paragraph 12?

PN675

At the beginning of the first part of that paragraph 12?---Well, it is a very basic sort of explanation of what happens. If you are working in a MICA crew in the MICA unit, yes, there is a MICA officer in the front driving and there is one in the back, but you are still in contact, you just talk to each other, consult, you work as a team unit. If you are in the back and the patient deteriorates or needs some further intervention he can easily just pull over and hop in the back with you and help you. Working with another MICA officer is instead of having two hands you have got four hands. You have two people equally trained that can insert an IV, can intubate someone, can make decisions on drugs, give those drugs without having to be instructed closely by someone else. Even though someone is driving and someone is in the back, you still work as a team when you are treating a patient, you are both equally responsible for the care that patient gets. In the air as a MICA flight paramedic I am solely responsible for that care, I can't consult with the pilot or the police pilot about what treatment I am going to give because they don't have any understanding of it, there is no help at all there, so you are by yourself, whereas, on the road there is two of you to do those jobs. In some cases people have trouble putting IV in and then your partner can put it in for you, there are a lot of things you can do as a team if you are both equally trained.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN676

If I could just take you to clause 13 where Mr Young is talking about the fixed wing aircraft which, as he states, they are used in both urgent and routine transport situations. He goes on to describe exactly what a fixed wing does in clause 13, now, do you agree with that description?---Once again, I agree with the description as in it is a very basic description of our work. It doesn't really describe the full picture of air ambulance work; it sort of makes it seem sort of fairly routine. Some cases are routine, we have patients who walk on and walk off, but then as part of being a flight paramedic or a MICA paramedic you are also part of your flight crew. You have your medical responsibilities, but you also have the aviation responsibilities from CASA, you are responsible for in-flight briefing of patients, the aircraft security and securing of patients and understanding that they know how to get out of that aircraft. You have to describe, you know, where the exits are, how to use those exits. If there is an in-flight emergency you are assisting the pilot with the emergency, maybe putting out a fire or, in the unfortunate thing where you are going to have a forced landing or crash, then making sure everyone aboard knows how to position themselves, how to get out of the aircraft in that emergency. Safety is of fairly high importance to us in aviation; it is a fairly unforgiving area. Every year we do what is called a 2011 which is like a safety training exercise. We do water training, we have to go in a pool with life rafts and practice deploying and getting injured people in and out of life rafts so apart from the medical side there is still quite a large responsibility just being a flight crew and you might have walk on, walk off patients, you may have three people on board who medically might not require a lot, but you have increased your workload by three and so you have got a fair bit of workload. Even though patients maybe routine, you still have problems with turbulence, nausea, vomiting and if you have suddenly got three people who are vomiting and you have to look after those three people you are still by yourself in a small aircraft treating three people. Besides that, going back to the more medical problems, I said earlier we transport a lot of time critical critically ill people, sometimes these are quite time consuming jobs, for example, to get a job for a ventilated patient from Bega down in Southern New South Wales that is probably going to take six, seven hours to do that one job, and the job starts when you have first been given a case, and I would contacted the hospital to find out what is actually wrong with the patient, advise on what treatments I might want them to do before I get there because you have to work on what the patient is like at that time, but also, say, in about four or five hours time or when you are flying back because that is when you are going to be in the place by yourself with this patient whether, you know, it is a ventilated patient or a trauma patient or whether you have someone else with you, whether you have a flight paramedic with you or you are just by yourself, people change, especially when people are that sick, and it is going to take you a long time to get there because you sort of fly for an hour and a half down to Merimbula, get in an ambulance for 40, 45 minutes to drive to Bega, package up the patient in Bega and then drive back to Merimbula, in the plane, fly back to Melbourne and then from Melbourne to a hospital. It can take, you know, that's a whole day gone just doing that one job.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN677

Can I just ask you, how often have you worked on the fixed wing?---On fixed wing?

PN678

Yes?---Seven years. Half my work is on fixed wing, half my work is on rotary.

PN679

When you are working on the fixed wing, do you ever work on the fixed wing alone or are you always with a flight paramedic?---No, more often then not by myself.

PN680

Roughly what percentage of times would you actually be on your own on the fixed wing?---I went through my log book, and flights both fixed wing and rotary, 92 per cent of my flights were by myself and 8 per cent with a flight paramedic or another paramedic.

PN681

Can I take you to paragraph 40? Mr Young says there that:

PN682

AAV roster a number of flight paramedics and MICA flight paramedics on a shift each day and these staff members are then allocated a task with a mix of paramedics depending on the clinical nature of the tasks to be undertaken. The rostering of staff was done to match the availability of aircraft, that is, one paramedic generally available for each aircraft.

PN683

To get it clear there are times then when you are actually rostered to a fixed wing?---Yes, that is right, yes.

PN684

Would you participate in all the flights on the fixed wing for that particular shift?
---No.

PN685

Why would that be?---Well, we work a four on, four off roster where you do two day shifts, two night shifts and I am just rostered either on fixed wing or rotary which rotates from one week about. I am rostered, for example, on a 7 o'clock day shift and I turn up for work, there maybe a flight for me because being a MICA flight paramedic you are not needed for every sort of flight, although, depending on work requirements, you know, if there is no-one else they will send you on a flight, but it might not need the level of a MICA flight paramedic, but you are the one there so you go and do the flight. So in a normal day there might be I am not sure how many flights we would have in a day, but it would be quite a few. I wouldn't go on every flight. They look at the workload and they might if you are a flight paramedic you will come in and they will have you on a flight leaving at 7.30 in the morning with two or three people going out sort of hopping around the state and then, you know, bringing people back to Melbourne, then an urgent case might come in and then I might get sent on that flight and they have to sort of cancel other flights to fit me in or whatever.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN686

During that shift then if you are not working on the fixed wing, what are you doing?---I am still working on the fixed wing because anytime during the day I can call for a flight, but while not actually flying we have a single responder car at Air Ambulance and I respond to road cases on the road as another response unit for MAS.

PN687

Paragraph 15, Mr Young talks about a RAV road MICA paramedic possibly coming on to the plane to help you deal with a patient, how often would a RAV MICA paramedic get on to the aircraft to work with either yourself or another flight paramedic?---I would think it would be fairly rare. It happens but it really depends on the nature of what is wrong with the patient To put a RAV or any other paramedic or MICA paramedic on the plane it sort of increases the workload as well for the - there is usually a flight paramedic that is on the plane because the MICA officer and ambulance officer wouldn't be - he is not familiar with the aircraft, the set up of the aircraft, how to load the aircraft, is not familiar with the equipment, where equipment is located, the drugs and things we use, ..... syringe pumps, for example, and they become like another passenger for the flight paramedic who is responsibility is then for them to look after - make sure that that MICA officer is secure in the aircraft, knows how to get out of the aircraft in an emergencies, what to do, and with the nature of aviation medicine, most of the cases that I would imagine that a MICA officer would be asked to join a flight from somewhere would be where there is sort of minimal intervention required. They would never put like a MICA officer with a ventilated patient, for example, or someone who is acutely ill, it would be more like someone who has had a cardiac problem and has still got some chest pain, those type of things, because it would be too difficult someone getting on with someone who is really sick, and the complications of altitude and flying could be a bit disastrous.

PN688

At paragraph 19, if you can have a look at that and paragraph 22, paragraph 19 deals with the assistance that a MAS or RAV ambulance might provide or even a non-emergency transport provider, a private companies that do the non-emergency work, that the assistance that they provide to both the flight paramedics and the MICA flight paramedics, the assistant that they provide to load the patient onto the aircraft, do you agree with that statement?---No, I don't.

PN689

Why is that?---A road ambulance will transport a patient to the airport, sometimes we go into the hospital, or wherever the patient is coming from, and package the patient up there onto an ambulance stretcher, and then transfer the patient back to the aircraft. For a fixed wing, the road crews will assist you because we have different stretchers in the aircraft, road crews will assist you to transfer the patient from their stretcher to our stretcher, but then we load the stretcher into the aircraft, the road crews aren't trained in the using the stretcher loading device, the ramp, the road crews never get into the aircraft to help us because they don't know how to - they are not trained in loading and securing the stretcher into the aircraft itself so they get us to the airport or to wherever we are and put the patient from the stretcher onto our stretcher, but it is then our responsibility to make sure the patient is secured on the stretcher and load the stretcher into the aircraft.

**** COLIN GIFFORD CARTHY XN MS FORBATH
PN690

On the fixed wing, does the pilot provide any assistance?---Occasionally the pilot will provide assistance to slide a patient onto the stretcher and to load the patient into the aircraft, but the pilot's responsibility is to check the aircraft and get that ready for flight, so we load the patients by ourselves while the pilot is checking the aircraft to try and minimise time.

PN691

Commissioner, I did have some questions for Mr Carthy about Mr Roger's statement, but I won't proceed with that and it maybe we need to recall him for those questions at a later date.

PN692

THE COMMISSIONER: Yes, thank you. Ms Maclean?

<CROSS-EXAMINATION BY MS MACLEAN [11.03AM]

PN693

MS MACLEAN: Mr Carthy, what have you got in the witness box with you?
---Sorry.

PN694

What have you got in front of you?---Mr Young's statement.

PN695

Sorry?---Mr Young's statement.

PN696

And it seems to have some notes on it?---Some of my scribble on it.

PN697

They are your notes are they?---Yes.

PN698

Is that all you have got there?---I have got my statement and I think I have got Mr Roger's statement and just some scribble underneath, my notes.

PN699

And notes of what?---Just notes from statements that I had read through.

PN700

Can I have a look at those?---Yes, all of it.

PN701

I am just naturally curious, Mr Carthy. This is all your writing, is it?---I'm sorry about my writing.

PN702

No, that is okay. It is all your writing?---Yes.

PN703

If you would be good enough to let us know if you were referring to your notes during the course of your answers?---Yes sure.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN704

When did you first see Mr Young's witness statement?---I'm not sure when they sent it to me. Prior to when we came here back in August, I think, I'm not sure.

PN705

Prior to you preparing your witness statement?---No, after - I'm not sure, when did he send it to me, I can't remember when I read Keith's statement, it was a while ago.

PN706

Mr Young's witness statement was filed in about towards the end of July, about 25 July and your witness statement came after that. Are you saying you hadn't seen Mr Young's statement when you prepared your statement or had helped you prepare your statement?---I don't believe so, but I can't remember.

PN707

I am just trying to work out why you didn't deal with all the matters you have dealt with this morning in your witness statement, but that is okay, if you hadn't seen it that is fine.

PN708

MS FORBATH: Commissioner, can I just clarify a point. I am reasonably sure that all of the statements from both parties were due in at the same time.

PN709

MS MACLEAN: I was just looking for the direction and that may well be the answer.

PN710

THE COMMISSIONER: Well, perhaps we will proceed and come back to that if necessary.

PN711

MS MACLEAN: I don't think that will be necessary.

PN712

Mr Carthy, you have told us a lot this morning about the, should I say, very difficult working conditions that you as a MICA flight paramedic have to endure. You have told us about the sole responsibility that you bear, the particularly onerous working conditions, noise, the aero medical environment, that type of thing, why did you join the air wing?---I have always enjoyed flying, I enjoy ambulance work. I spoke to people who worked there and thought that I would enjoy the work. I enjoy the training, the extra skills that you pick up on the way. It seemed a good place to work, where I enjoy work.

PN713

And you do enjoy working there, and you would agree that the MICA flight paramedics, we'll start with them, are the most clinically skilled of the operational ambulance employees in MAS?---Yes, they are.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN714

You hold skills and can perform procedures that other MICA paramedics cannot?
---That's right.

PN715

You can use drugs and procedures that are not available to on-road crews?
---That's right.

PN716

You are trained in a very different way to road paramedics?---We are trained - our initial training is the same as road paramedics and we build on that training at Air Ambulance, yes.

PN717

If you were to join the air wing you have to go through, can I suggest, a very rigorous training and selection process?---Yes. When I joined there was about I believe about nine steps in the selection process. It went over several months, probably five or six months I think the selection process, scenarios .....

PN718

There are very specific psychological and fitness requirements to join the air wing?---Yes.

PN719

And they are designed, are they not, to ensure that the MICA flight paramedic is able to cope with the environment that you were describing in your evidence earlier, a difficult and stressful environment?---Yes, it is designed that you are capable of working in difficult areas, yes.

PN720

And it is designed, is it not, to identify whether you can cope with the stresses and strains of that environment on your own?---I think the selection process, when I did it, they indicated that particularly the scenario was geared around seeing how you could perform as a sole operator. I was fortunate enough to do a couple of scenarios and, for example, one of them was where you had to climb a tower, a patient in a tower who was unconscious or post fit and then you had to carry your equipment up the tower and the only assistance you have was the bystander and ..... patient, so the direction of the thing was to determine how well you could work by yourself.

PN721

And it has never been part of your day-to-day work as a MICA flight paramedic that you are rostered with a partner, has it?---No, you never get rostered with a partner, pardon me, I wouldn't say partnered with, I have been a clinical instructor for people who have applied to the Air Ambulance and I have been rostered with a student, that's the only time.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN722

But it is an accepted feature, isn't it, of the work of the MICA flight paramedic that they work, largely, alone?---Yes, I accept that.

PN723

And that is part of the deal that you sign up for when you join the air wing, you know that, don't you, when you apply to join and you go through the scenarios as you just then described?---Yes, everyone knows when you go there that it is fairly arduous. It is difficult work, you probably don't realise how difficult some of the work is going to be until you get there, but you do it by yourself.

PN724

And it is regarded, I think Mr Young told us yesterday, as a very challenging environment and that the MICA flight paramedics relish that challenge, would you agree with that?---It is a very challenging environment. The people that work there probably appreciate the work they do in their role, but some of the work they don't relish, because it's not all sort of awkward work all the time, things do go wrong, but we do probably enjoy the work I would say.

PN725

And it is, could I suggest to you, regarded within the ambulance service as the top of the tree clinically and operationally, would you agree with that?---I would agree it is a very high level and people on the road or in other areas would agree it is a very high level, a highly skilled area to work in.

PN726

And it is also highly remunerated, would you agree with that?---I wouldn't say it is highly remunerated.

PN727

You are more highly remunerated if you work in the air wing than if you work as a MICA paramedic on the road, are you not?---You receive, yes, you receive more money then working as a MICA paramedic on road.

PN728

And it is about 12 per cent more than if you work on the road?---I am not sure about percentages, I would have to go back to - I don't know, it could be, I don't know exactly.

PN729

Let's say, for the sake of this point, you agree that the MICA flight paramedics are more highly paid then the MICA road paramedics?---Yes.

PN730

And you receive when you are performing work at the air wing you receive a flying allowance?---Yes.

PN731

Were you at the air wing back in 2001?---Yes, I was.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN732

And you know, don't you, that there was at that time a claim to put into the EBA that was being negotiated then a classification for MICA flight paramedic?---Yes.

PN733

You were part of the formulation of that claim and the negotiating team, were you?---No, I wasn't part of a team or negotiating back then, no.

PN734

Do you recall participating in any discussions with other MICA flight paramedics about that particular claim and their justification for it?---We all discussed it.

PN735

And Mr Jim Sams was heavily involved in the preparation of the, if I can call it, a log of claims or a document which set out the reasons why there ought to be a classification for a MICA flight paramedic in the EBA?---Yes.

PN736

And you have seen that document?---A long time ago.

PN737

And it sets out a lot of the things that relate to the work of the MICA flight paramedic and the reason that there should be, firstly, a classification in the agreement and, secondly, why they should receive a fairly substantial pay increase, that was also on the table at that time, wasn't it?---I believe so, yes.

PN738

Can I show you just to refresh your memory show you a copy of that document? Do you recall that document now, Mr Carthy?---Roughly, a long time ago now.

PN739

Can I just refer you to a couple of sections of it? You will see that it sets out in the introduction the unique environment in which the MICA flight paramedic is said to work and that is the environment that you have been describing for us this morning, and then it sets out the selection process, and it refers specifically there in the third line you will see, Mr Carthy, to working in hostile environments under great stress on their own. Do you see that?---Yes.

PN740

It was part of and always has been part of the work of the MICA flight paramedic indeed the justification for the pay rise claimed here that they work on their own. Do you recall that as being part of their discussions?---No, I would put the justification for the pay rise were for the skills and knowledge and the work that we did not just for working by yourself. When the EBA came out as far as I understood it, the pay rise we received was for skills and knowledge and we got a four per cent flying allowance as well when we are actually flying, but in no way did it mention in our pay rise that it was for working as a single operator. I imagine if they put two MICA flight paramedics on the aircraft then I would still be paid as MICA flight paramedic. Working along is not always the best thing so as far as I am concerned the pay rise for the extra training and skills and knowledge I picked up to work there, not for working by myself.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN741

That is all very interesting, Mr Carthy, what I am asking you to do is have a look at this document, which was prepared as you have agreed by Mr Sams as part of the negotiating process both for the inclusion of the classification and for a pay rise for MICA flight paramedics, let's just leave aside for the moment what it may or may not have been for - - -

PN742

THE COMMISSIONER: I can't hear you Ms Maclean.

PN743

MS MACLEAN: I'm sorry.

PN744

One of the factors that Mr Sams mentions on the first page is that the MICA flight paramedics work under great stress in hostile environments on their own. You don't disagree with that?---No, we still do.

PN745

That is right, and you have never been paid the single officer crewing allowance, have you?---No.

PN746

Ever claimed it?---Yes.

PN747

When?---Probably about 10 years ago when we started working as single responders in station wagons - sedans in the city.

PN748

No, I am talking about at the air wing.

PN749

THE COMMISSIONER: Yes, we are only talking about the air wing.

