As evidenced by Toronto’s experience with Severe Acute Respiratory Syndrome (SARS), paramedics provide an integral ‘frontline’ role during a public health emergency. During normal operating procedures paramedics understand their ‘duty of care’ to individual patients. However, is there a ‘duty to respond’ when the point of care moves from the individual patient to the greater population during a public health emergency? An extensive search of publicly available state and national legislation and regulations was conducted to examine the concept of ‘duty to respond’ in the Australian context. Relevant Emergency Management Acts, Health Acts, and ambulance service regulations lacked a clear focus on ‘duty to respond’ and failed to address the ramifications of paramedic refusal to work. As Australia is a Common Law Country the issue of duty to respond could be managed through paramedics’ individual employment contracts with their respective ambulance services, and failing to respond could potentially be addressed using pre-existing standard terms and conditions for employment. This issue is particularly topical in light of the current public health challenge posed by the Swine Influenza pandemic.Introduction The continuing threat of both naturally emerging and man-made public health emergencies has brought the issue of emergency health care workers’ responsibilities and duty to respond into question. These questions are complicated by the potential risk that emergency health care workers face during the frontline response to such health disasters. As a core component of the frontline response, paramedics are at high risk for a variety of health and injury risks, including physical injury, death, communicable disease, contamination, and psychological effects such as anxiety, neuroses and depression (Hooke 2001). These health risks were highlighted by the exposure, infection, illness, and death of paramedics and emergency health care staff during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 (Maunder 2004). SARS exposed the vulnerabilities of our health care systems, where health care workers (HCWs) bore the brunt of the outbreak and were the most at risk population for SARS, accounting for 21% of all cases worldwide (WHO 2003). Public health emergencies place unprecedented demands on the health care system regarding surge capacity and test HCWs’ personal commitment to the health care profession. Despite this challenge, professional codes of ethics and health services management guidelines are largely silent on the issue of duty to respond during public health emergencies, thus providing no guidance on what is expected of HCWs, or how they ought to approach their duty to care and respond in the face of risk (Ruderman 2006). In the context of the current pandemic of Swine Influenza it is imperative that health care agencies, including ambulance services, consider the responsibilities and ‘duty to respond’ of their employees, and give a clear indication of what standard of care is expected in the event of a public health emergency.

s 16th World Congress on Disaster and Emergency Medicine Paramedics and Public Health Emergencies: Is There a "Duty to Respond"? Erin C. Smith; Frederick M. Burk/ejr,Peter Jurkovsky; Carly Woodd; Simon Jensen 1. Monash University, Melbourne, Victoria Australia 2. Harvard Humanitarian Initiavtive, Boston, Massachusetts USA Introduction: As evidenced by Toronto's experience with severe acute respiratory syndrome (SARS), paramedics provide an integral role during a public health emergency or disaster, potentially risking exposure to infection, illness, and death. Given that a range of serious risks are associated with response to a public health emergency, paramedics may be unwilling to work. As the paramedic workforce is not an unlimited resource, consideration must be given to this issue by emergency and disaster planners, with a specific focus on "duty to respond". During normal operating procedures, paramedics understand their "duty of care" to individual patients. However, during a public health emergency, when the point of care moves from the individual patient to the greater population, is there a "duty to respond", and can this be legally enforced? Methods: An extensive search of existing state and national legislation was conducted to examine the concept of "duty to respond" in the Australian context. Results: National Emergency Management and Health Acts, along with ambulance service regulations, were reviewed with a focus on "duty to respond". There was no clear focus on "duty to respond" or the ramifications of failing to respond. As Australia is a Common Law Country, the issue of duty to respond would be managed through paramedics individual contracts with their respective ambulance services, and failing to respond could be managed using preexisting standard terms and conditions for employment. Under such circumstances, the ambulance services would need to demonstrate that the direction to respond was appropriate. Conclusions: The concept of "duty to respond"was not adequately addressed in any of the legislation or regulations identified and needs to be addressed by appropriate agencies.