AGREEMENT FOR SERVICES

between

HER MAJESTY THE QUEEN IN RIGHT OF HER GOVERNMENT IN

NEW ZEALAND (acting by and through the Ministry of Health)

together with

ACCIDENT COMPENSATION CORPORATION

AND

[PROVIDER NAME]

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Table of Contents
Table of Contents............................................................................................................................... 2
Agreement for Services...................................................................................................................... 5
Execution........................................................................................................................................... 6
Part 1: Organisational Terms and Conditions.....................................................................................8
Schedule 1: Quick Reference Information..........................................................................................8
Schedule 2: General Terms and Conditions.......................................................................................9
1 Service Schedule to take Precedence........................................................................................ 9
2 Relationship of Parties................................................................................................................ 9
3 Parties Remain Responsible.................................................................................................... 11
4 Responsibilities of Parties......................................................................................................... 11
5 Information/Confidentiality........................................................................................................ 12
6 Variation of Agreement............................................................................................................. 13
7 Inability to Deliver the Services................................................................................................. 13
8 Circumstances beyond Control................................................................................................. 14
9 Agreement Termination or Service Cancellation by Notice.......................................................14
10 Termination on Insolvency........................................................................................................ 15
11 Termination for Breach............................................................................................................. 16
12 Cancellation or Expiry - Rights Preserved................................................................................16
13 Indemnity.................................................................................................................................. 17
14 Disputes.................................................................................................................................... 17
15 Notices...................................................................................................................................... 17
16 Conflicts of Interest/Financial Incentives...................................................................................18
17 Cost and Volume Shifting......................................................................................................... 18
18 Other Arrangements................................................................................................................. 18
19 No Extension or Renewal......................................................................................................... 19
20 Multiple Providers..................................................................................................................... 19
21 Waiver...................................................................................................................................... 19
22 Services for Injured Employees of Accredited Employers........................................................19
23 Where ACC Approval, Price or Cover is Uncertain...................................................................20
24 Definitions and Interpretation.................................................................................................... 20
Schedule 3: Organisational Quality Standards.................................................................................26
1 Introduction............................................................................................................................... 26
2 Written Policy, Procedures, Protocol, Guideline, Policy............................................................26
3 All Staff Informed...................................................................................................................... 26
4 Philosophy................................................................................................................................ 26
5 Quality Standards..................................................................................................................... 26
6 Risk Management..................................................................................................................... 28
Schedule 4: Monitoring and Evaluation............................................................................................ 29

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1 Service Evaluation.................................................................................................................... 29
2 Service Review......................................................................................................................... 29
3 Audit Provisions........................................................................................................................ 30
4 Reporting.................................................................................................................................. 30
Schedule 5: Prices and Payments................................................................................................... 31
1 Prices........................................................................................................................................ 31
2 No Additional Payments........................................................................................................... 31
3 Billing and Payment.................................................................................................................. 31
Part 2: Individual Service Schedules................................................................................................ 32
Service Schedule – Emergency Road Ambulance Services............................................................32
Part A: Terms and Conditions Specific to the Ministry related Services..........................................37
1 Payment Details....................................................................................................................... 37
2 Invoicing................................................................................................................................... 37
3 Payment Schedule.................................................................................................................... 37
4 Coverage Area......................................................................................................................... 37
5 Service Specification................................................................................................................ 37
6 Service Provision...................................................................................................................... 37
7 Payment of Services................................................................................................................. 37
8 Part Charging........................................................................................................................... 37
Part B: Terms and Conditions Specific to ACC-related Services....................................................39
1 Coverage Area......................................................................................................................... 39
2 Pricing....................................................................................................................................... 39
3 Service Description................................................................................................................... 39
4 Completion and Turn-Over Of Forms.......................................................................................42
5 Invoicing and Payment............................................................................................................. 43
Appendix 1: Injury Assessment Criteria............................................................................................ 46
Part C: Service Specification for emergency road ambulance services...........................................48
1 Term......................................................................................................................................... 48
2 Purpose.................................................................................................................................... 48
3 Service Objectives.................................................................................................................... 48
4 Principles.................................................................................................................................. 48
5 Overview of Emergency Ambulance Services..........................................................................48
6 Background.............................................................................................................................. 49
7 Service Description................................................................................................................... 51
8 Maori Health and Cultural Requirements..................................................................................53
9 Exclusions................................................................................................................................ 53
10 Service Linkages...................................................................................................................... 54
11 Quality Requirements............................................................................................................... 54
12 Reporting.................................................................................................................................. 55
13 Incident reporting...................................................................................................................... 56