PN750

THE WITNESS: Sorry, well, I was just - she asked if I ever claimed it and that is when I claimed it back then, and I spoke to the pay office about that claim because we were working by ourselves and they said, "No, you can't have it because you haven't got a stretcher" and I said, "What about the air wing, they get paid allowances" and Mark Barbous said, "The pay office said that, no, that is just for flying it is not for working by themselves" so they wouldn't pay us the single officer crewing allowance back then.

PN751

MS MACLEAN: That is about 10 years ago?---Yes, about 10 years ago.

PN752

You were familiar enough with the single officer crewing allowance to claim it when you were working in a sedan I think you just said, what, as a MICA single responder?---MICA single responder.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN753

And when you went to the air wing, when was that?---'98.

PN754

So that is, what, three or four years later?---Yes.

PN755

Have you ever claimed the allowance at the air wing?---I have claimed it, we put in a claim at the pay office and they knocked us back and that is why we ended up here and that was - I had spoken to the pay office in previous years and they just said, "No, MAS won't pay it".

PN756

Just let's take this step by step, Mr Carthy, have you claimed an entitlement to the single officer crewing allowance prior to the claim that we are here discussing which was, I think, in December of last year?---Verbally I have, yes.

PN757

Sorry?---Verbally I have spoken to the pay office, this is several years ago when a few of us were discussing, I rang them and asked them and they said, "No, they don't pay it".

PN758

At the air wing?---At the air wing, yes.

PN759

And you spoke to the pay office?---Yes.

PN760

Who?---I don't think it was Mark that time, I can't remember.

PN761

Mark Barbous, or someone else?---No, I think it was someone else, it could have been Mark, but I don't think so.

PN762

And he said, or somebody said, "No, we don't pay it"?---MAS don't pay it, that was basically it, and so I left to go and then - because we had been discussing it for some time with the air wing and then eventually we put in the claim and that is how we ended up here.

PN763

Did you take it up with the union?---Finally we did.

PN764

What, when the pay office said, "No, you can't have it"?---No, not the first time, no.

PN765

THE COMMISSIONER: Could you please stop having a conversation, because it is very difficult for purposes of transcript because it is almost impossible for me to understand what you are saying.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN766

MS MACLEAN: Did you take it up with the union?---Not originally, no.

PN767

Why not?---I just let it go.

PN768

And from the discussions that you have had with other MICA flight paramedics who also made a claim, have any of them informed you that they have also taken it up prior to this particular claim?---No, I don't recall them saying that, no.

PN769

You don't recall?---I don't recall any of them telling me that they had spoken to the pay office about it before, don't know.

PN770

MS FORBATH: Sorry, Commissioner, this document that was put before the witness, who wrote this document, is it an MAS document or a Jim Sams document? I don't know that the witness identified it as being written by Jim Sams.

PN771

MS MACLEAN: Commissioner, I asked the witness whether he was familiar with Mr Sams preparing the document of this kind. I gave it to him and asked him if that was familiar to him and he said, "Yes, vaguely".

PN772

THE COMMISSIONER: Yes.

PN773

MS MACLEAN: That is pretty good enough for me. It is an exhibit in the MX case, Commissioner, if there is any doubt about its authenticity, Mr Sams adopted it and I will get the transcript if that is required.

PN774

THE COMMISSIONER: Yes.

PN775

MS MACLEAN: And I tender it.

EXHIBIT #M6 DOCUMENT PREPARED BY MR SAMS

PN776

MS MACLEAN: Mr Carthy, if we could turn to the crewmen, you are not involved in the training of the crewmen, are you?---Which document?

PN777

No, I am just asking you a question?---Okay, sorry.

PN778

Are you involved in the training of the crewmen?---No, I haven't been, no.

PN779

So when you say they receive fairly basic training, you don't say that from any particular knowledge that you have, that is just a view that you formed on your own?---No, yes, involved with their training initially, no, I haven't been, but crewmen occasionally come up to you on an ad hoc basis and say, "Look, can you just show me the pro-pack because I haven't worked here for six months and I am unfamiliar with it" or "Can you show me through the drug box because I don't know where things are" so as in training so if you have people coming up to you and asking you things like that then you have a pretty good understanding that they are not - because, sometimes a crewman will work on the police machine for several months they go on leave and they don't work on the ambulance machine for quite some time, and not being medically trained and not being trained with our equipment to a high level, a lot of times they are unfamiliar with it, so it is not uncommon especially when you have new people going through that you turn up to a job or a scene and you asking for a piece of equipment and they will go, "Where's that" and you might be asking for like a bougie and you say, "Look, the blue thing in the lid on the airway box" and they'll get it for you. So to say they are highly trained; I think that is not correct.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN780

Did I say they were highly trained?---Well, you asked me whether I thought they were well trained, or something like that, I can't remember the words though.

PN781

I asked if you participated in their training, that was all, I didn't ask you to go into an excurses on running them down?---I wasn't trying to run them down, I was trying to answer your question, you asked how I formed my opinion or whether it was just an opinion or whether I had any knowledge of it. My knowledge is practical knowledge with it.

PN782

So the crewman asks you a question about a particular piece of equipment or its location after a period of extended absence from the air wing and you say that discloses a lack of training, is that what you are saying?---No, that is one part of an example, there are also other examples of crewman coming to me who are saying they are unfamiliar with the equipment and needed to be shown things, so there is more than one instance, it is not just an isolated instance that I have picked on, it is just an example.

PN783

And that doesn't happen with a paramedic or another person that might form part of your team, it is not something that you as colleagues do on a day-to-day basis is provide each other with information and advise about various equipment and procedures and things like that, you think that discloses a lack of training, do you?---If I was working with a qualified MICA officer as a team with them then I would expect them to know where the equipment is on the aircraft or in that ambulance and in the drug box and where drugs and things are.

PN784

What if they had been on a period of extended leave and there had been something new introduced in the meantime?---Well, we are sort of talking about normal regular stuff, there is nothing new that has been introduced, and everyone has to be shown that, myself included.

PN785

They are not paramedics, are they, the crewmen?---No, they are not.

PN786

They are there to provide you with assistance?---Basic assistance, yes.

PN787

And that is what they do?---That is what they do, but they don't provide the same assistance - - -

PN788

THE COMMISSIONER: Mr Carthy, there is a few problems, you are far too close to the microphone, it is causing some problems, just sit back, it will pick up your voice, it is for the purposes of transcript, it is not for amplification.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN789

MS MACLEAN: Do you agree, Mr Carthy, that the crewman is there and able to at the direction of the MICA flight paramedic draw up drugs?---They can draw up drugs and only after they have been under direct supervision told what drug to draw up, how much to draw up and into what syringe.

PN790

What I asked you was, do you agree that they can draw up drugs at the direction of the MICA flight paramedic?---Yes.

PN791

And they do?---Yes.

PN792

And if you had you as a MICA flight paramedic and a MICA road paramedic at a scene, trauma scene for instance, the MICA road paramedic would also act under your direction, wouldn't they?---Would they work under my direction?

PN793

Yes?---I would assume they would work under my direction, but they can work under their own direction as well.

PN794

They would draw up drugs at your direction in the same way that the crewman would because you are the most clinically qualified person at the scene?---I agree with that.

PN795

The crewman is also able to assist with a ventilated patient?---In what way?

PN796

The crewman, if you needed to perform rapid sequence intubation, for instance, Commissioner, I am not sure whether you know what that is, so I might just get Mr Carthy to describe what that is, if you were to perform rapid sequence intubation the crewman would assist you in that process, would they?---Under direct supervision I would ask him to do minor to basic practical procedures to assist me, yes.

PN797

They would hold the head if the patient is stable?---It would really depend on the situation. If we were the only two there then he probably wouldn't because I would have to ask him to do other things. There is more than one procedure that needs to be done in a rapid sequence induction if there are only two people. If there are more people there, if there was an ambulance officer there, I would use them to do that.

PN798

What I am asking you about is a situation where there is you and the crewman. The crewman might maintain cricoid pressure is need be?---If need be under direction.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN799

And they would know how to do that?---No, I would have to show them.

PN800

You would tell them?---I would show them, I would put their hands in the right spot to show them what I want them to do and how hard the same as I would show yourself to do, because I have used bystanders before.

PN801

But, Mr Carthy, at the end of the day you are the MICA flight paramedic, a highly skilled and highly trained, it is your job to be responsible for the clinical management of the patient, isn't it?---Based like that, yes.

PN802

And it is part of the gig you signed up for in the air wing that you are solely responsible for that treatment and care, isn't it?---Signed on the for air wing - I went to work at the air wing because of the work and the challenges of the work. Part of that work is working by yourself, but if they put someone with you then I will work with somebody, it wouldn't bother me at all. The work that is done will still be the same, I accept and enjoy working there, that I work by myself is part of it.

PN803

You gave some evidence this morning about working on the road and the shared responsibility that a two person crew has and the advantages, I am putting words in your mouth, but you seem to be suggesting that that is an environment that was your preference where that shared responsibility, consultation, working together et cetera on the road that that was something that you lacked at the air wing. Is that a fair summation of what you said this morning?---No, I wouldn't say that it is where I prefer to work, I prefer to work at the air wing. What I said before was working on the road the responsibility is shared between two people. I said I enjoy and appreciate working in the air wing, but I still enjoy working on the road as well, but I prefer to work in the air wing.

PN804

What I am driving at, Mr Carthy, is what is your beef here? I just don't understand what your concern is about the environment in which you work. You say that you understand that there is a requirement that you work alone in the air wing that is different from the road, that your training is different, you are more highly skilled, what is your concern about the environment in which you work?
---Concerned about the environment. Well, we put in the claim because we believe we deserved it, we work by ourselves in - whether they are difficult circumstances or not, I mean, some of the work in the country, I don't know, a single ambulance by themselves and whether they are assisted by the local anaesthetist or ten ambulances or St John's or anyone they still receive their single officer crewing allowance, it doesn't matter how many people go there to help them, they still get it, and we thought, well, we work for ourselves as part of our award we should get it. We all like working at Air Ambulance, we enjoy the environment, we enjoy the work, we appreciate the challenges of it, but as part of our award there is a clause for a single officer crewing allowance, we believe we work by ourselves in stretcher carrying capacity and deserve that remuneration from the system. It doesn't effect where I prefer to work though.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN805

You are already some at least 12 per cent more highly paid then a road paramedic, you understand that?---Yes.

PN806

You receive a flying allowance?---Yes.

PN807

And there will be times when you work not as a single paramedic but on a particular flight you could be with a flight paramedic, for instance, on a fixed wing?---Yes.

PN808

But you say you are still entitled to the allowance?---Well, as I said before, if you work - I mean, I understand RAV pay the single officer crewing allowance whether - - -

PN809

This is not about RAV, Mr Carthy, why do you say you are entitled to the allowance?---Because I work by myself.

PN810

But what if you don't work by yourself on a particular flight, do you still get it?
---Well, that is one flight in - I might do three flights in a shift. Two flights might be by myself, one flight with a flight paramedic.

PN811

What happens then?---Pardon?

PN812

What happens then?---Well, as far as I am aware, I don't have the exact wording of the clause for the single officer crewing allowance, but I think if you work a shift or part of a shift as a single officer you are paid the allowance or don't get payment.

PN813

Is that what you have been told is it, that it is for a shift or part of a shift you should get the allowance?---It is just I have assumed that, I don't know if that is true or not, I can't say for sure whether the - if they want to break it down into flying hours, then that will be up to them.

PN814

Up to who?---Whoever makes the decision on how the award will work or what the award means. I can only say that I work by myself and I am an operational employee from the Ambulance Service and I believe I should get paid an allowance.

PN815

What about if for a shift you have said to us earlier you turn up for work at Essendon, you might be not required to go on a flight and you might work as a single responder on the road, what if for the course of a whole shift you just worked as MICA single responder and you didn't have a flight, what happens then?---I am not sure of the wording, it is going back to the allowance, I don't know how the wording of the allowance - if you are rostered to a shift where you may work by yourself, I don't know the wording of the allowance or means.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN816

You see, Mr Carthy, this is where we all get a bit confused because you have made a claim along with many others and you are here giving evidence to tell us why you should receive this particular allowance, and am I right in saying that really what you are saying is that you deserve it because RAV get it and you need a bit more money. Would that be a fair summation?---No, I wouldn't say that at all. I would say I deserve it because I am rostered as a single officer to my shift in a stretcher carrying vehicle.

PN817

And your - - -?---Whether I go out and do a flight or not I think is immaterial. I’m still rostered as per the wording of the award to - as a single officer. I’m not rostered with a partner, I’m not rostered with a group of people, I’m rostered as a single officer.

PN818

So even if, for instance, for the course of a whole shift you don’t actually do any work, that is, you don’t go flying, you should still receive the allowance? Is that the way you look at it?---If that’s the wording of the allowance, yes.

PN819

Yes, all right. Now, you said this morning, a bit earlier, that when you are on the road, you can consult with your partner and receive advice and discuss patient treatment issues?---Yes.

PN820

Is that right?---That’s correct.

PN821

You can do that in the air, can’t you?---Consult with people?

PN822

Well, you can consult by radio with other clinicians, either paramedics, doctors, receiving hospital? You can’t talk to anyone in the helicopter, can you?---Can I talk to anyone?

PN823

In flight? You would have to speak via a headset and radio?---Yes, yes. Yes.

PN824

Yes, and you would be able to speak, can I suggest to you, to a wide range of clinicians, should you need advice in-flight?---No, I would say that’s not right. You can talk to some people sometimes, but if - with radio transmissions in flight, trying to talk to - there are a great many times when you can’t even - can’t communicate with air ambulance, it’s depending on the location of the aircraft, the - you just can’t communicate. You can’t get out your mobile phones. You have trouble communicating and if you want to talk to someone, like you want to talk to the clinician at MAS, I may have to go through Wangaratta, get Wangaratta to call the clinician. I mean, it’s just - it’s not a practical solution because it’s - you can’t - the time consumed trying to consult with someone negates the benefit of it. At times, you can talk to them, I agree. You can call on the radio, if you can get through with the radio traffic, to the clinician, then you can do that, but that’s very difficult to do sometimes.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN825

And that’s why, Mr Carthy, you are more highly-trained and have available to you a broader range of procedures and drugs to use in flight than on the road like a paramedic, isn’t it?---I think it’s why they have the selection process they do, to select the people that can work there, and then you are trained to get to that level, so whether you can consult with something, is whether you can meet the demands of the job.

PN826

Now, you were asked some questions about Mr Young’s comments, that it was his expectation that interventions, medical interventions, in the air would be kept to a minimum, and you said something like it wasn’t possible to do everything on the ground. That’s not what Mr Young said, is it? It is his expectation, and you know, it’s your expectation too, that you will stabilise the patient as much as possible and do as much as you can on the ground before you transport them. That’s the practical situation, isn’t it?---Not particularly. The practical solution is that we work on a system where you have a goal and an aim. You want to get people to an appropriate facility in the shortest possible time. Now, you can spend time on the ground trying to stabilise someone, but it comes to a stage where you can’t spend forever trying to stabilise someone who is sick or injured, you need to get them there, because the only thing that may stabilise that patient is an operating theatre or surgeons, so our preference is we do what we can to stabilise a patient, to get them loaded and get them airborne and get to wherever we need to go. Preferably, there are some areas you need to - you know, you need to stabilise before you go, like - and that’s why we have early intervention in, like, airway management, things like that, chest decompression, but in flight, you still have a lot of interventions to - because patients - it’s not a black and white situation. Patients deteriorate, and you have to be aware of that and treat them properly.

PN827

Yes. All I am suggesting to you, Mr Carthy, is that the ideal situation is to do as much as you can on the ground to avoid interventions in the air, if you can? That’s the ideal way of managing somebody in that position?---It would be, in an ideal world. It is. It’s preferable to do as much on the ground before you go, but that’s not always possible.

PN828

No, and that’s not what Mr Young said either. He said it’s his expectation that you keep it to a minimum, not that you do everything on the ground?---Well, it’s not really keep it to a minimum. You do what you can on the ground, but that still doesn’t mean you’re minimising your treatment in flight because a lot of times in flight, that’s when your workload’s increasing.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN829

That is precisely what your training and skills are there to achieve, isn’t it?---Yes.

PN830

You were asked also some questions about pulling over in a road ambulance and providing further treatment. How often would you do that, stop on your way to hospital and provide further treatment?---Working on a MICA vehicle, it’s quite often, if I was driving and - - -

PN831

Have you ever done it?---What’s that? Pulled over?

PN832

Have you ever done?---Yes.

PN833

Pulled over?---Yes.

PN834

How often?---I can’t think of the exact figures. If I was driving and the bloke in the back wants me to pull over, then I’ll pull over. If he wants me to get in the back and help him intubate someone, I’ll do that. It’s not something that happens, like, every shift, but depending on - it depends on what the problem is. It’s like saying how many jobs do you do a day? There’s no exact answer to it, to say how many times I’ve done it.

PN835

THE COMMISSIONER: Well, would you be able to say, in your seven years, it’s happened hundreds of times, or would it be dozens of time?---Well, in the seven years I’ve been working with the ambulance, I haven’t spent as much time on the road, so the question was about if you’re in an ambulance and pulling over on the side of the road, so I’m working in that area that much, but - - -

PN836

You use a single responder, don’t you?---Yes.

PN837

MS MACLEAN: When you were on the road, how often? You know, just ballpark?---There’s no - I can’t give you an answer. There’s no real answer how many times you do it or done it. I mean, I would have done it probably hundreds of times over the years, I don’t know.

PN838

Pull over, in a MICA vehicle on the way to hospital and treat somebody on the roadside?---Yes. Over the years. I mean, I’ve been in the job for 19 years, so I suppose I’ve pulled over lots of times in that time.

PN839

All right. Now, in the fixed wing aircraft, would you agree that about 80 per cent of the work undertaken - and I gather you wouldn’t go in the fixed wing aircraft very often?---No, half my shifts are on fixed wing.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN840

And you would be on the fixed wing either on your own - - -?---Mostly on my own, yes.

PN841

Yes, and sometimes with a flight paramedic?---Occasionally.

PN842

If you’re put on the fixed wing aircraft, that would indicate, would it, that the particular patient requires the skills of a MICA person - - - ?---Not always.

PN843

- - - rather than just - not always?---No.

PN844

You might just be the person who’s left on that shift, available to do the flight?
---Yes.

PN845

THE COMMISSIONER: You started off saying something about 80 per cent, Ms Maclean. What was that in relation to?

PN846

MS MACLEAN: 80 per cent of the work of the fixed wing aircraft, and you may not know this, Mr Carthy, and if you don’t, please say so, about 80 per cent is non-urgent, non-emergency work - - -?---I’m sorry, I don’t have figures, but - - -

PN847

- - - and about 20 per cent is urgent or emergency work, in the fixed wing aircraft?---Okay. I’m not familiar with the figures.

PN848

Okay, but would you agree that, from your experience on the fixed wing aircraft, the majority of patients are non-emergency, not unstable patients? They’re walk-on/walk-off patients?---Well, not all walk-on/walk-off. I agree, the majority of the fixed wing patients are non-urgent transfers, but not necessarily walk-on/walk-off. There’s still stretcher patients.

PN849

A proportion of the patients on each flight - - -?---A proportion of them are.

PN850

- - - will be walk-on/walk-off?---Mm.

PN851

Yes.

PN852

THE COMMISSIONER: Well, what does that mean?

PN853

MS MACLEAN: They get on and get off on their own. They’re not stretcher patients.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN854

THE COMMISSIONER: Well, I understand that. A proportion?

PN855

MS MACLEAN: On each - - -

PN856

THE COMMISSIONER: What assistance is that to me? Is it 1 per cent? Is it 99 per cent?

PN857

MS MACLEAN: On each flight, Mr Carthy, would you carry a mixture of stretcher and seated patients, who are capable of walking off the aircraft on their own?---You can. I’ve done a lot of flights where I’ve patients could walk on as well as a stretcher patients. I’ve had flights where I’ve had two stretcher patients and maybe two walk-on patients. I might have two stretcher patients and two relatives.

PN858

It will vary from flight to flight?---It varies from flight to flight, depending on what you’re doing. If - depending on the - and the conditions of the patient. It doesn’t - you’re still responsible for all those people on the aircraft as the flight crew .....

PN859

I’ll come to that in a minute. Would there be fixed wing flights where there are no patients on stretchers, in your recollection?---There would be, yes.

PN860

That would happen?---Yes.

PN861

Now, you were referring just a moment, and in your evidence earlier, to the aviation responsibilities you had, emergency procedures and briefing passengers, matters of that kind. Do you recall giving that evidence this morning?---Yes.

PN862

That’s also part of your training as a MICA flight paramedic?---Yes.

PN863

And there’s also training undertaken by the flight paramedics?---Yes.

PN864

I think you said that it would be of no assistance to you to have another RAV MICA, I think was the scenario postulated, to have another MICA officer come onto the aircraft would be of no assistance. They would be, I think you describe them as another passenger. So am I right in saying from that answer that, really, it’s not a question of assistance in the air that you say is lacking, you’re quite clinically able to perform the functions that you are required to do in respect of patient care, et cetera, that’s not the issue for you? If another RAV MICA is just going to be another passenger?---I didn’t - when I spoke before about bringing up a RAV MICA officer, I didn’t say they wouldn’t be able to assist, but I said it would be - it does not decrease the workload of a flight paramedic, because I was talking of flight paramedics who - I can’t recall a time when I’ve flown on fixed wing to pick up a patient and then they have put a RAV MICA officer on board with me, because it’s - - -

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN865

Well, they wouldn’t have to, because you’re MICA - - -?---They wouldn’t have to, and so I was speaking of the flight paramedics having a RAV MICA put on with them to - for someone - where there had to be minimal clinical intervention because they’re not training in aviation medicine, but that doesn’t - I said it didn’t reduce the flight paramedic’s work because they may also have the responsibility of securing the RAV MICA officer and briefing them on the flight, looking after them in-flight. Not everyone takes flying very well - you know, good. Some people get nauseous and vomit and - - -

PN866

Mr Carthy, weren’t you telling us earlier that one of the concerns that you had about the working in the air environment was the sole responsibility aspect, in respect of consultation, clinical decisions, patient care and those matters. Are you suggesting that the presence of a MICA paramedic wouldn’t be of assistance to a flight paramedic, when those sorts of matters were under discussion or they needed assistance of a more clinical kind?---Well, that’s right. I just said that the RAV MICA would be of assistance, but it wouldn’t decrease the workload of the flight paramedic. That’s what I said.

PN867

But the presence of any person is going to require the emergency briefing aeronautical aspects of the flight - - - ?---I understand that.

PN868

- - - paramedics’ work?---Yes.

PN869

Yes. You didn’t really mean to say that the RAV MICA paramedic on a flight with a flight paramedic would just be another passenger, did you?---I said he would be like another passenger, that you have to be responsible for him as - because you’re the flight crew. I didn’t say he’d just be another passenger, as he would sit there and do nothing. I said it would be like having another passenger that you have to be responsible for.

PN870

You said that the presence of another MICA paramedic or another paramedic could lead to disastrous complications if you put another road MICA on. What did you mean by that?---I was - I said they have to be very selective on the patient that they put the RAV MICA on with, that they wouldn’t put a RAV MICA patient - a RAV MICA officer on with, like, a ventilated patient or someone who was critically ill because they’re not familiar with the equipment we use, where the resuscitation equipment is, the drugs, and things like that, that commonly accompany those sorts of patients. So to put someone who’s unfamiliar with equipment onto an aircraft with someone who is critically ill could have disastrous consequences. It’s like putting someone who’s untrained in an area and then telling them to look after someone who is very sick and then if things start to go a bit pear-shaped, it could have disastrous consequences. That’s why, if they were going to put a RAV MICA bloke on, it would have to be probably where there’s going to be minimal intervention. I mean, they may - - -

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN871

Are you talking about a fixed wing aircraft still?---That’s right, yes.

PN872

Yes, and there will be a flight paramedic on that flight?---Yes.

PN873

They would be trained in those procedures that you were just talking about?---In some of them, not in all equipment. I mean, they’re not trained in intubating patients or - - -

PN874

But the RAV MICA paramedic would be?---Yes, but not in flight, in a plane.

PN875

No. That’s your job?---That’s my job.

PN876

Yes, and that’s why the rostering of the air ambulance is such that patient needs are matched by the clinical skill set of the paramedic needed, isn’t it?---That’s what they try to do. It’s not always the case.

PN877

All right. Now, the loading and unloading of the stretcher aircraft, the stretcher coming out of a fixed wing aircraft is done by a hydraulic device, isn’t it?---That’s right.

PN878

And the road ambulance which meets the fixed wing aircraft will come out onto the tarmac generally?---Yes.

PN879

And the road crew will take the person from the stretcher which is unloaded by the hydraulic device onto their stretcher and pop them in the back of the back of the ambulance. Is that what happens?---In very brief terms. Depending what’s wrong with the patient. The flight paramedic or MICA flight paramedic, whoever’s there, unloads the patient from the aircraft to the ground and then - - -

PN880

By a hydraulic device?---I’m not sure if it’s a hydraulic. It’s like a big screw thing, it just winds up and down type of thing.

PN881

You don’t lift them out of the plane?---No, you don’t lift them, but it’s a device for lifting the stretcher out of the aircraft.

PN882

Yes?---But there’s certain procedures in getting the stretcher onto there. If you just wheel it out and pop it on, you’ll end up with the wheels falling off, so it is not just a procedure of, you know, pulling it out and putting it on the ground. There are procedures that we do to get that stretcher out of the aircraft and also to load it back into the aircraft and secure it in the aircraft. So we do that, we get them onto the ground, or the tarmac and then assist the road crew, whoever they may be, to get the patient from our stretcher to their stretcher, or vice versa, their stretcher to our stretcher.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN883

Similarly, as you would do in a road ambulance? You unload your patient and transfer them into a hospital or do whatever it is that you need to do with them?
---If I’m working on the road, do you mean?

PN884

That’s part of your training, is to unload the ambulance, isn’t it?---That’s right, yes.

PN885

And it’s part of the training you received at the Air Wing, to unload the fixed wing stretcher?---Yes.

PN886

Yes, and in the helicopter, you can’t unload it without assistance from others, can you?---No, you need several people to do it.

PN887

Yes, and who are those people, generally speaking? Crew?---Whoever you can get; CFA, SES, a crewman, hospital staff at the hospitals. It’s a coordinated effort. It’s very awkward, but it’s an awkward sort of thing. The MICA flight paramedic is in charge of it and dictates when you want to move in, because if you’re going to ventilate a patient, you have - is intubated, you’re looking after the airway and you don’t people just to grab things and move because you’ll have an extubated patient.

PN888

No, all I am suggesting to you, Mr Carthy, is that you cannot unload the helicopter stretcher on your own?---No, you can’t.

PN889

It is part of the duties of the crewman to assist in that loading and unloading of the stretcher from the helicopter?---I assume it is. I’m not sure if it’s written anywhere that it’s part of their duties, but as part of a crew, you work together as a team and so that’s what you’re trying to do.

PN890

That’s right. I have nothing, I don’t think. Just hold on for a moment - - -

PN891

THE COMMISSIONER: I beg your pardon?

PN892

MS MACLEAN: I’m just seeing if I need to ask this witness any further questions. If the Commission will just pardon me for a moment?

PN893

Just one final thing, Mr Carthy. You mentioned earlier that some people, I think you said, in the Rural Ambulance Service, received a single officer crewing allowance. What’s your understanding of the payment of the allowance in the rural ambulance scene?---Talking to friends in the country, they say if they work - if they’re rostered to work as a single officer on an ambulance, then they get paid that allowance for every shift they work, whether they do no jobs in that day or they - if they go to a job as a single officer, they always get backed up by another ambulance from whatever the closest town is, they still get paid an allowance then. If they’re - usually in the country, in the small places, they - there’s a lot of work to get the police and fire, CFA, SES, they may have a police officer drive the ambulance to the hospital with them in the back. They may have a GP there, they may have visiting surgeons or anaesthetists, whoever, it doesn’t matter. Whoever helps them in a job, they still get paid the single officer crewing allowance. Whether they send two ambulances to back them up or whoever - - -

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN894

And you say that’s analogous to your situation, do you, that that’s the sort of situation that you work in?---I would say it’s similar, yes. I mean, I’m rostered to an operational ambulance vehicle that has a stretcher and I work by myself, so I’d say it’s similar, yes.

PN895

And you work in a team every day? Every shift?---In a team?

PN896

Yes, crew member, pilot?---Who work as a crew on the aircraft, yes.

PN897

Yes, so when a person in the rural sector is going out in the ambulance on their own and relying on whoever might be standing around to help them, that’s not your situation, is it?---It can be. It’s the same - same thing. I am rostered to work by myself on that helicopter.

PN898

Do you fly the plane?---Do I fly the plane?

PN899

Do you fly it?---No.

PN900

Do you perform the crew duties?---Yes.

PN901

What I am suggesting to you, Mr Carthy, is that every day that you go out to work, you go as a team. Do you disagree with that?---Yes.

PN902

You do?---Yes.

PN903

Why?---Well, depending on the work, if I’m working on a fixed wing, I’m rostered by myself to go out to work, to treat people, to - we treat people from country hospitals, or we take people home. Whatever work they assign me to do, that’s what I go to do.

PN904

Are you flying the plane?---No.

PN905

No. The pilots are doing that, aren’t they?---That’s right.

PN906

So there’s another person there?---He’s there flying the plane, but I mean, he’s not coming into the back to help me.

PN907

And nor would they, if you were in an ambulance?---But they can in an ambulance. And you can - I can’t consult with the pilot on what treatment is going to happen or can’t discuss things with him. I work as a single operator.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN908

Mr Carthy, what I’m asking you is why you say that the experience of a single officer in a country branch, who’s driving the ambulance by themselves to a scene, picking up the patient by themselves, is analogous to your situation. You say it is. What I’m trying to understand is why?---Because if that single officer drives to a scene and then treats a patient, and another ambulance comes to assist him - - -

PN909

No, no, no. No. Let’s just concentrate on the situation where this person in a single officer branch goes to a scene, driving the ambulance and is required, alone, to treat the patient. Let’s concentrate on that first. Why is that similar to your situation?---Because I go to a scene to treat the patient alone.

PN910

Alone?---That’s right. As an ambulance officer - - -

PN911

You get there alone?--- - - - I treat them alone.

PN912

No, no?---I would think it would be very rare for a country officer to go and treat someone where they are totally by themselves.

PN913

But you don’t know that?---Talking to friends I have working in the country, I’d say I do know that.

PN914

And you say, from these discussions with your friends in the country, that they get the allowance as prescribed by the award? Is that what you’re saying? Or by the agreement?---That’s right.

PN915

Yes. You don’t know whether it’s included in their rolled-up rate or not, do you?
---No, I don’t know. I think it could be - I think it is included in the rolled-up rate. I think - - -

PN916

It is, Mr Carthy. Everyone gets it, whether they go out on their own or not. Do you understand that now?---Well, I understand it, if that’s what you’re telling me the award says - - -

PN917

So it doesn’t matter whether they go out alone or with 10 people in the back of the ambulance, they get the single officer crewing allowance. Do you see that?---Yes.

PN918

Yes. So how does the position in RAV assist in your claim, the, for the single officer crewing allowance?---Well, you just said it doesn’t matter if they go out alone, they still receive that allowance. I believe that I’m rostered as a single operator on an ambulance vehicle in a stretcher-carrying capacity and I should get the single officer crewing allowance. You’re saying that in RAV, they get it whether they’re alone or not. Well, that doesn’t really change my opinion of whether - you’re telling me that I’m not alone and they don’t have to be alone. But I am still rostered as a single officer on an ambulance vehicle that goes out, treats people, by myself, and transports them to hospital.

**** COLIN GIFFORD CARTHY XXN MS MACLEAN
PN919

And what about when you’re not by yourself? When you’ve got another paramedic onboard with you?---Well, as we spoke before, it comes down to the wording of the allowance. As far as I’m aware, and I could be wrong, that if you are rostered - it’s not what you actually do within the shift, it’s whether you’re rostered as a single operator - a single officer on an ambulance, a stretcher-carrying ambulance vehicle. Whether I - if I work in the country as a single officer and I sat in the branch for three days, they’d still get paid for three days. Whether you do a job or not is immaterial, as far I’m aware. Whether I fly one job with a flight with that paramedic and then do two jobs by myself, I think it’s immaterial. I’m still rostered as a single operator.

PN920

And the fact that you are paid some 12 per cent more than a road paramedic who works in a team with another paramedic at least, and the fact that you have been through the training and selection process to ensure that your skills and capabilities are such that you can work well in the aero-medical environment and are remunerated for that, that that’s immaterial too, isn’t it? You have fastened on this allowance and you think you deserve it. Is that basically your position?
---Yes. We spoke before, the flight paramedic, MICA flight paramedic salary is worked out on the - for their skills and knowledge that you have trained to do. It has nothing to do with working by yourself. As part of our award, we have it as a single officer crewing allowance which I believe, and my peers at - believe that we’re entitled to.

PN921

You have no knowledge, do you, Mr Carthy, of the circumstances in which the allowance was first put into the old State Award?---No.

PN922

No. Thank you. I have nothing further.

<RE-EXAMINATION BY MS FORBATH [12.03PM]

PN923

MS FORBATH: Mr Carthy, Ms Maclean asked you some questions about why you say that the situation with single officers and RAV is similar to your situation at Air Ambulance. Now, do you know - have you any knowledge of the way in which RAV single officers have responded to jobs and what sort of back-up arrangements they get and so forth? Do you have any knowledge about that?
---Only basic. I mean, I imagine when a single officer is sent out, it would depend on - - -

PN924

No, no, I’m just asking you, do you have any knowledge of it?---Only basic.

**** COLIN GIFFORD CARTHY RXN MS FORBATH
PN925

You have some basic knowledge, you’re saying?---Yes.

PN926

All right. Are you aware of the sorts of other resources that get called out with a RAV single officer?---Yes.

PN927

What are they?---CERT teams. Volunteers.

PN928

Well, can you explain to the Commission what a CERT team is?---A CERT team is a Community Emergency Response Team. They’re set up in areas that are isolated, like where they haven’t had good ambulance coverage. For example, I think the first one was set up in Melbourne, in Craigieburn. There’s another one in King Lake. Because of the response times of getting an ambulance to, say King Lake, which is quite long, people in the community were perturbed about that because they had to wait half an hour to get an ambulance and they got together, and with the Ambulance Service, organised volunteers who receive some training in first aid and defibrillation, airway management, some basic drugs, Ventolin for asthmatics, and the Ambulance Services provided them with a car and some equipment and ongoing support and training by the clinical department and CSOs, and so if a job came in for an accident or for anything up in King Lake, for example, they would respond, a CERT team, they had people on call with AGs and radios, and the CERT team would respond to the job and they would be backed up by a metropolitan ambulance service vehicle from whatever the closest one. So the CERT team would arrive first, they would give a sitrep of what’s wrong with the patient to the Melbourne MAS and they wouldn’t have transport, but they could hopefully treat the patient - - -

PN929

Well, Mr Carthy, but are those CERT teams in existence in RAV?---I believe so. I don’t know where, but I believe there are CERT teams in RAV.