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14 Monitoring and Evaluation........................................................................................................ 57
Appendix 1: Service Capability Levels as per NZS 8156............................................................58
Appendix 2: Response Time Targets............................................................................................... 59
Appendix 3: Reporting Templates.................................................................................................... 61
Appendix 4: Allocating the Severity Assessment Code (SAC Score)...............................................64
Appendix 5: Serious and Sentinel Events Quarterly Reporting Template........................................66
Appendix 6: Volume Template – Adverse Events............................................................................67

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Agreement for Services
This Agreement is made on the day of 2012

Between

1 Her Majesty The Queen In Right Of Her Government In New Zealand (acting by and through
the Ministry of Health) together with the Accident Compensation Corporation, a statutory
corporation continued by the Accident Compensation Act 2001 (together called “the Purchasers”)

and

2 Provider name (“the Provider”)

The Purchasers and the Provider agree that:

1 The Provider will provide each Service described in the Individual Service Schedules in Part 2 for
the Term described in the applicable Service Schedule.

2 The Purchasers will pay for each Service provided during the relevant Term for that Service,
subject to and in accordance with the terms and conditions set out in this Agreement which are
applicable to that Service.

3 Each Party will comply with all the provisions of this Agreement that apply to that party.

4 This Agreement includes the Parts listed below, and any variations to this Agreement made at any
time:

Part 1: Organisational Terms and Conditions

Part 2: Individual Service Schedules

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Execution
Signed for and on behalf of the Ministry of Health
by:

Name Signature

In the presence of:

Witness signature

Witness name

Witness Occupation

Witness Address

Signed for and on behalf of the Accident Compensation

Corporation by:

Name Signature

In the presence of:

Witness signature

Witness name

Witness Occupation

Witness Address

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Signed for and on behalf of [Provider’s Name)
by:

Name Signature

In the presence of:

Witness signature

Witness name

Witness Occupation

Witness Address

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Part 1: Organisational Terms and Conditions

Schedule 1: Quick Reference Information

1 Provider’s Bank Account (Schedule 5, clause 3.3)

Payments will be made into the account(s) nominated by the Provider.

2 Addresses for Notices (Schedule 2, clause 15)

NOTICES FOR THE PURCHASERS TO:

ACC
Vogel Centre (For deliveries)
19 Aitken Street
PO Box 242 (For mail)
Wellington

Marked: “Attention: Health Procurement”

The Ministry of Health

133 Molesworth Street (For deliveries)
PO Box 5013 (For mail)
Wellington

Marked: “Attention: Group Manager, National Ambulance Sector Office”

NOTICES FOR PROVIDER TO:

Provider Name
Physical Address (For deliveries)
Physical address 2
City
Postal Address (For mail)
Postal Address 2
CityMarked: “Attention: Name, Position”

Facsimile: (##) ### ####

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Schedule 2: General Terms and Conditions

1 Service Schedule to take Precedence

1.1 Documents forming part of the Agreement

This Agreement comprises these terms of agreement, including all schedules and appendices
attached to them and the documents listed below. In the event of any conflict of meaning or
ambiguity, the documents that comprise this Agreement shall have the descending order of
precedence set out below:

a any variations to this Agreement agreed in writing between authorised representatives of the
parties after the date of this Agreement;

b Part 2 Individual Service Schedules;

c the terms of Part 1 Schedule 2 General Terms and Conditions;

d any appendices

1.2 Precedence

If there is any conflict of meaning between information contained within the documents having the
same level of precedence in the hierarchy described above then the order of precedence shall be
reverse chronological order, that is, information contained in later documents shall prevail over
information contained in earlier documents. However, requirements stated in earlier documents
that are omitted in later documents shall continue to apply unless the later documents expressly
exclude those requirements or those requirements are clearly inconsistent with the provisions of
the later documents.