PN930

And what other resources do they call out on RAV?---They have in - they have volunteers they can call out to assist the senior officer with his management treatment, driving the ambulance, things like that, in place like Eildon, Alexander, they have a volunteer service totally. They’re trained, it’s a little separate ambulance system, and then they back them up as well with RAV cars from - wherever close, Mansfield, things like that, they may come from, but there is CERT teams in the country, but I’m not sure how many or where they are, but they do have a lot of volunteers in the country, especially in isolated places.

PN931

Right. Ms Maclean also asked you a series of questions about patients who are able to walk onto the plane and walk off the plane. Do these sorts of patients need any assistance from the flight paramedic or the MICA flight paramedic on the airplane?---Frequently they do, yes. They may have IVs running, they may need oxygen, they need monitoring. It depends on what the clinical problem of the patient is. Even though they can walk-on/walk-off, they may still have medical conditions that require them to be assessed and maintained or intervention taken.

**** COLIN GIFFORD CARTHY RXN MS FORBATH
PN932

They’re not necessarily a person like myself or Mr McGhie who just walk off and we’re just going to a doctor’s appointment?---On occasion they can be, because you have patients come down for outpatients’ clinics, who may have had, I don’t know, some minor surgery or something and just the distance, they’ve used the Air Wing to transport them on. They may walk off and hop in a taxi, but that doesn’t create the problems that you have in flight. They may still need - - -

PN933

Would they be the majority of walk-on/walk-off patients, or would they be patients who need some sort of other assistance?---The walk-on/walk-off ones?

PN934

Yes?---No, I think most of them probably need some sort of assistance in some ways.

PN935

Now, in regard to the document that was tabled by Ms Maclean, the document that was identified as M6, it was this - described as a negotiating document during the 2001 enterprise bargaining negotiations, I just want to clarify with you whether you know for a fact that this document was written by Jim Sands?---No, I don’t know for a fact it was written by Jim Sands.

PN936

But you had seen the document, had you?---Well, I’ve seen - I responded before, I sort of recognise it vaguely, but whether it’s a document Jim wrote or not, I don’t know. It’s five years ago, so - - -

PN937

But you think you’ve seen it before?---Yes, it looks familiar. Yes.

PN938

Right. Now, there was another point when Ms Maclean put to you a question that if you’re out on the road and as a qualified MICA flight paramedic, and you were rostered to work with, say, a MICA paramedic on a MICA road unit, that you would be in charge because you’re more highly trained than the MICA paramedic. Is that correct?

PN939

MS MACLEAN: That’s not the question I asked the witness, in fairness, before he answers that.

PN940

THE COMMISSIONER: I can’t hear you.

PN941

MS MACLEAN: That’s not the question I asked him. The question I asked him was, at a particular scene, not when he was rostered in a crew with a MICA flight paramedic, but at a particular trauma scene that he would be in charge because of his superior clinical skills. That was the question I asked him.

**** COLIN GIFFORD CARTHY RXN MS FORBATH
PN942

MS FORBATH: Well, perhaps the transcript will help us to clarify that. Well, whether it’s in a vehicle or whether it was at a scene, that you - that the MICA paramedic would work under your direction in that situation, and that that would be the same as the sort of direction that you would give to a crewman. Now, do you think those two situations - I need to - - -?---No.

PN943

- - - clarify whether those two situations are comparable?---No. Well, you don’t - well, if I work on a MICA truck with another MICA officer, he doesn’t work under my direction unless he’s very junior and he might - depending on the patient. If it’s something complicated, he might turn to me for some advice, but he doesn’t work under my direction normally. If I’m working on a MICA truck with a qualified MICA officer, we just work together as a team to treat the people. I mean, I’m not lording over someone on the road. If he’s treating people - if I think someone’s going to do something wrong, obviously I’ll step in, as I assume if I was - if someone thought I was going to do something wrong, because you both have equal responsibility for the management treatment of the patient and if you thought someone was going to do something wrong, you’d step in, but that very rarely happens. But, no, you work as a team. I’m not in charge of a job, as per se, just because I’m more senior or something.

PN944

And how does that compare with the crewman at a trauma scene?---Well, they work under my direction totally, as in anything I want them to do - they have other roles in assisting the pilot in the safety of the aircraft as such, but I want them to do something, it’s under my direct supervision.

PN945

Now, there was some questions that Ms Maclean put to you about working in a challenging environment and that you’re trained to cope, as a sole operator, I think you said, and it’s part of your training. How would you react if you were - if it was possible to roster another MICA flight paramedic on the helicopter?---It wouldn’t concern me. I’m happy to work with someone else. I enjoy the work, I enjoy the environment, but if you’re working with another paramedic, that wouldn’t bother me at all.

PN946

Thank you.

PN947

THE COMMISSIONER: Yes, thank you, you can step down, Mr Cathy.

<THE WITNESS WITHDREW [12.13PM]

PN948

THE COMMISSIONER: Ms Forbath, I’m not going to go onto the next witness now. I have another matter at 12.30. We’ll adjourn these proceedings until 2 o’clock. Are you then ready to proceed with the rest of your witnesses?

PN949

MS FORBATH: Yes, they’re all waiting outside.

PN950

THE COMMISSIONER: Yes. How many more do we have?

PN951

MS FORBATH: We have Jim Stafford, who is the crewman who I will call next and then I will call Mr Steve Groves, who is another MICA flight paramedic, and then I’ll call the two flight paramedics and that’s Darryl Gogh and Peter Hoffman.

PN952

THE COMMISSIONER: In light of the evidence of Mr Carthy, it may be that if you’re calling further MICA flight paramedics, that they may not have to repeat the same sort of - - -

PN953

MS FORBATH: I beg your pardon, sorry?

PN954

THE COMMISSIONER: It’s not necessary with any of these further witnesses to go over the same issues which have been gone over with Mr Carthy.

PN955

MS FORBATH: No, I’m not attempting to do that.

PN956

THE COMMISSIONER: These proceedings are adjourned until 2 o’clock.

<LUNCHEON ADJOURNMENT [12.14PM]
<RESUMED [2.08PM]

PN957

THE COMMISSIONER: Ms Forbath?

PN958

MS FORBATH: Yes. I’d like to call Jim Stafford.

<JAMES WILLIAM STAFFORD, SWORN [2.10PM]
<EXAMINATION-IN-CHIEF BY MS FORBATH

PN959

MS FORBATH: Thank you. Mr Stafford, can you just for the record state again your name and address?---James Stafford. My work address? Is that satisfactory? Is Hangar 104, Lionel Street, Essendon Airport.

PN960

Mr Stafford, did you prepare a witness statement for this hearing today?---Yes, I did.

PN961

Right, and do you have a copy of that?---Yes, I do.

PN962

Are there any changes that you want to make to it?---No.

PN963

I tender that, Commissioner.

EXHIBIT #A5 WITNESS STATEMENT OF J W STAFFORD

PN964

MS FORBATH: Mr Stafford, just as a point of clarification, are you employed by Victoria Police?---Yes, I am.

PN965

Right, and directly accountable to the Victorian Police?---That’s correct, yes.

PN966

Are you accountable in any way to the Metropolitan Ambulance Service?---I would suggest only via my superiors, insofar as, I guess, my behaviour whilst associated with the Ambulance Service would be accountable through their management to my management.

PN967

Okay. I want to take you to Mr Keith Wilson’s - sorry, Mr Young’s statement. Do you have a copy of that?---No, I don’t. Not with me.

PN968

I take you to paragraph 8 of that statement. Now, can I clarify with you, Mr Stafford, whether or not you completed the training as referred to there in the last sentence?---Yes. I did complete the training, although it was slightly different to as stated here.

PN969

What was the difference?---My recollection, without having checked records, is that I did a two-day course. And further, that the 80 hours worked with on-road MICA units, probably unfortunately for me, was spent at the Air Ambulance facility and not out on the road, only as a matter of - that no jobs came in where I was able to attend and that was done over three, 8-hour shifts.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN970

Right. Now, that paragraph refers to an attachment A and that’s the training manual. Do you have a copy of that?---Yes, I do.

PN971

Can you turn to that? Firstly, can we just turn to page 8, at attachment A to Mr Wilson’s - Mr Young’s - - -

PN972

THE COMMISSIONER: Who is Mr Wilson?

PN973

MS FORBATH: I know, I - I don’t know, it must be somebody I know.

PN974

Mr Young’s statement. Now, on page 8 there is a heading there that says, "Non-MICA Air Crew Currency Check Record". Can you tell us whether or not you have been through that MICA Air Crew Currency Check Record in the - along the timelines as set out there?---Not - not as per the timelines, but I have completed it. I’ve been qualified to work on the air ambulance for almost four years and I have completed the annual check twice in that period.

PN975

Right, but not in accordance with this timeline that’s set out here?---Not - not annually, no.

PN976

How did that come about, that checking system? Did you get called in to do the course again?---No. That was a matter of me obtaining a copy of this document and then during a course of several shifts, I would ask the paramedics to check me on each item as listed.

PN977

Right?---And over the course of several shifts, I would complete this and then submit it for storage in my folder.

PN978

Now, let’s go back to the beginning of this document, attachment A. I take you to page 2. The majority of the document, between page 2 and page 7, there are 18 areas of training that are identified there. I’d like to take you to each one and ask you to comment on each of them, from the point of view of telling the Commission, under each one of these headings, what you do or what you don’t do in terms of your practice out in the field. So let’s start with drug box. Which of those items do you practise and which do you not practise, or do you practise in a different way to what is set out there?---Well, under part A of drug box, as a matter of course for most scenes that we attend, I would draw up drugs - - -

PN979

THE COMMISSIONER: I’m sorry, I’ve lost the page, Ms Forbath.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN980

MS FORBATH: It’s attachment A. It’s numbered page 2 at the bottom, but there are actually three pages before. There’s the front page, the table of contents and then - - -

PN981

THE COMMISSIONER: Yes, thank you.

PN982

MS FORBATH: - - - and introduction page.

PN983

THE COMMISSIONER: Yes.

PN984

MS FORBATH: Okay?---I would quite often draw up drugs; pre-loaded syringes, I haven’t really had much to do with, but I could identify them. The vials and ampoules I’m familiar with and know how to open those. Part B, setting up an infusion with three-way tap using Hartlins, is fairly common for me to do that. Tape in IV lines, giving set and bung. We practise doing that in the training, but generally - well, I don’t tape the IV line onto a patient as such. That would normally be done by a paramedic. Part D, identify that if required to draw up multiple ampoules of certain drugs. Well, that’s leading to the different size syringes and I’m capable of doing that. Prepare equipment for an infusion, that’s something that I can do. The part F also, I would do - prepare and prime a syringe. Part G, I would be able to complete part G. And H. H would be something I could complete as well, so for the drug box, probably the only one that I’m not overly-familiar with would be the preloaded syringes, although I could identify them and pass them to a paramedic if I was asked to, but it’s not something that I would probably be asked to use myself.

PN985

Now, in regard to the items under airway box?---Part A is relating to the oxygen cylinders. I wouldn’t have to - well, I would have done this for the training, but in the normal course of events in practice, I wouldn’t normally change the oxygen cylinder. That would be done by the paramedic, or if it’s part of the aircraft, it would be done by an engineer, but I would be able to turn it on and regulate the flow. The suction devices, under part B, again I’m trained - I was trained in how to identify those and how to operate them initially, but in the normal course of events, with a patient, I wouldn’t be the one that is actually administering suction to a patient. Part C, I couldn’t say I’m that familiar with the Penthrane analgiser. And I would probably link that with D, with the nebuliser. With both those items, I have been shown how to - well, I could identify them and probably set them up, but I wouldn’t - wouldn’t be actually administering that to a patient. With part E, ventilation. We are shown how to do that. It’s not uncommon for us to perhaps put a mask on a patient’s face. Normally the paramedic would determine the volume of oxygen that the patient would receive. I wouldn’t just turn it on myself. I’d either ask or be told. Part F, I can’t say I’m - I’d probably be able to identify a self-inflating bag, but just by reading this, I can’t - I can’t say I’m familiar with that item. Part G, that is to do with intubating a patient and I carry a list I made myself with these items so I can easily recognise and get these items from the case that they’re carried in and pass them to the paramedic when they ask, but they’re not something that I would actually use on the patient, as such. Part H, that’s an extension of part G, so it’s locating additional items required for an intubation and that is something that I would be able to do. Part I, battery blade change for laryngoscope, that’s a fairly easy item to identify. I could change the blade on that. And the batteries. That item looks similar to a torch at the base and so - part J, set up chest drain and cortex bag. My experience with that, I’ve seen that done several times, but generally I’d just pass that kit to the paramedic. He may ask me to open the kit, but I don’t actually assemble it or operate it.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN986

Okay. Over the page; fluid box?

PN987

THE COMMISSIONER: Are we going to go through the next five pages?

PN988

MS FORBATH: Yes.

PN989

THE WITNESS: The fluid box, we’ve changed to a newer aircraft and the fluid box is now a bag containing additional fluid and so that part A, setting up an IV fluid and prime giving set is pretty much the same as in part 1 of the drug box, so I can do that.

PN990

MS FORBATH: Fine?---Securing cannula and IV line, part B; again, probably all I would do in practice is break some adhesive tape for the paramedic to do that, so I wouldn’t normally attach that to the patient. We were shown these in training, however. Apply pressure cuff to fluid, increase or decrease the pressure and state usual pressure ranges; I can - I can do that. I could put the fluid into a pressure cuff, but the paramedic would have to tell me which - what pressure to inflate that to. And part D, apply pad and dressing to insertion site on forearm; that’s pretty much just - would be like putting a bandage on, I guess, but again, I’d have to be directed by the paramedic as to that being required. Should I go on to part 4?

PN991

Yes, pro-pack?---The pro-pack. The pro-pack is the monitoring device and I can turn the pro-pack on as in part A. The battery life, I would have been shown, but I can’t recall offhand. If I had a look at the device, I may be able to work out how to check that, but couldn’t state that for sure. Connect the patient to the ECG leads; I can do that. Part C, change between adult and paediatric modes. I can do that. Part D, connect the patient to the BP cuff and take blood pressure and then set five-minute intervals I can do. Connect the patient to the pulseoxymeter. I might - if I could link E through to H, because they’re items that normally aren’t used in all cases and the paramedic would have to direct me. There’s several leads that are carried in the pouch of this unit and more often than not, I would have to check with the paramedic which lead is required for those additional items. Part G, probably I could do that without any problem, but the temperature probe and pulseoxymeter, and the art-line are ones that normally are not connected as a matter of course, so a paramedic would direct me to connect those and I would have to verify that I’ve got the correct lead out by asking him, in those cases. Part I, print-out report. I can do that. That’s simply hitting the print button, and J is changing the paper and I have done that.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN992

Sole phiphasic defibrillator?---Yes. Part A is connecting the patient to the monitor and the leads. I’d have to look at the device in front of me to say whether I could do that. I know the leads are the same, perform the same function as they do in the pro-pack, but there’s different leads, so generally with the defibrillator, it would be a matter of me obtaining that instrument for the paramedic from the machine, and he would then set about the set-up and use of that device so changing the batteries, calibrating it, replacing the paper, are probably things that the paramedic would do. I certainly couldn’t do it in a hurry. I’d have to have a look at it and refresh my memory with how that would be done, but quite often with these, the pro-pack and the defibrillator, the leads will only go into one hole, so often you can work it out, but it’s not something I’d want to be doing in the heat of the moment. And safety with the defibrillator; I would understand that because that is the device used to give high-voltage shock to the patient to correct their heart problem, so we’re taught about the dangers associated with that.

PN993

Okay. The Donway splint, next page?---The Donway splint is something that I’ve - I did the initial training with and then I’ve done the subsequent assessment and I’ve also had several goes at it since, but I would still probably - well, I certainly would be under any direction of a paramedic as to when or when it would not be used and certainly I could assist with the set-up of it, but it would have to be done under direct supervision of the paramedic because it’s a fairly - well, it looks like a fairly simple device, but unless you’re quite familiar with it, it’s a device where air pressure is applied to basically pull the bones apart to prevent further injury, so it’s not something I would do without direct supervision.

PN994

Okay. Cervical collar and spine collar?---The collars are kept in a bag so I can identify what they look like, and we got to put them on during the initial training, but I’ve never had to put one on a patient. That’s something that the paramedics do. And part B, assist in removing a patient from a spine board prior to transport; that’s something that we do assist the paramedic with. Normally with several people that would be at the scene and that’s done under the supervision of the paramedic.

PN995

Okay. Suction wall unit?---Part A, demonstrate the selection - these again are items that we do have training in, however it’s used by the paramedic so I never actually used it on a patient as such, but certainly I can identify the unit, both in the kit and the one in the aircraft. I would be able to turn it on, but not - I wouldn’t know really how to operate it exactly.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN996

Okay. Number 9, manual suction unit?---That’s a device that’s located in the - in the - one of the cases that we carry and it’s a back-up to the other units, if they were to fail, I believe. It’s like a hand pump, so again I could identify it and know how to operate it, but I wouldn’t know - I wouldn’t actually use it on a patient. That would be done by a paramedic.

PN997

Right. 10, the ventilator, Oxylife and LTV1000?---Part A, demonstrate by connecting all parts including oxygen of course. I could connect the - there’s a hose that connects the ventilator to the oxygen bottle. I could do that. Connecting it to the patient, well, that would be done by the paramedic. And part C, demonstrate how to remove from its mounting bracket. That is something that I could do. Probably that would be the most I would normally do with that, would be to remove it from the aircraft if it was required externally.

PN998

Right. Portable radios?---The portable radios, they’re pretty much - they’re similar to the police radios, they’re probably a different brand, I’m not sure, but it’s fairly easy to be able to turn the on/off switch on. Selecting the channels, yeah, there’s nothing too hard normally. There is some variations between the police and ambulance radio, so I would have to have a look at it, if you gave it to me now, to work out how to do that, but - - -

PN999

Fixed radio?--- - - - we don’t usually use those. Again, that’s another radio, this one fixed in the aircraft and normally I would - that would already be selected by the paramedic and I would just be able to transmit on it, so it would already normally be set up.

PN1000

Patient restraints, 14?---Yes, I could locate the patient restraints and attach them to a patient. But that, again, would be done under the direction of the paramedic. It’s not something that I would make a decision on doing.

PN1001

Number 14; the backpack/drawers?---Well, in the aircraft, we have a number of drawers that contain various equipment and drugs that can be removed from the aircraft and put into a backpack. Generally, for example, if we had to winch down some equipment with the paramedic, the items would be removed from the drawers and they would select what items that they think they need and put them in the backpack and that would be winched down. So the backpack is a method of containing these items, to get them safely to the ground or the scene. Similarly, if we were on the ground, the paramedic could put that on his back and walk to a patient. So part A says checking against the list. The list is normally done by the paramedic at the start of the shift. I think they check all of the equipment, so - but I would be familiar with most of the components.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN1002

Number 15, equipment for the spare helicopter?---Compile all equipment needed to fit second machine, including restraining straps. This is in the event that the ambulance helicopter is already on a job and may require a second helicopter to be used. It’s usually only for emergency situations and the equipment is all stored ready to be put onto that second helicopter, so I would be able to identify that equipment and assist in the fitment of it to the aircraft, including the restraining straps. And now with newer aircraft, some of it’s already in drawers that lock in so you don’t need the restraining straps for those.

PN1003

Vacuum mattress, number 16?---I’ve used the vacuum mattress. I’ve set that up a couple of times in training and I’ve assisted in its use on patients and I don’t think I have any problems with any of the items, on how to set that up and operate it. The only thing would be that it would be the paramedic that would decide whether to use that or not. I wouldn’t have any idea when or when it wouldn’t be used, but I could help set it up.

PN1004

Okay. The air splints?---Well, that’s similar response to the vacuum mattress. I can identify them. I would be able to set them up, but would be under the direction of the paramedic as to whether they would be used.

PN1005

Okay. And 18, fixed oxygen source?---This is the large oxygen cylinder that’s attached to the aircraft, I think that’s the one we’re looking at, and that cylinder is changed now by the engineers, so it’s not something that I would need to do, however, I can locate the outlet points on the aircraft. I understand the safe handling of the cylinders and I know how to check whether the level - before requiring a refill, so there’s no - nothing on that one that I don’t really do, except for changing the cylinder itself.

PN1006

Moving over to page 11, which is the - what you do at the scene, is that an accurate outline of what you do at the scene?---I’ll just have a quick glance through this. I guess, in part 2, assistance at the scene, it’s a bit hard to know if the patient’s - assist patient in emotional or physical mood. I guess it doesn’t really - well, I sort of don’t recall from the training as to what degree that referred to, so I guess, emotional need, we may well say to the patient, you know, “We’ll get you to the hospital” and that sort of thing, but physical need would be really just assisting the paramedic insofar as helping them get that patient to the aircraft.

PN1007

Right?---Part 3, assistance from the scene, evacuate the patient and load, evacuate all equipment and restraint. Normally I would be the one evacuating the equipment and the paramedic is normally with the patient and more often than not, we have the assistance of other people at the scene to assist with the loading of the patient into the aircraft, so personally I have more responsibility in getting all the equipment back, rather than the patient, but it can vary from job to job. Assist and so move to the hospital. This is probably referring to the occasion where I’m - where I may be required to be in the back of the helicopter, assisting the patient, and that’s very infrequently. But I would be able to assist pushing fluids through. If the paramedic directed to draw up drugs, I would be able to do that. But again, that’s - it’s fairly rare that we are in the back because we’re normally primarily responsible for the navigation back to the hospital. But if the paramedic does make that request, then certainly I can get in the back and assist.

**** JAMES WILLIAM STAFFORD XN MS FORBATH
PN1008

Yes?---Assistance at the hospital. In charge of the unload. I sort of think the paramedic’s really in charge of the unload because no one unloads the patient until the paramedic gives that direction. And cleaning up and preparing for another job, that is something I would do. Emotional support to patient and relatives. At the hospital, generally we don’t have anything to do with the relatives or the patient, is normally in the hands of the paramedic and the hospital staff at that point.

PN1009

Okay?---At the hangar when we return, normally I’m responsible for refuelling the aircraft and the paramedic generally restocks the medical equipment. There is times, once I’ve finished refuelling, I’ll give them a hand if they need it. And part 7, second helicopter fit-out, is - that’s a sort of repeat of the spare aircraft in the other category there that we’ve covered.

PN1010

Okay. Thank you. Now, just the last point; how often have you worked in the back of the helicopter?---I’ve probably done it maybe half a dozen times in four years.

PN1011

Half a dozen times in four years?---Yes.

PN1012

Thank you. I have nothing further.

PN1013

THE WITNESS: Excuse me, I’ll just have a quick - - -

PN1014

THE COMMISSIONER: Yes, of course?---Thank you.

<CROSS-EXAMINATION BY MS MACLEAN [2.46PM]

PN1015

MS MACLEAN: How often have you been asked to go in the back of the helicopter and you haven’t been able to?---Probably never.

PN1016

So on the six occasions that you’ve just told us about that you’ve worked in the back of the helicopter, those are the six occasions when you’ve been asked to work in the back of the helicopter?---I would say so.

PN1017

Yes, and the other times when you’ve been acting as a crewman, the MICA flight paramedic has been managing the patient in the back of the helicopter alone?
---Yes. Occasionally we may have a doctor, but that’s rare as well.

PN1018

Yes. You don’t work in the fixed wing aircraft at all?---No.

**** JAMES WILLIAM STAFFORD XXN MS MACLEAN
PN1019

No. What’s your rank, Mr Stafford, in the police?---Leading senior constable.

PN1020

Thank you. Are you a fulltime secondee to the Air Ambulance Service, or do you perform police duties as well?---That’s correct. I - as a member of the Police Air Wing, I rotate through both the police and ambulance helicopters.

PN1021

In what sort of proportion of your time? You say in your statement, for the last 3 and a half years, you’ve worked on the rotary wing ambulance. That’s not fulltime, is it?---No. No.

PN1022

How do you divide up your time?---Generally speaking, you would do a - well, up until a couple of years ago, we did 8-hour shifts and you would do perhaps one shift on each aircraft and one shift in the office and it was no set pattern, so you would have done probably 25 per cent of your time on the ambulance, as a rough figure. Now we operate 10 and 12-hour shifts and we do a two-month block of 12-hour shifts, which is two days, two nights, and four days off for two months, and then normally you would go either on leave or back onto the police aircraft, although by chance, for the last - up until I commenced leave two weeks ago, I had just done four two-month blocks in a row on the ambulance. But that’s unusual.

PN1023

I gathered from the answer you gave to Ms Forbath earlier about seeking out paramedics to get them to check you off on your particular competencies, that you take your role in the Air Ambulance very seriously and like to keep up to date with the clinical aspects of that work, familiarising yourself with equipment and matters such as that?---Personally I do, because I enjoy the work. But that’s probably not the norm.

PN1024

I’m sorry?---Well, that’s probably not normal, because I’ve checked - - -

PN1025

Not normal for you or not normal - - -?---No, not normal for the rest of the air observers.

PN1026

Well, let’s just talk about you?---Yes.

PN1027

I don’t think we need to go into what your colleagues may or may not do. You have gone through each of those 18 competencies with Ms Forbath and I don’t propose to go back over that, but you said in relation to a number of your answers that you would do a particular thing or take a particular step under the direction of the paramedic, that you wouldn’t do that without supervision. Do you recall qualifying your answers in that sort of way?---Yes. Yes.

**** JAMES WILLIAM STAFFORD XXN MS MACLEAN
PN1028

It hasn’t been suggested to you, has it, Mr Stafford, that you would be responsible, or required, indeed, to take any of these clinical steps on your own initiative, or by yourself, has it?---No.

PN1029

No. It’s going to be your role as an assistant, the crew person, that’s as you understand your role, isn’t it?---That I would - well, in relation to this document that we were referring to, I certainly undertook all of that in the training, but as it’s written, the way I read it where it indicates fixing certain items to a patient, for the training that’s what we did, because we used a dummy, but in practical terms, when we’re out at a - with a real patient, that’s not exactly what we do, and that was the difference I was distinguishing.

PN1030

I understand that, but if for instance a paramedic was to ask you to put a bit of tape on an IV line, on a patient, you could do that?---Yes.

PN1031

Yes. That’s what I was asking you about, Mr Stafford, that the things that you say that you may not do, or you would do under the supervision of the paramedic, if you were asked, you would be capable of doing those things?---Yes.

PN1032

Yes. Now, when it comes time for loading and unloading in the fixed wing aircraft - in the helicopter, I’m sorry, of a patient on the stretcher, would you agree that it’s not possible for one person to load or unload the stretcher in the helicopter?---Not with a patient on it.

PN1033

It has to be done by more than one person?---With a patient on, yes.

PN1034

Yes?---Yes.

PN1035

How many?---You could do it with three, but you probably wouldn’t be having work safety issues in mind if you were doing that. Ideally four, minimum.

PN1036

One on each corner?---Yes, but if you have a particularly strong person, you could do it with three.

PN1037

And that’s a process that you would routinely assist in, as part of your day to day functions?---Yes. Yes.

PN1038

Thank you. I have nothing further for this witness.

**** JAMES WILLIAM STAFFORD XXN MS MACLEAN
PN1039

THE COMMISSIONER: Yes, thank you. Ms Forbath?

PN1040

MS FORBATH: I have no further questions.

PN1041

THE COMMISSIONER: Yes, thank you, Mr Stafford. You can step down?
---Thank you. Am I excused from the hearing?

PN1042

Yes you are. Thank you?---Thank you.

<THE WITNESS WITHDREW [2.53PM]

PN1043

MS FORBATH: I call Steven Grove.

<STEVEN JOHN GROVE, SWORN [2.53PM]
<EXAMINATION-IN-CHIEF BY MS FORBATH [2.54PM]

PN1044

MS FORBATH: Mr Grove, can you just state your name and address again for the record?---Steven John Grove (address supplied).

PN1045

Have you prepared a statement for this hearing?---That’s correct.

PN1046

And do you have a copy of that in front of you?---Yes, I do.

PN1047

Are there any changes you wish to make to that statement?---No.

PN1048

I tender that, Commissioner.

EXHIBIT #A6 STATEMENT OF S J GROVES

PN1049

MS FORBATH: Mr Grove, do you have a copy of Mr Keith Young’s statement?---Yes, I do.

PN1050

I just take you to the first part of that paragraph 8, beginning with the sentence:

PN1051

In particular, the crewman is trained to assist the MICA flight paramedic at an accident or other emergency scene or in the hospital, the setting up of medical equipment, drawing up drugs and medical procedures.

PN1052

Do you agree with that statement?---Setting up of some medical equipment, yes. Drawing up some drugs under my supervision. With medical procedures, I don’t know what actual medical procedures that the crewman actually performs. Yes, they don’t actually perform any intervention as such. I don’t know what they mean by medical procedures.

PN1053

What’s been your experience, then, in light of that paragraph 8, in working with the crewman in the back of the helicopter, and secondly, at a scene?---Quite a broad question, but working in - as far as working in the back of the helicopter, this doesn’t often happen, in that most of the work we do, we try to do prior to leaving the scene. And the intervention we do in the back of the helicopter, there’s also the space issue in the rear of the helicopter, and we certainly try and avoid the crew members coming through from the front of the helicopter to the rear of the helicopter during the flight. In fact, a couple of years ago on not one of the ambulance helicopters, but the police helicopter which is the same type of aircraft, a crewman was coming from the front seat to the back and actually caught his life-vest on one of the engine throttles and actually shut down an engine during the flight. So we’ll try and avoid that coming through from the front to the back during a flight. As I say, the assistance required in the back of the aircraft, we try to keep it to a minimum. If the - so we - I would have only had a crewman in the back of the aircraft with me, at most, two or three times in the last five years. And that’s on the rotary aircraft, not on the fixed wing.

**** STEVEN JOHN GROVE XN MS FORBATH
PN1054

The crewman doesn’t work on the fixed wing?---No, on the fixed wing, I’ll be alone.

PN1055

Are you familiar with attachment A to - - -

PN1056

THE COMMISSIONER: Well, just before you go off that, in the fixed wing, you’ll be on your own; always?---Not always, no. Sometimes we’re with a flight crewman. My - I do a reasonable amount of flying, some guys prefer to fly more than others and the flight coordinators get to know who prefers to fly. So I’d probably spend, I’d say more than 50 per cent of the time by myself in the back of a fixed wing.

PN1057

MS FORBATH: Now, can I take you to attachment A?---That’s the non-MICA air crew - - -

PN1058

That’s correct, that’s attached to Mr Young’s statement?---Yes.

PN1059

Now, we’ve just had Mr Stafford go through that and speak to it and tell us what he does and doesn’t do in relation to that training. Now, without going through every single word of this document, otherwise we’ll be here all afternoon, can you identify things in this list of matters, 1 to 18, sections 1 to 18 on pages 2 to 7, things that you might have a different view upon, the things that you think that the crewman doesn’t do?

PN1060

MS MACLEAN: Might I just, before the witness starts to go through that laborious process, this document is not a duty statement for the crewmen. It’s a training manual. It sets out the things that they’re trained to do, not what they do on a daily basis and that much has been established from the evidence of Mr Stafford. If this witness is going to be asked to go through, line by line, and say whether in his experience a crewman has done that duty or hasn’t done that duty, I don’t know where that gets us, except to use up a lot of the available time.

PN1061

MS FORBATH: Well, can I say that I think that this attachment to Mr Young’s statement is quite significant, otherwise the Metropolitan Ambulance Service wouldn’t have put it up, and the document itself does suggest a very wide range of duties

PN1062

performed by the crewmen. Now, the crewman is trained to do these things. I think it's a fair assumption that there's some expectation that they're going to perform the functions and I think it's important that we understand, the Commission understands clearly that there might be things that they've been trained for, but that they don't actually perform out in the field and I do want to establish that quite clearly.

**** STEVEN JOHN GROVE XN MS FORBATH
PN1063

Mr Stafford has given his version of that and explained in some detail about that. I've asked Mr Grove. He has worked with Mr Stafford and worked with a range of crewmen over a period of time and I think his perspective on the applicability of this training in a practical sense would be quite important.

PN1064

THE COMMISSIONER: Yes.

PN1065

MS FORBATH: If you can just identify those things?---Okay, number one, drug locks, practical. Drugs, including pre-loaded syringes, they draw up some drugs under my supervision. Pre-loaded syringes they do not use often. Therefore, I would not be confident for one of them to set up pre-loaded syringes for me or the rubber topped vials. Rubber topped vials are difficult to open and they don't do it often enough so therefore I would not get one of them to do that. Plastic ampules and glass ampules, yes, they are competent at drawing up those drugs. They don't make any selection of the drug. However, they are instructed as to what to draw up, into what syringe. Set up an infusion with a three way tab, yes, they are proficient at that. Taping an IV line. I've never had a crewman tape in an IV line - in fact, people are very particular about the way they take in their IV lines and I doubt whether anyone would ever get a crewman to tape in a particular line.

PN1066

THE COMMISSIONER: Do you have another witness, Ms Forbath?

PN1067

MS FORBATH: We have another witness. We've got two witnesses who work on the fixed wing.

PN1068

THE COMMISSIONER: This is a very inefficient use of the time. It might be useful for Mr Grove to step down and go through the list that has been provided and then return to the witness box and identify particular items.

PN1069

MS FORBATH: Yes, that's what I asked him, just to maybe pick out those ones that he's at odds with.

PN1070

THE COMMISSIONER: Well, sitting in the witness box puts a little bit of pressure on him in relation to just skimming through them. He doesn't want to miss anything, so I think it would be better to move the way I'm suggesting.
Mr Grove, could you take that document with you that you are being asked to go through and I'll give you some time. Perhaps if you would just stay in court to do that and we'll proceed with the next witness and then when you've had an opportunity to go through that, my understanding is that you've been asked to identify particular tasks that in your experience have not been performed or that the crew member could not be - - -?---Just identify - - -

**** STEVEN JOHN GROVE XN MS FORBATH
PN1071

The ones that are not?---That are not.

PN1072

Thank you.

<THE WITNESS WITHDREW [3.06PM]

PN1073

MS FORBATH: I call Darryl Gogh.

<DARRYL BRADLEY GOGH, SWORN [3.06PM]
<EXAMINATION-IN-CHIEF BY MS FORBATH

PN1074

MS FORBATH: Mr Gogh, could you just state your name and address again for the record, please?---My name is Darryl Bradley Gogh, (address supplied).

PN1075

Thank you, and did you prepare a witness statement for this hearing?---Yes, I did.

PN1076

Do you have a copy of that in front of you?---Yes, I do.

PN1077

Did you wish to make any changes to it?---No, I don't.

PN1078

I tender that, Commissioner.