2 Relationship of Parties
2.1 Relationship Principles

a Both parties acknowledge that our relationship is fundamental in achieving both of our
objectives in entering into this Agreement.

b Both parties agree to foster a long-term co-operative and collaborative relationship to enable
us both to achieve our respective objectives efficiently and effectively. We both agree that
the following relationship principles will guide each of us in our dealings with each other
under this Agreement.

c Both parties agree to observe the principles of natural justice in giving effect to this
Agreement.

d The Provider acknowledges that the Purchasers are subject to, and must comply with, the
strategic and policy directions of the Crown. Equally, the Purchasers acknowledge that the
Provider has its own strategic and policy directions.

e The Purchasers recognise the Provider’s right to maintain its clinical and business autonomy.

f Both parties agree that clinical interventions should be based on the best evidence available
at the time.

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 g Both parties will respect and maintain patient confidentiality.

h Both parties recognise and value the other’s skills and expertise and commitment to high
quality performance.

i Both parties will negotiate and implement agreements in good faith and respect, and trust the
other to work together to find solutions to problems.

j Both parties will communicate directly with each other, openly and in a timely manner.

k Both parties will work in a co-operative and constructive manner, and where appropriate
undertake joint projects.

l Both parties will encourage continuing quality improvement and innovative service
development to achieve the objectives of both parties to the extent possible within available
funding.

2.2 This Agreement is to be interpreted in light of the principles set out in clause 2.1 above. To the
extent that a clause in this Agreement can be given a meaning that is consistent with the
principles set out in clause 2.1 above, that meaning is to be preferred.

2.3 Meetings

Both parties acknowledge that holding meetings is important for developing and maintaining an
effective working relationship. Accordingly, we both agree to make appropriate personnel
available as might be reasonably required by either of us to discuss matters arising in relation to
this Agreement, including:

a how the contractual relationship is functioning and how the Services are being delivered;

b whether there are aspects of the functioning of the relationship or the delivery of the Services
that either of us could improve;

c how such improvement might be implemented; and

d wider issues in the health and injury prevention, treatment and rehabilitation sectors that are
relevant to either Party, which may include issues relating to implementation of the
Government's strategies for these sectors.

2.4 Independent Contractor

The Provider is an independent contractor, contracted by the Purchasers to provide the Services
described in this Agreement. Nothing contained or implied in this Agreement shall be construed
as creating, and neither Party shall state, imply or do anything to suggest, that this Agreement
creates an employer/employee partnership or principal/agent relationship between the Purchasers
and the Provider or any of its proprietors, officers, employees or subcontractors.

2.5 Privity of Contract

Nothing in this Agreement is intended to confer any enforceable rights or benefits on a Service
User or any other person.

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2.6 Complete Agreement

This Agreement represents the whole of the agreement between the parties, and any provisions in
tenders, correspondence or other documents prior to the date of this Agreement and all
representations are excluded.

2.7 No Adverse Comments

Neither Party will make any oral or written statement or comment to the media, any Service User
or any member of the public in relation to the operation of this Agreement which criticises the
other Party or which could adversely affect a Service User’s or public opinion of the other Party or
which brings the other Party into disrepute. If such a statement or comment is made, that Party
will, at the request and with the prior agreement of the other Party, promptly make an appropriate
retraction or take such other remedial steps as are appropriate and reasonable in the
circumstances. This will be without prejudice to any other rights, remedies or actions available to
the other Party.

2.8 Contract Excludes Regulations

This Agreement and any other agreement in effect between the parties at the relevant time
exclusively regulates the provision by the Provider for the Purchasers of personal health and
disability services of the kinds included within the Services that are to be provided under this
Agreement and the pricing and the payment obligations of the Purchasers for those Services.

3 Parties Remain Responsible

3.1 Assignment/Subcontracting

The Provider shall not assign, transfer, subcontract or otherwise dispose of any benefits, rights,
liabilities or obligations under this Agreement or any part of this Agreement without the prior
written consent of the Purchasers, such consent not to be unreasonably withheld.

3.2 Ensure Subcontractors Bound

Subject to clause 3.1, the Provider shall ensure there is included in every agreement entered into
with a subcontractor provisions which enable the Provider to discharge and secure compliance
with its obligations under this Agreement including (without limitation) clause 4 of this Schedule 2.

3.3 Provider not Relieved

The assignment, transfer, subcontracting or other disposal of any of the Provider’s liabilities or
obligations shall not relieve the Provider from any liability or obligation.