EXHIBIT #A7 STATEMENT OF MR GOGH

PN1079

MS FORBATH: Do you have with you a copy of Mr Keith Young's statement?
---Yes, I do.

PN1080

Could I take you to paragraph 34? In regard to paragraph 34, do you or do you not ever have to initiate clinical treatments in flight?---Yes, we do have to initiate them in flight.

PN1081

And what are they?---Treatments can vary, obviously depending on the patient's condition, pain relief, fluid management is a second one, treatment for nausea. Sometimes conditions vary, some are totally different. It's an evolving cycle, many different things.

PN1082

When a patient has been in hospital, have they generally been stabilised prior to the flight, as Mr Young states?---Yes, generally patients have been stabilised prior to flight. However, sometimes the practice of more remote locations, quite often what will happen is patient presentations will be I guess modified to suit what they know we want to hear and quite often when we go to retrieve these patients, they're slightly different or sometimes quite different to what we're initially told.

PN1083

Can you give some examples of that?---Some examples of that? Off the top of my head, gee, I'm not prepared for that one.

PN1084

THE COMMISSIONER: Well, I hope you weren't prepared for any questions that were going to be asked of you?---No, I wasn't, madam, no. No, that's not what I meant. Sometimes when the initial call goes through to us, we'll ring up the hospital just to clarify and further establish what happens, but then we'll find out for example the patient's last experience, had chest pain four hours ago. Upon arriving there, we'll find out the last chest pain was one hour ago, then sometimes different drugs were required to resolve a patient's chest pains, as an example.

**** DARRYL BRADLEY GOGH XN MS FORBATH
PN1085

MS FORBATH: So if the patient hasn't been completely stabilised prior to coming onto the aircraft, what would be your role during the flight?---My role during the flight would be to continue treatments and management which has been initiated by the referring hospital according to medical officers' orders and standards. Also, if conditions change, then to manage and treat those conditions in accordance with the Metropolitan Ambulance Service clinical practice guidelines.

PN1086

What's the average flying time of the fixed wing aircraft?---The average flying time can be broken down into flying sectors of which the average would be probably 40 minutes, but the whole flight from air ambulance back, leaving air ambulance back to air ambulance, the average would be two hours.

PN1087

So is it correct to say that some patients might be on the aircraft for up to two hours?---Yes, it is correct to say that. Without having any evidence or documentation in front of me to support such a thing, some of our trips could be for example from Essendon to drop someone off in Bendigo. We'll then pick up a patient in Bendigo, continue on to Mildura, pick up a second patient, then fly from Mildura back to Essendon in which case then that Bendigo patient would be on the plane for one hour and 40 minutes actual flying time, plus 20 minutes on the ground in Mildura whilst we pick up the Mildura patient as well.

PN1088

And how does that compare with the time frames that patients spend in the back of a road ambulance?---It's much longer than the time patients spend in the back of a road ambulance. The goal there is for 20 minutes transport time and road ambulance for certainly the Metropolitan Ambulance Service.

PN1089

And does that have any implications for your work with the patient or your role with the patient?---The time has lots of implications due to the nature that a patient's condition can change. Obviously the ideal place or position for patients is in a hospital and just the continuing needs of patients, simple things, toileting and drinks, as opposed to some other procedures that we do.

PN1090

How many patients do you usually have on each flight, on the fixed wing?
---Once again that's a varying standard. There is no golden rule. However, the air ambulance is run as a business of the Metropolitan Ambulance Service and we try to maintain an efficiency and be as productive as they can. The most number of patients I've had on one trip is five. That's occupying both stretchers and three seats on the aircraft, as well as a seat for myself. With more urgent flights, there could be only one patient on the plane at any time.

**** DARRYL BRADLEY GOGH XN MS FORBATH
PN1091

And how does the number of patients affect your work?---The larger number of patients affects the work in my lack of ability to be able to give everybody sometimes attention of focusing on things that they at times do need.

PN1092

Can I just take you to paragraph 24 of Mr Young's statement? In relation to that clause 24, does the flight paramedic complete exactly the same course of training as the MICA flight paramedic?---The ambulance flight paramedic does undertake the same course with a few variances and additions to the MICA flight paramedic. The MICA flight paramedic has for example winching as part of his course criteria which is undertaking on a further week and also sign off in operation of equipment such as a ventilator I'll use as an example. Our requirement is we're to be signed off in the use of it, but not the solo use of it, if you understand what I mean, more of a supporting role as opposed to a guiding role on that type of equipment.

PN1093

If I can take you to paragraph 19 of Mr Young's statement. Do you agree with Mr Young's description there at paragraph 19 of the loading and unloading of the stretchers?---No, I don't agree entirely there with Mr Young's statement. The main difference there is that the road ambulance crews aren't trained in the operation of any of the aircraft systems, being the stretcher loading device, even how to open the door. The assistance that they provide to us is transfer from one actual bed to another, from the fixed wing bed to the road ambulance bed which is the same type of assistance that you'll get in a hospital as an example.

PN1094

I have got no further questions.

PN1095

THE COMMISSIONER: Thank you.

<CROSS-EXAMINATION BY MS MACLEAN [3.17PM]

PN1096

MS MACLEAN: Just on that loading and unloading, you are trained in the loading and unloading of the stretcher from the fixed wing aircraft?---That's right, yes.

PN1097

That's part of the course that you undertake to join the air wing as a flight paramedic?---That's correct.

PN1098

And the routine situation can I suggest to you is that a road ambulance should it be required for further transport of a patient will meet the fixed wing aircraft on the tarmac and take the patient from there?---Sometimes that is a distinct possibility.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1099

Or there will be a patient transport vehicle, one of the private vehicles, awaiting that transportation, if the person doesn't need an ambulance vehicle?---That's still an ambulance vehicle, whether it's privately operated or State Government funded. It still has a qualified ambulance officer, but the question is correct, yes.

PN1100

It might not be an emergency ambulance vehicle, an MAS vehicle with paramedics on it. It might have patient transport officers from the privatised systems?---That's correct, but each privatised ambulance has access to defibrillators, to oxygen and to life-saving equipment. Yes, it is, but they're still ambulance officers.

PN1101

THE COMMISSIONER: Do you normally have ambulances or private road transport, whatever they're called, meeting the fixed wing aircraft on the tarmac?
---There will always be something to meet us, to take the patient to hospital.

PN1102

MS MACLEAN: Thank you, Mr Gogh. It's the case, isn't it, just to state the obvious, that the fixed wing aircraft can only land at an air strip?---As far as I understand in regards to our operation of the Royal Flying Doctor Service, being the south-east operation, yes, they are onto landing strips only, but other regions can do road landings.

PN1103

It is the vast majority of your work, Mr Gogh, to go from one air strip, that is Essendon, to another air strip?---That's correct.

PN1104

Somewhere in rural Victoria?---Yes.

PN1105

And you will there pick up patients who are a varied presentation in terms of their medical conditions and symptoms?---Yes, that's correct.

PN1106

You will provide the majority of your work, can I suggest to you is non-emergency transport?---Yes, I think that's reasonable.

PN1107

And the patients who are on stretchers in the majority of cases are not emergency cases, that is what you would understand as a paramedic, as unstable or emergency cases?---Yes, that would be a reasonable assumption.

PN1108

And it would be an unusual aspect of your work as a flight paramedic to be required to resuscitate or stabilise a patient during flight in a fixed wing aircraft?
---I agree it would be unusual to have the requirement to resuscitate a patient. However, to stabilise a patient and continue with ongoing management would not be unusual, no.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1109

And the ongoing management that you refer to may involve further drug therapy continuing on from the drug therapy that was provided by the hospital staff prior to pick-up. You might give a further dose of some medication or other under doctor's orders?---That's correct, continue as was ordered by a doctor, sometimes altering the rate of infusions, managing a patient's changing condition and also treating and managing as sometimes different presentations evolve and appear.

PN1110

And this would be nothing out of the ordinary for a trained paramedic such as yourself?---No, no, we're trained to deal with the things we - - -

PN1111

Are you A-list qualified?---Yes, I am.

PN1112

Completely?---Yes.

PN1113

And when you're working for the air wing, you receive a flying allowance?
---Yes, I do.

PN1114

And that I think is about four per cent in addition to your normal base rate of pay?
---It's eight per cent whilst I am actually rostered to air ambulance of my base rate of pay.

PN1115

Eight per cent?---Yes.

PN1116

That's the additional payment you receive?---Yes.

PN1117

When you're working in the fixed wing aircraft, you will from time to time have a medical escort with you?---Yes, that's correct.

PN1118

Is that something - what proportion of the time would you suggest that that happens, that you would have a doctor or a nurse on board or both?---Five to 10 per cent of the time.

PN1119

And when you have a nurse or when you have a medical team on board, that's with paediatric and neonatal cases more commonly?---More commonly, yes, but with adults also.

PN1120

Sometimes with adults?---Yes.

PN1121

And do you say that you would be entitled to the allowance, the single officer crewing allowance when there's a medical team on board, doctor and nurse?
---Yes, absolutely.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1122

I am sorry?---Yes, absolutely.

PN1123

And that is because you're the only paramedic on board, is that the position there?---Yes, also responsible for safety of the plane.

PN1124

You're responsible for the safety of the plane?---Well, the safety of the people inside the plane and the operation of emergency procedures.

PN1125

This is in your flight attendant role, if I can refer to it in that way?---Okay.

PN1126

Is that what you're talking about there, not in a clinical or treatment capacity but in the briefing of passengers on safety procedures, that kind of thing?---Yes.

PN1127

And because you're the only person doing that, you'd say you'd be entitled to the single officer crewing allowance?---Yes.

PN1128

Now, you were asked some questions about unstable patients when you get to a hospital and there would be a person there who was more unstable in a medical sense than you had been led to believe by the booking arrangements that had been made for that pick-up. Do you recall you said something along the lines of they know what we want to hear? I presume by they, you mean the hospitals when they're making the bookings?---Yes.

PN1129

If you got to a hospital and there was a patient who was not stable or you were concerned about their stability during flight, you'd call for MICA back-up, wouldn't you?---If it was outside of the scope of my training and ability, certainly, but as was mentioned to me before, we are trained paramedics and we do deal with emergencies, so as long as it's within the scope of my training, I'd deal with it, yes.

PN1130

Of course you would and if you felt that you couldn't or you were concerned that during flight, the person might deteriorate to the point where they'd need extra clinical support, you'd call for MICA back-up, wouldn't you, a MICA flight paramedic?---If I was in a metropolitan environment, a lot of the rural settings where we're going to, there are no MICA resources available and if a person was in a rural setting which had not started the appropriate and necessary treatment and there were no doctors on hand, as has been experienced by me in the past, then there is no-one to turn to.

PN1131

No doctors on hand at a country hospital you're referring to?---Correct.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1132

And no RAV MICA paramedics?---Correct.

PN1133

You'd call then for a MICA flight paramedic response, wouldn't you?---Sure, I would negotiate that and discuss the options, but at times, I'll use the example of Balranald, far northern Victoria, actually southern New South Wales, the times of a MICA flight paramedic travelling up from Bendigo which is the nearest helicopter base versus other things sometimes removes that option for you.

PN1134

Mr Gogh, you're not suggesting that on a regular basis you are required to put people in the back of the fixed wing aircraft that you have no clinical skill to treat?---No, I'm not suggesting that. That's not what you asked.

PN1135

You also said that the average flying time was - I think I've got a correct note of this, about 40 minutes, your average flight in the fixed wing aircraft?---Yes.

PN1136

And on occasions you might have a patient who's on the aircraft for somewhere up to two hours if you've got a couple of stops to make and pick other people up?
---Occasionally, yes.

PN1137

That would be reasonably rare, can I suggest?---No, that would be reasonably common.

PN1138

Reasonably common, but you would not take a person who was in any way unstable or requiring more urgent medical treatment on that sort of flight, would you?---Yes, we could pick up that person from Mildura. They would then have one leg from Mildura back to Essendon. The more routine patient could then go in the number two stretcher position, as we'll call it and they don't require as much ongoing treatment, but, yes, it certainly does happen that way.

PN1139

Yes, the more routine patient could be on the aircraft for an extended period, but you wouldn't do that with a person who was needing more emergent care?---I am sorry, no, no. The more urgent care, we'd take the shortest trip, yes.

PN1140

You were asked then to compare that with the position in a road ambulance. Have you ever worked in rural Victoria in a road ambulance?---No, I have not.

PN1141

You would know, though, wouldn't you, that there would be times when patients would spend considerable periods in the back of a road ambulance coming from an isolated area in rural Victoria perhaps to a major trauma centre in Melbourne? That could take a considerable time, couldn't it?---Sure, if they were doing that, yes, it would take a long time.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1142

You were then asked a question about the loading and unloading of the fixed wing aircraft. It is the situation, isn't it, that the fixed wing aircraft has a hydraulic device or some sort of mechanical device that assists with the unloading of a stretcher? You don't physically carry it off by yourself, the stretcher?---That's correct, we have a stretcher loading device.

PN1143

And that applies to loading and unloading?---Yes, it does.

PN1144

And when you are loading a patient at a hospital or an airstrip to bring them to Melbourne, for instance, that patient would be transferred onto the ambulance stretcher by you and hospital staff or road ambulance staff commonly?---Yes.

PN1145

And the pilot of the fixed wing aircraft is available to assist you with loading and unloading of patients as required, aren't they?---Not as required, no, depending on what stage of the flight we're at. The pilot has his aviation responsibilities to conclude which I can't comment on. I'm not a pilot. I don't know exactly what they are, but I know he has lots of things to do before and after we conduct the flight prior to doing the next one.

PN1146

If you need a hand loading or unloading and you ask him, is it your experience that the pilot has refused you that assistance?---Not often, but there are some pilots who are not keen on lending a hand due to it being above and beyond the scope of their role.

PN1147

I have nothing further for this witness.

PN1148

THE COMMISSIONER: Ms Forbath.

<RE-EXAMINATION BY MS FORBATH [3.31PM]

PN1149

MS FORBATH: I have only got one question. Ms Maclean asked you about whether or not there's always an ambulance crew or a crew from the non-emergency patient transport private providers waiting for you on the tarmac when the fixed wing lands. Are there occasions when there is no crew waiting?---Yes, many occasions for that, primarily taking patients from Melbourne back to rural or regional centres, sometimes due to work load within the immediate location, they're unable to meet our time of arrival and we have a waiting time on our PCRs, our patient care records which we fill out in the time waiting at an airport and I've had it before where 50 minutes, 60 minutes we've been waiting there.

**** DARRYL BRADLEY GOGH RXN MS FORBATH
PN1150

That is all. Thank you.

PN1151

THE COMMISSIONER: Thank you, Mr Gogh. You can step down.

<THE WITNESS WITHDREW [3.32PM]

PN1152

MS FORBATH: Commissioner, we can either do Mr Hoffmann or we can complete Mr Grove.

PN1153

THE COMMISSIONER: No, I would prefer to complete Mr Grove, I think.

<JOHN GROVE, ON FORMER OATH [3.33PM]

PN1154

THE COMMISSIONER: Worse than being a student, Mr Grove, had to do homework?---So we will just start from the drug box again and I'll just point out the points that I believe are inconsistent.

PN1155

You will point out the items which you what?---Which I don't believe the crewman performs or has a problem with.

PN1156

Yes?---Section number 1, drug box, the ones I mentioned earlier and now if we move down to G, nominate all equipment to establish an IV infusion. They have no say in what size IV or anything we're putting in. We will say to them can you get me a particular size. Airway box, number A, turn on and regulate the cylinder, we don't actually have that oxygen cylinder in there any more, so that's irrelevant. Number C, demonstrate the correct use of the Penthrone analgyser, we don't certainly in the rotary setting don't often use a Penthrone analgyser and I don't know whether any of them would be able to set that up. Set up, connect and regulate the 02 flow of a child nebuliser mask. They would be able to assemble it. They wouldn't know the rate of flow at which we put the oxygen through, the same again for E. F, assemble, connect and demonstrate adult/child self inflating bag, connect maybe, not assemble. There's a few pieces that go together for that. Letter G, select all equipment needed to insert an ETT and additional requirements in case of a difficult intubation, the finding of the larangeal masks. Recently I had a difficult intubation where I required a larangeal mask and I had specifically placed it in a position where the crewman could get access to it because I pre-empted that this was going to be a difficult intubation. I required that larangeal mask, I asked for the larangeal mask of which I was placed in a position of prominence and who was unable to locate that for me.

PN1157

Has that happened on many occasions?---Well, simply because we very rarely use, we very rarely have a failed intubation, so we would very rarely use a larangeal mask, so simply it's an unfamiliarity issue. Demonstrate battery change, battery change maybe, whether they would be able to change it, familiar enough to quickly change a battery, set up the chest drainage, letter J, that would be basically pass me a drainage bag. They would never connect the drainage bag or initiate its connection. Over the page, number 3, fluid drops, B, demonstrate knowledge of securing an IV cannular. That was what I referred to back into the drug box and that's taping in an IV line. As I said before, they don't do that. Apply a pressure cup to fluid and adjust the pressure up and down and state the usual pressure ranges. They don't actually - I've never known of a crewman to actually put a pressure bag on, a bag of fluid and regulate the pressure. Check battery life, they certainly turn it on. I don't know about checking battery life, how they would know where to check the amount of volts available, B, connect the patient to ECG leads and select the three leads. They certainly do that to increase or lower the amplitude. I find it hard to believe that a crewman would know what the amplitude was. Down to F on that same section, connect the patient to a temperature probe. Temperature probes we don't often use and it's quite a different cable to what we normally use and where it goes in on the Propack. Most of them are unfamiliar with that temperature probe and that's simply again a familiarity issue. Connect the patient to C02 monitoring. Now, the person who intervenes with the intubation would be responsible for connecting the C02 monitor, so therefore I don't see how they would ever connect the C02 monitor. Plug the lead into the Propack, but not actually connect the other end of the lead to the patient's tubing system. H, connect an arterial line to the patient. That again is like a phone jack type socket. They would connect that up, but arterial lines, there's a procedure that we follow once they're connected to actually calibrate that to the specific patient and altitude that you're at at the time which is a reasonably complex process. They don't actually zero the line and calibrate it. Bond Plasec sole, that is hardly ever used, so their familiarity with that I am uncertain of because that monitor is very rarely used. Number 6, splint, apply a splint to a suspected fractured femur. I doubt, I've never seen and I doubt that a crewman would actually ever apply the split or identify a fractured femur. Yes, they may assist the MICA flight paramedic to get it out of the bag and put it together, but not actually apply and as I say identify when it's needed.