3.4 Change in Control

If at any time there is a change in the shareholding or ownership of the Provider that alters the
effective control of the Provider (other than where the Provider is a company whose shares are
listed on any recognised Stock Exchange) without the Provider obtaining the Purchasers’ prior
written approval to the change, then the Purchasers may, within 15 working days of receiving
notice of the change, give to the Provider notice of breach pursuant to clause 11.1.

4 Responsibilities of Parties
4.1 Provider to Provide Services

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 The Provider agrees to:

a provide the Services in accordance with the provisions of this Agreement;

b advise the Purchasers immediately if an Insolvency Event occurs in respect of the Provider
or on the bankruptcy or liquidation of the Provider.

4.2 Request for additional services

The Purchasers may from time to time request the provision of additional services or the extra
provision of existing Services. This request, if accepted by the Provider, will be governed by the
terms of this Agreement unless otherwise agreed. All additional Services will be by way of a
variation to this Agreement.

4.3 The Purchasers to Pay for Services

The Purchasers agree to:

a pay the Provider for the Services as required by this Agreement and in accordance with and
subject to the provisions of this Agreement;

b comply with all Law applicable to them.

4.4 Good Faith

The Parties agree to act in good faith and consult with each other whenever and as often as may
be appropriate on matters affecting their respective obligations.

4.5 Statutory Obligations

Nothing in this Agreement shall affect the statutory obligations of either Party to Service Users or
shall bind either Party to do or refrain from doing anything in a manner that is not consistent with
the Law.

5 Information/Confidentiality
5.1 General

All matters relating to this Agreement and all information acquired or received by either Party in
the course of providing the Services under this Agreement shall be held confidential and shall not
be divulged in any way to any other person without the prior written approval of the Party which
provided the information.

5.2 No Breach

Disclosure of information in the following circumstances shall not be a breach of clause 5.1:

a to the extent that the information has become generally available to the public other than as a
result of unauthorised disclosure by a Party;

b to the extent that a Party is required to disclose the same pursuant to the Official Information
Act 1982 or any other Law;

c to the extent that it is necessary and reasonable for the Purchasers to disclose certain
information (such as the name of the Provider) to ensure the efficient and uninterrupted
operation of this Agreement;

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 d as provided in this Agreement.

5.3 High Profile Issues

a The Provider will immediately advise the Purchasers if it becomes aware of any issue relating
to the provision or non provision of the Services, or the operation of this Agreement which, in
the Provider’s opinion, has or may have media or public interest.

b Neither Party will make or issue to the media or any member of the public any oral or written
statement or comment concerning a Service User, the Service User’s treatment or the
operation of this Agreement, without prior consultation with the other Party.

c Each Party will promptly advise the other if it is required to provide information to a Service
User, professional disciplinary body or other person under the Official Information Act 1982,
the current Code of Health and Disability Services Consumers’ Rights or other legislation or
is the subject of a complaint, concerning a Service User, the Service User’s treatment or the
operation of this Agreement.

6 Variation of Agreement
6.1 Variations by Agreement

No variation of this Agreement shall be effective, unless it is agreed in writing by the Parties or
unless it is made pursuant to clause 6.2 or clause 6.3.

6.2 The Purchasers may Amend Specifications

After consultation with the Provider, the Purchasers may at any time give notice to the Provider
that the provisions of any one or more of the Parts of, or Schedules, to this Agreement (excluding
prices) are amended or added to with effect from a date stated in the notice, and this Agreement
shall be deemed varied accordingly with effect from that date, provided that notice may not be
given if this would have the effect of reducing the prices payable under this Agreement. The
Provider may claim any additional costs from the Purchasers that it can show that it will suffer as a
result of the variation, and upon obtaining the Purchasers’ agreement, the Purchasers shall be
liable to pay such additional costs to the Provider. If agreement cannot be reached, either Party
may require the matter to be resolved under clause 14 (Disputes).

6.3 Variations to give Effect to Government Policy Changes

Notwithstanding clause 6.2, where a change in legislation or regulations or a ministerial directive

under the Accident Compensation Act 2001 or the New Zealand Public Health and Disability
Services Act 2001 is stated by notice given to the Provider by the Purchasers to have the effect of
requiring this Agreement to be varied in any respect, this Agreement shall be deemed varied
accordingly from the date stated in the notice. The Provider may claim any additional costs from
the Purchasers that it can show it will suffer as a result of the variation, and upon obtaining the
Purchasers’ written agreement, the Purchasers shall be liable to pay such additional costs to the
Provider. If agreement cannot be reached, either Party may require the matter to be resolved
under clause 14 (Disputes).