**** DARRYL BRADLEY GOGH XN
PN1158

Well, in fact, that's not what is required, is it, because if you look there, it says familiarisation with all component parts, so identification of - - -?--- A says apply the split.

PN1159

Perhaps if I could just finish my sentence?---Sorry.

PN1160

It says nowhere there that they have to identify that the femur is broken?
---That's correct. 7, cervical collar and spine board, demonstrate application of an adult cervical collar. I don't know whether a crewman would ever actually apply a cervical collar in the field, but section B of that section, yes, they do help us remove a patient from a spine board prior to transport. Number 8, suction warm unit, under practical, A, demonstrate selection of a Yanker or Y sucker. They would be able to determine between a Yanker or a Y sucker. However, they would not - we would have to instruct them as to the particular size of the Y suction cap that we required for a specific purpose. Manual suction unit, number 9, familiarise self with all components, practical, attach suction to the unit. I don't know what they mean by that because it's a manual one piece unit, so I don't know what they mean by attach suction to the unit. Ventilators, number 10, the Oxylog 1000 we don't carry on the aircraft any more and I don't think they're used in MAS any more or in - you very rarely see them in hospitals any more. It says here demonstrate and connect all parts including 02 source, connect patient and turn on 02 to 100 per cent. Now, the Oxylog 2000, quite a simple machine and they would be able to turn that machine on. The LTV1000 is what I would regard as quite a complex ventilator and it takes a MICA flight paramedic many hours of practice and use to become proficient in the use of that particular item, so their familiarity with the LTV1000 would be extremely limited other than sort of knowing where it is and what it's actually used for. C in that section, demonstrate how to remove the ventilator from its mounting bracket, yes, they would be able to remove it from its mounting bracket. Portable radios, number 11, our portable radios, the crewmen never get involved in the use of our portable radios. However, fixed radios within the aircraft number 12, I would say, yes, they are very proficient at their radio use. That's one thing they are very good at. Patient restraints, apply wrist and ankle strap to stretcher. There's also other restraints and we actually had an email from our team manager the other day saying that in regards to one of the restraints in our helicopter, the sole responsibility of whether that harness goes on the patient is up to us. Flatpack and drawers, check all items against the list. I don't know whether they would - this is number 14, I don't know when they would actually check those items. Other than knowing we have drawers and there's medical equipment in there, I doubt whether they would be familiar with what's in each particular drawer. Helicopter, compile all equipment needed to fit second machine including restraint straps. This equipment is all contained in the one area. It's like a cart, trolley type assembly and all the gear is on there and basically if we're not there and they are going to assemble the second helicopter, they basically just grab all that gear out. They don't have to source any of that gear. It's all just kept in the one spot. Vacuum mattress, yes, they assist with vacuum mattresses under supervision and there's certain ways you may mould that vacuum mattress depending on the patient's condition which we would be responsible for. Number 17, air splints, demonstrate an understanding of the principles in application of air splints and the various sizes, yes, they would be able to demonstrate an understanding, but they never select which particular ones we use or apply them. Number 18, fixed oxygen source. They know where the oxygen source is and so forth. However, this is not the responsibility of the crewman. This is usually done between the MICA flight paramedic and the pilot in command because the pilot in command ultimately has responsibility for oxygen on his aircraft, so therefore he has - we will often put it together for them and then the pilot in command would check that system to see if he's happy with it and I don't know whether I've ever seen a crewman actually change the seat bolt on a certain type of aircraft and the fixed oxygen bottles on the newer types of aircraft, that is filled by a licensed engineer under CASA regulations. We don't have any nor do crewmen have anything to do with that. That's between the pilot and the aircraft engineer to do that.

<EXAMINATION-IN-CHIEF BY MS FORBATH, CONTINUING [3.45PM]

PN1161

MS FORBATH: Just following on from that, Mr Grove, there's at page 8 of that attachment A, there's a currency check record. Are you aware of whether or not these currency checks occur in the time line set down in the document?---I don't know. You'd have to ask the crewmen in relation to this. However, I don't think these are ever done as per the time lines, maybe the first initial check, but from then on I think it's a bit of an ad hoc arrangement.

**** DARRYL BRADLEY GOGH XN MS FORBATH
PN1162

Just have a look at paragraph 10 of Mr Young's statement. Paragraph 10, what
Mr Young is saying there is that there's a similarity between the assistance provided by the crewman to the MICA flight paramedic and in addition the assistance that the MICA flight paramedic gets from on-road ambulance crews at the loading and unloading stages, that there's a strong similarity between that and the range of on-road paramedic services that are provided within MAS. Now, do you agree with that statement?---Are you saying that - the question you're asking is do I think the crewman provides me as much assistance as I would find in the road setting from another MICA paramedic?

PN1163

Well, what I'm saying is that Mr Young says a particular thing, there's a similarity between the situations. First of all, do you agree with that or not?

PN1164

MS MACLEAN: I just might ask Ms Forbath to be good enough to read what Mr Young does say, which is in respect of loading and unloading of the patient to or from the aircraft. This is similar to the assistance provide with on-road services.

PN1165

THE COMMISSIONER: Yes, it's only with respect to that task.

PN1166

MS FORBATH: Look at the sentence - after the reference to a document marked B which I am not concerned to take you to, there's a sentence that says:

PN1167

This is due to the availability of a trained crewman to assist the MFP during flight and under most circumstances the availability of on-road paramedic assistance in respect of loading and unloading the patient to or from the aircraft. This is similar to the assistance provided with on-road paramedic services in MAS.

PN1168

And it goes on to talk about there are times when the MICA flight paramedic doesn't have any assistance in that winching situation, but putting to one side the winching situation when the MICA flight paramedic would be completely by themselves. The question was does that similarity exist as stated there by
Mr Young?

PN1169

THE COMMISSIONER: Regarding loading and unloading?

PN1170

MS FORBATH: No, no, not just regarding unloading and loading, because it talks about the availability for trained - - -

**** DARRYL BRADLEY GOGH XN MS FORBATH
PN1171

THE COMMISSIONER: Yes, I can read what it says.

PN1172

MS FORBATH: It's talking about historically, they've only been staffed by one MICA flight paramedic and that that level of crewing was endorsed in principle by the Association in 1986 and that endorsement was reflected in the document, attachment B. Now, what Mr Young seems to be saying is that the union endorsed a single MICA flight paramedic because there was a crewman to assist them, so he goes on to say:

PN1173

This is due to the availability of a trained crewman to assist the MICA flight paramedic during flight.

PN1174

And goes on to talk about the other assistance that the MICA flight paramedic gets with loading and unloading, so it's not just about loading and unloading, it's about the assistance that the crewman provides and the assistance that other ambulance crews might provide in terms of loading and unloading.

PN1175

THE COMMISSIONER: Yes, well, now you've gone to a full submission in relation to it, but just when you pulled out the words, that was specifically in relation to the loading and unloading. Now, how are you going, Mr Grove? Are you still with what we're talking about?---I think - is the question being asked whether I feel that the crewman provides me as much assistance as I would get on the road from a MICA paramedic?

PN1176

You have done very well. That is my memory of what it is.

PN1177

MS FORBATH: Well, that would be the general - - -?---The question?

PN1178

Yes?---I would strongly disagree with that. I work a considerable amount of overtime and a lot of my overtime is spent on road MICA units and I know from experience the assistance I have from a fellow MICA paramedic compared to the crewman. It is not comparable.

PN1179

At paragraph 12, Mr Young is saying that most of the clinical interventions are performed on land and I want to ask you if you agree with that?---Most are performed on land. The training behind aero-medical retrievals is to have as much done as you possibly can before you leave the ground, simply because it's difficult to do within the aircraft. However, sometimes long transport times and people are dynamic and they will change and sometimes you have to grossly intervene during a flight, but our primary objective is to try and get the patient under control as much as we can in the ground situation.

**** DARRYL BRADLEY GOGH XN MS FORBATH
PN1180

And when you do all that stabilising work of clinical interventions on land, do you have any assistance from anyone else?---Well, this varies. You may be in a country hospital of reasonable standing. I've done transfers out of Geelong theatre. Geelong is a regional hospital and had an anaesthetist to assist me. I've winched into a valley up the back of Mount Buller where I had no-one to assist me. There may be a motorcyclist there and he may have a mate with him and that is my assistance, so my assistance on the ground varies from virtually nothing to maybe quite reasonable assistance.

PN1181

I think that is all I have.

PN1182

THE COMMISSIONER: Thank you. Ms Maclean.

<CROSS-EXAMINATION BY MS MACLEAN [3.54PM]

PN1183

MS MACLEAN: Thank you, Commissioner. Commissioner, might I ask whether it would be convenient for us to sit on to complete the evidence of
Mr Hoffmann who is the next witness? Mr Hoffmann has been excused from one period of duty already and Mr Young tells me that if he comes back tomorrow, he'll have to be excused from another period of duty tomorrow evening, so I was wondering perhaps if we could get his evidence out of the way. I anticipate, like Mr Gogh, it will be very short in compass, certainly from my perspective and I won't be very long with Mr Grove.

PN1184

THE COMMISSIONER: Let's continue and finish Mr Grove.

PN1185

MS MACLEAN: Thank you.

PN1186

THE COMMISSIONER: I think you're getting a bit anxious. It's not near rising time yet.

PN1187

MS MACLEAN: Well, no, but I thought I'd better get in first.

PN1188

Mr Grove, you have been with the air ambulance service since 1995 on and off, I presume?---On and off. There was about a three-year break in between time.

PN1189

And you are a qualified MICA flight paramedic?---That's correct, yes.

PN1190

And that involves, does it not, a considerable period of rigorous training and selection processes?---Yes.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1191

You have psychological and physical testing to assure - well, to make sure that you are physically and mentally fit to perform the sort of work that you do?
---That's correct, yes.

PN1192

And it is a fundamental aspect of the work of the MICA flight paramedic that clinically, leave aside when there is a medical team on board, that clinically you hold very high skills, superior skills to a MICA road paramedic?---You're making me feel very good. Yes.

PN1193

Well, that's my job?---Yes, that is correct.

PN1194

You can use interventions such as rapid sequence intubation, for instance, a long time before MICA road paramedics could do it?---That's correct, yes.

PN1195

You have been able to use various drug therapies before they're introduced on the road for considerable periods?---That's correct.

PN1196

You are the - - -

PN1197

THE COMMISSIONER: Easy, Ms Maclean.

PN1198

MS MACLEAN: Well, I am right into it now.

PN1199

THE COMMISSIONER: Well, don't. You only have limited time.

PN1200

MS MACLEAN: Can I just put it to you this way? You are trained to cope with very severely ill patients in a very difficult environment?---I would hope that I'm trained to do that, yes. That's what we're trained to do.

PN1201

And it is a routine aspect of that work that you are the only paramedic on the rotary wing aircraft?---We are the only - well, maybe two or three times I've had another MICA flight paramedic with me in the last five years on a particular task because logistics allowed it, but it's not routine.

PN1202

No. That was my question. Normally, for the vast majority of your work, you work alone?---That's correct.

PN1203

And that is the skill set of the MICA flight paramedic?---The training that we undergo prepares us and promotes us working alone, that's correct.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1204

And you receive when you are flying a 12 per cent allowance in addition to your normal rate of pay. Your pay is 12 per cent higher than a MICA road paramedic when you're in the air?---Under the new pay structure, I don't know whether it's 12 per cent, but we do receive a higher level of pay and then when we fly, we receive a four per cent allowance, but I don't know whether that adds up to 12 per cent.

PN1205

Well, let me suggest to you that it does, but let's put it this way. You are more highly remunerated than a road MICA paramedic?---That's correct.

PN1206

At all times, whether flying or not?---That's correct.

PN1207

And when you fly, you receive an additional flying allowance?---That's correct, yes.

PN1208

There will be times, won't there, where you will have on board on the fixed wing aircraft in particular a medical escort, will there not?---Very occasionally, I think a figure quoted before was five to 10 per cent mark where we have a medical team, whether it be the paediatric emergency or the now naval. The MICA flight paramedic's work load with those teams is minimal simply because they like to keep a MICA flight paramedic available for other jobs that may be more serious, so therefore ideally they don't like to use a MICA flight paramedic to go with a medical team.

PN1209

It's the case, isn't it, that what the MICA flight paramedics are principally utilised for is the job they're trained to do, that is to pick up, treat and transport very seriously ill patients by themselves. It would be overloading the arc to have you with a medical escort?---That is the ideal situation, but sometimes logistics don't allow it, but that's what we aim for.

PN1210

Yes, and on the fixed wing aircraft, if you were rostered by yourself on the fixed wing aircraft, it would be unusual for you to have a medical team on board unless there was somebody very, very ill?---Unusual, yes.

PN1211

And if there was a flight paramedic with you, that would be determined, would it not, by the clinical needs of the patients on board at that particular flight?---The clinical needs and the logistical availability at the given time.

PN1212

On the fixed wing aircraft, it's possible, isn't it, for a flight paramedic to have with them another flight paramedic from time to time?---Sometimes, yes, occasionally I think to go out.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1213

And sometimes they might have a MICA flight paramedic with them?---That's correct.

PN1214

And in that event, Mr Grove, would you say that the single officer crewing allowance would still apply to both those persons on the fixed wing aircraft?
---I think that's what we're here to determine, but, well, if I have a flight paramedic with me and I don't have him with me all the time, as I said before, probably less than 50 per cent of the time on fixed wing jobs and 100 per cent of the time not on rotary wing jobs, he's still not at my clinical level to make decisions in regards to clinical interventions.

PN1215

But unless there was another MICA flight paramedic with you, that would never be the case?---That's correct.

PN1216

So are you saying that to your way of thinking, this allowance is warranted because you are the senior clinician on that flight, that you're making a decision?
---That's one of the reasons, yes.

PN1217

You know, don't you, that there was in the recent EBA and MX process a claim to increase the rate of pay for MICA flight paramedics based on their additional skills and responsibilities?---That's correct, yes.

PN1218

And you know that that claim was rejected by the Full Bench?---That's correct, yes.

PN1219

When did you first form the opinion that you were entitled or should be paid the single officer crewing allowance?---This is something that has evolved over a considerable time now, I'd say even up to maybe two years. People started talking about it at work and we sort of made some inquiries, made some inquiries in relationship to the RAV single officer crewing, the Rural Ambulance Victoria single officer crewing, when they're paid it, when they're not and so forth and then the process got legs, but it would be over 12 months.

PN1220

You know, don't you, that RAV doesn't operate an air wing?---Yes, that's correct.

PN1221

They operate only a road ambulance system?---That's correct, yes.

PN1222

So what was the information that you received in relation to the RAV situation that helped your thinking on this question?---I haven't read the official document. I can't quote any official awards or anything, but my understanding is that a RAV officer is rostered to a single officer branch type situation. He is paid that single officer crewing allowance all the time, even if he's backed up by another road ambulance has a casual officer with him, a helicopter coming behind him, he's still paid as a single officer.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1223

And you think that that situation should apply to the air wing, too?---I believe I work the majority of my time as a single officer in a stretcher carrying ambulance vehicle.

PN1224

Now, you go in paragraph 12 to set out a number of the difficulties as you see them?---Sorry, this is in my statement?

PN1225

Yes, the difficulties as you identify them working alone. Can I suggest to you that all of those difficulties are a feature of the employment which you sought in the air wing as a MICA flight paramedic, part of the job?---Yes, they are part of the job as a MICA flight paramedic.

PN1226

And you receive specific training and remuneration directed to those particular difficulties, don't you?---Well, I don't know whether the payment is for that or the higher level of knowledge. Does it specify what our specific pay structure is for?

PN1227

Mr Grove, if you would be good enough to answer the question. You are more highly remunerated, are you not, than a MICA road paramedic?---That's correct, yes.

PN1228

THE COMMISSIONER: Which paragraph are you looking at?

PN1229

MS MACLEAN: Paragraph 12.

PN1230

You receive particular - we've already been through this - particular training and the selection - - -

PN1231

THE COMMISSIONER: Why are we going through it again?

PN1232

MS MACLEAN: Because Mr Grove didn't agree with the proposition I put to him?---I have, I've said that we are paid more than a road MICA paramedic.

PN1233

And it's a specific part of your training and the selection process to ensure that you are capable and cope well with working along, isn't it?---One would hope that's what we achieve with the training process, yes.

PN1234

Thank you. That wasn't so difficult. Now, if we could just go to attachment A very briefly. Are you in any way involved in the training - attachment A to
Mr Young's statement which you ought to be able to now recite for us, you are not involved, are you, in the training of crewmen?---I haven't been involved in their three-day course.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1235

No, you weren't involved in the preparation of this document?---No, I wasn't involved in the preparation of this document.

PN1236

Do you accept that the document sets out the matters that will be covered in the training of the crewmen?---Well, I have to assume that it sets it out. As I say, I haven't been involved in the preparation of the document or the training of the three-day course, so I don't know whether this is done or not.

PN1237

What this document sets out, do you accept, is not the position description for the crewman? It's not what they do every day. It sets out the training that they will be assessed by a certain person on a particular date and sets out in the practical section what they have to do to get that assessment. Do you accept that?---Well, I suppose that is the aim of the document, but as I say, I have had no input into this document and I don't do any of their training as far as the three-day course goes, so I don't know - today is the first day I've seen this document.

PN1238

Yes, and you've gone through it and looked at what in your experience on the ground or in the air the crewman has or hasn't done for you or at your direction?
---Correct.

PN1239

What I am suggesting to you and it's evident from the document itself, if you turn to 1, it deals with the familiarisation with that equipment and giving drugs their names and then there's a practical example set out there from A to H as to what is required for the assessment. Do you see that?---Yes, I see that.

PN1240

It's not going through - it's never been suggested, has it, to you, Mr Grove, that the crewman is a second paramedic and has those clinical skills and can make those judgments, has it?---No, it's never been suggested that they are a second paramedic.

PN1241

You were then asked some questions about Mr Young's statement about the assistance that you might receive from the crewman and to compare that to the assistance that you might receive as a road paramedic or from another MICA road paramedic. Can I suggest to you that it would be and I think you strongly disagree that you would get the same assistance or similar assistance, it's an absurd proposition, isn't it, would you agree, that the crewman would be compared to a fully qualified MICA flight paramedic or MICA paramedic, indeed, in terms of the assistance that they could provide you? That's never been suggested by the air ambulance or any person at air ambulance, has it?---No, it's never been suggested that they're at that level.

**** DARRYL BRADLEY GOGH XXN MS MACLEAN
PN1242

No, they are an assistant, aren't they?---That is their - I think it says in there here to assist.

PN1243

And they do?---Yes, they are an assistant.

PN1244

And they do assist?---Yes, on the rotary wing aircraft, the majority of times they assist with ground procedures, but we're drawing a long bow at the level of assistance, but they do assist.

PN1245

They are an extra pair of hands?---They are an extra pair of hands.

PN1246

If you need drugs drawn up, et cetera, they can do that for you?---To an extent, yes.

PN1247

But it is your training and clinical skills that allow you to cope with most situations by yourself and provide patient care if required?---I would hope I achieve that, yes.

PN1248

That is your job?---Yes.

PN1249

Thank you. I have nothing further for this witness.

PN1250

THE COMMISSIONER: Thank you.

PN1251

MS FORBATH: I have got no further questions.

PN1252

THE COMMISSIONER: Thank you, Mr Grove. Make sure with this inflated head that you now have that you can fit through the door.

<THE WITNESS WITHDREW [4.11PM]

PN1253

MS FORBATH: I call Mr Hoffmann, Peter Hoffmann.

<PETER FREDERICK HOFFMANN, SWORN [4.12PM]
<EXAMINATION-IN-CHIEF BY MS FORBATH

PN1254

MS FORBATH: Mr Hoffmann, can you state for the record your name and address again, please?---Peter Frederick Hoffmann, (address supplied).

PN1255

You might need to speak up a little bit for the transcript?---Okay.

PN1256

Did you prepare a witness statement for this case?---I have.

PN1257

And do you have a copy of it there with you?---I do.

PN1258

Do you wish to make any changes to it?---No.

PN1259

I tender that, Commissioner.

EXHIBIT #A8 STATEMENT OF PETER FREDERICK HOFFMANN

PN1260

MS FORBATH: I have got no further questions of Mr Hoffmann.

PN1261

THE COMMISSIONER: Thank you.

<CROSS-EXAMINATION BY MS MACLEAN [4.14PM]

PN1262

MS MACLEAN: Mr Hoffmann, you are a flight paramedic, not a MICA flight paramedic?---That's right.

PN1263

And I think you are also a qualified flight co-ordinator?---Yes.

PN1264

Do you perform flight co-ordinator work at air ambulance?---I do.

PN1265

As well as flight paramedic duties?---When required.

PN1266

You work then only on the fixed wing aircraft?---That's right.

PN1267

And you would I think spend about 40 per cent of your time on the road and about 60 per cent at air ambulance, is that about right?---Yes.

PN1268

THE COMMISSIONER: Mr Hoffmann, I can't hear a word you're saying and I think that the recorder may - - -

PN1269

MS MACLEAN: You might need to keep your voice up?---Okay.

**** PETER FREDERICK HOFFMANN XXN MS MACLEAN
PN1270

We've been waiting a long time and it's late in the day. We don't want to miss anything that you've got to say. Can I ask you to turn to paragraph 7 of your witness statement. It is a very important aspect, is it not, of the work of flight paramedics and MICA flight paramedics as you understand it that you have to be able to work alone in the aero-medical environment which is sometimes a difficult environment? That's part of the training and part of the job you sign on for, is it not?---Yes.

PN1271

Yes, and you're referring here in paragraph 7 to specific training that you received to what was it, assess your suitability to work in that particular environment? Is that what that was directed to?---I was just referring to a couple of questions asked in the interview back in '99. I believe since then, the interview process has changed, but that was just referring to a couple of questions that were asked in the interview, that's all.

PN1272

And you were under no illusions that it was a significant part of your role in the air ambulance to work from time to time alone in a clinical sense?---As a single officer you mean?

PN1273

By yourself, as the only paramedic on board the fixed wing aircraft?---Yes.

PN1274

And your selection focused on that, from what you're telling us in paragraph 7, that's right?---I assume from the questions they were trying to ascertain whether I could work by myself.

PN1275

Yes, and your training in the aero-medical course was directed in part to that aspect as well?---The actual course are you referring to?

PN1276

Yes?---I could not say the course is actually geared to setting you up to work by yourself. I mean, it's about aero-medical - the difference between aero-medical conditions you might meet compared to on the road.

PN1277

Yes, and you have access as a result of completing that course to a range of say drug therapies and interventions that you wouldn't be able to use on the road as an ambulance paramedic, non-MICA?---There are a few extra skills, yes.

PN1278

And they are covered in the course that you do to join the air wing, aren't they?
---Yes.

**** PETER FREDERICK HOFFMANN XXN MS MACLEAN
PN1279

On the fixed wing aircraft there are a number of permutations insofar as the paramedic resourcing is concerned, aren't there, from maybe flight to flight or shift to shift? Would you agree with that?---Say again?

PN1280

There may be a flight where you are the only paramedic on board during the course of a shift?---The majority, yes.

PN1281

There may be flights during the course of a shift where you have a MICA flight paramedic with you?---That could happen, yes.

PN1282

Or another flight paramedic?---Yes, that could happen.

PN1283

Or you may indeed have a medical team with you, doctor and nurse perhaps?
---Occasionally that happens, too.

PN1284

That happens in the paediatric and neonatal context quite a bit, doesn't it?---I wouldn't say quite a bit. It occasionally happens, a large majority of time by myself.

PN1285

Yes, but all I am asking you to tell us is whether during the course of a shift it might be any one of those things that we were just discussing?---Yes, depending on the clinical needs of the patient.

PN1286

Exactly?---Yes.

PN1287

And those clinical needs of the patient will be assessed obviously on a flight by flight basis. Each flight might differ or you might have a day where the crew of the fixed wing would be the same throughout the shift?---Yes.

PN1288

You receive when you are at air ambulance an additional payment of a flying allowance when you're performing duties at air ambulance which I think is about eight per cent at the moment?---Yes.

PN1289

THE COMMISSIONER: What did you say then, you receive?

PN1290

MS MACLEAN: A flying allowance of eight per cent when you're at air ambulance.

PN1291

THE COMMISSIONER: It is too late in the day. I thought it was only four per cent.

**** PETER FREDERICK HOFFMANN XXN MS MACLEAN
PN1292

MS MACLEAN: No, it is eight per cent.

PN1293

That is right, isn't it, Mr Hoffmann? Yes, and when you're working on the road, you don't receive that allowance?---No.

PN1294

And is it your position that the single officer crewing allowance which you claim here or that you've put in a claim for and a grievance about, that regardless of the paramedic resources on a particular flight during the course of your shift, that that allowance should be payable for the whole shift? Is that your understanding of the claim that you've made?---Yes, I think comparing it - like compared with like the RAV, I'm sure you've been through it today, like with how they get paid the single officer crewing, regardless whether they get backed up. Are you comparing it with that?

PN1295

Can I summarise what your position is, that they get it at RAV and so we should get it, too? Is that basically it?---When you start a shift, you don't know what jobs you're going to do. You don't know what resources are required for the patient.

PN1296

So you should start with the premise that you get the allowance and what if you work with someone all day, what happens then?---You're never going to know. You might go days, you might go weeks without ever working with anyone else. You don't know what's coming from day to day.

PN1297

What I am trying to work out, Mr Hoffmann, is how you see the allowance being paid in a practical way, that is how are the MAS supposed to pay the allowance as far as you can figure it out? What is the claim as you see it to your entitlement for the allowance? Is it because you're at air ambulance and you're a flight paramedic and that will do or does it depend on what you do on a day to day basis?---I think it's the large majority of the time we're by ourselves. You were talking about going with other retrieval teams and that sort of thing. I think the figures - I am sure the figures have been - have they been noted today? Having been last in, I don't know what's said already, but I believe it's quite a small percentage of the time we go with another specialised retrieval team. I think it's under 10 per cent.

PN1298

But you might have another flight paramedic on with you during the course of your shift, mightn't you? That's not so unusual, is that right?---Depending on the clinical needs of the patient, depending how many patients are on board.

PN1299

What I am trying to understand, Mr Hoffmann, this is not really all that difficult, although it is - - -?---The eight per cent I don't believe that's for gaining the accreditation for doing the course.

**** PETER FREDERICK HOFFMANN XXN MS MACLEAN
PN1300

No, we're not talking about that. We're not talking about the flying allowance. What I am asking you is how it is that you say the single officer crewing allowance ought to be payable to you. Is it because you're a flight paramedic at the air ambulance or because the RAV people get it?---The majority of the time we work as a single officer.

PN1301

And you say, do you, because they get it in RAV, whether they're backed up or not or whatever your understanding - - -?---No, I am not saying we should get it because RAV gets it. I am just using that as a comparison, that's all.

PN1302

And do you know the circumstances in which they get the allowance in RAV?
---The circumstances?

PN1303

Yes?---They get paid the single officer crewing - - -

PN1304

Yes, when?---When do they get it?

PN1305

Yes?---They get paid it all the time.

PN1306

What do you mean all the time?---Whether they're backed up or not with another resource, they still get their allowance.

PN1307

And who is they?---The single officers, at the single officer branches.

PN1308

Yes. Do you know that it's part of the RAV rolled-in rate, everyone gets it?
---I did read something about that.

PN1309

So it's not just the single officer branch of paramedics, is it, that gets it? It's everyone, it's in the rolled-in rate. Is that your understanding?---Yes.

PN1310

So that's a very different situation to what applies at MAS, isn't it?---At air ambulance or MAS?

PN1311

MAS generally. If you don't know, you don't know. You can say you don't know?---Yes, I am not sure.

PN1312

Can I just ask you one final thing? In paragraph 12 you are talking about the loading and unloading of the fixed wing aircraft in paragraph 13 you are also discussing that issue. You say that there's no official requirement for the pilot to help you with the stretcher. Have you ever been refused assistance by the pilot if you've asked for it, to unload the stretcher from the fixed wing aircraft?---I probably haven't been refused. I don't think it's one of their requirements.

**** PETER FREDERICK HOFFMANN XXN MS MACLEAN
PN1313

I wasn't asking you that. Have you ever asked a pilot for help and they've said no?---No.

PN1314

And it's the normal - well, it's the more routine position that there is an ambulance or a patient transport vehicle waiting at the air strip to take the patient on to further treatment or medical appointments or whatever and they will help you get the stretcher off the plane. Is that the way it works?---No, they won't help unload. They don't know how to use the plane, or open the door or take the actual stretcher off the plane.

PN1315

That is your job?---That's my job.

PN1316

That's what you've been trained to do and that's part of your job description, isn't it?---Yes.

PN1317

But once the person is on the tarmac, I don't mean that literally, I mean still on the stretcher, they will, the road crew then take over, transfer that person to their stretcher and take them off to hospital with your assistance presumably, transferring them, not the taking to hospital. Would you agree with that?---Yes.

PN1318

Thank you. I have nothing further for this witness.

PN1319

THE COMMISSIONER: Ms Forbath.

<RE-EXAMINATION BY MS FORBATH [4.26PM]

PN1320

MS FORBATH: Just two points. You were asked some questions about the rostering arrangements on the fixed wing. Is it usual or unusual to have another flight paramedic go on to a flight with you?---It can happen. I mean, obviously it depends on the patient's needs and the amount of patients on the plane. I would say it would be unusual and the majority of time by yourself.

PN1321

I am just trying to get a bit of a picture of whether it's the majority or 50/50 or 60/40?---No, it's minor, a small amount of the time.

PN1322

The other question you were asked was again about rostering and who you work with. It's correct, is it not, that as a flight paramedic you are actually rostered on your own for every shift? Is that correct?---That's correct.

PN1323

And if an additional staff member is to go on a particular flight with you, that that will really - they'll be brought in for a specific purpose and if they are available, is that correct?---Yes. I mean, they might be rostered on that day, too. If they're required to go on that flight with you, most of the time it's either that the patient needs two people or that there's extra patients on the plane so you're going to end up looking after one person by yourself, anyway.

**** PETER FREDERICK HOFFMANN RXN MS FORBATH
PN1324

Thank you. That is all.

PN1325

THE COMMISSIONER: Thank you, Mr Hoffmann. You can step down.

<THE WITNESS WITHDREW [4.29PM]

PN1326

THE COMMISSIONER: If the parties could address me on how they believe that we can now proceed to finalise this matter. My understanding that I would issue directions in relation to the lodgement of all materials and statements relating to that section of the application pertaining to road ambulance and following hearings associated with those or at the same time associated with those, the final submissions of the parties would be heard.

PN1327

MS MACLEAN: That is my understanding, Commissioner, of how we proceed from here. It seems illogical to present submissions now on the question relating just to the air wing because the question is the same. It's the interpretation of that particular allowance clause. It doesn't seem sensible to double up on that. As you said, you are indicating particularly a pretty tight timetable for getting the road issue out of the way. It may well be that the particular issue goes away because the individuals don't want to proceed with their grievances or whatever that may happen, so if we could set a timetable for documents and then perhaps another hearing date to knock that issue over and submissions at the same time.

PN1328

MS FORBATH: I don't have any objection to that course of action. I would think perhaps final submissions might be more efficiently done by say written final submissions.

PN1329

THE COMMISSIONER: I am open to the parties in relation to this. I just thought that having a hearing would put the parties to less work.

PN1330

MS MACLEAN: I am quite open to doing written submissions if we're running out of hearing time. If we were getting towards the evidence say tomorrow and we weren't going to have time to make proper submissions, I am happy to do them in writing, but generally my preference is not if it can be avoided and if we're going to have to come back for further evidence, anyway, then it seems appropriate to do submissions at the same time.

PN1331

THE COMMISSIONER: Yes. Thank you.

<ADJOURNED INDEFINITELY [4.31PM]

LIST OF WITNESSES, EXHIBITS AND MFIs

STEVEN MCGHIE, ON FORMER OATH PN549
CROSS-EXAMINATION BY MS MACLEAN, CONTINUING PN554
THE WITNESS WITHDREW PN656
COLIN GIFFORD CARTHY, SWORN PN656
EXAMINATION-IN-CHIEF BY MS FORBATH PN656
EXHIBIT #A4 WITNESS STATEMENT OF COLIN GIFFORD CARTHY PN661
CROSS-EXAMINATION BY MS MACLEAN PN692
EXHIBIT #M6 DOCUMENT PREPARED BY MR SAMS PN775
RE-EXAMINATION BY MS FORBATH PN922
THE WITNESS WITHDREW PN947
JAMES WILLIAM STAFFORD, SWORN PN958
EXAMINATION-IN-CHIEF BY MS FORBATH PN958
EXHIBIT #A5 WITNESS STATEMENT OF J W STAFFORD PN963
CROSS-EXAMINATION BY MS MACLEAN PN1014
THE WITNESS WITHDREW PN1042
STEVEN JOHN GROVE, SWORN PN1043
EXAMINATION-IN-CHIEF BY MS FORBATH PN1043
EXHIBIT #A6 STATEMENT OF S J GROVES PN1048
THE WITNESS WITHDREW PN1072
DARRYL BRADLEY GOGH, SWORN PN1073
EXAMINATION-IN-CHIEF BY MS FORBATH PN1073
EXHIBIT #A7 STATEMENT OF MR GOGH PN1078
CROSS-EXAMINATION BY MS MACLEAN PN1095
RE-EXAMINATION BY MS FORBATH PN1148
THE WITNESS WITHDREW PN1151
JOHN GROVE, ON FORMER OATH PN1153
EXAMINATION-IN-CHIEF BY MS FORBATH, CONTINUING PN1160
CROSS-EXAMINATION BY MS MACLEAN PN1182
THE WITNESS WITHDREW PN1252
PETER FREDERICK HOFFMANN, SWORN PN1253
EXAMINATION-IN-CHIEF BY MS FORBATH PN1253
EXHIBIT #A8 STATEMENT OF PETER FREDERICK HOFFMANN PN1259
CROSS-EXAMINATION BY MS MACLEAN PN1261
RE-EXAMINATION BY MS FORBATH PN1319
THE WITNESS WITHDREW PN1325