7 Inability to Deliver the Services

7.1 Where the Provider believes that it will not be able to deliver any of the Services described in this
Agreement to the extent that this Agreement requires, the Provider will notify the Purchasers of

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 the extent to which the Provider is prevented from providing those Services and the reasons for
that inability.

7.2 Without limiting any right of either party under this Agreement, both parties will then discuss the
reasons why the Provider is prevented from performing those Services and both parties will seek
to reach agreement about changes to the Provider’s levels of Service provision by way of an
amendment to this Agreement.

7.3 If the parties are unable to reach agreement about the scope of any amendments to this
Agreement within one month of notice being given by the Provider under clause 7.1, any party
may refer the matter to mediation by notice in writing to the other parties. The mediator will be
appointed by agreement of the parties or, failing agreement, by the President for the time being of
the New Zealand Law Society.

7.4 The cost of mediation must be borne equally between the parties unless otherwise agreed in
writing prior to the commencement of mediation.

8 Circumstances beyond Control

8.1 Suspension of Obligations

Neither Party shall be liable for failure to perform nor delay in performing this Agreement to the
extent that the cause of such failure or delay is beyond that Party’s reasonable control (this does
not include lack of funds) providing notice claiming suspension of its obligations is given under
clause 8.2.

8.2 Notice Claiming Suspension

A Party claiming suspension of its obligations shall, within three working days after the Party
becomes aware of the cause and its supervening effects in respect of which suspension of its
obligations is claimed, give notice of the cause, furnish all available information detailing the
cause and give an estimate of the period of time required to remedy the cause (if such remedy is
deemed practicable), to the other Party.

8.3 Period of Suspension

Any suspension of the obligations of a Party shall be limited to the period during which the cause
falling within clause 8.1 continues to exist.

9 Agreement Termination or Service Cancellation by Notice

9.1 By Notice as of Right

Either Party may, without incurring any liability to the other for damages or other compensation, at
any time give to the other no less than:

a six calendar months’ notice of termination of this Agreement and all the Services; or

b six calendar months’ notice of the cancellation (or any lesser notice period for cancellation
permitted under the applicable Service Schedule) from this Agreement of a particular Service
Schedule and the Service(s) described in that Service Schedule.

9.2 Termination Date

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 The later of six calendar months after the date upon which such notice is received by the Provider
and any date specified in the notice as the date upon which this Agreement shall come to an end,
shall be the date upon which this Agreement and all the Services shall come to an end (the
“Termination Date”).

9.3 Cancellation Date

The later of six calendar months (or any lesser notice period for cancellation permitted under the
applicable Service Schedule) after the date upon which such notice is received by the Provider
and any date specified in the notice as the date at which the Service Schedule is to be cancelled,
shall be the date (“Cancellation Date”) when the Service Schedule and the Service(s) described
in that Service Schedule are removed from this Agreement. From the Cancellation Date the
Provider is released from the obligation to provide the Service(s) described in that Service
Schedule, and the Purchasers are released from the obligation to pay for such Service(s)
provided after that date.

9.4 Disengagement Process

a Upon any party giving notice of termination, or otherwise six months prior to the expiry of this
Agreement, the parties agree to meet to formulate a transition plan to facilitate the transfer of
the Services to the new provider.

b The Provider acknowledges that the Purchasers must be able to maintain continuity of the
Services upon the termination of this Agreement.

c The Provider agrees to cooperate to the extent reasonably expected of an emergency

ambulance service provider in order to ensure that any hand-over of the Services to another
provider or to the Purchasers itself is conducted smoothly and professionally. The
Purchasers acknowledge that in complying with this clause, the Provider is not required to
provide access to or disclose or make available its know-how, techniques, intellectual
property rights or information that is confidential to the Provider, and is not required to divest
any assets (including the benefit of any contracts to which it is a party).

d In the event of the need for a hand-over of the Services to another service provider, the
Provider will provide the Services until such time as the Agreement is terminated in
accordance with its terms unless the parties otherwise agree in writing.

10 Termination on Insolvency
10.1 Immediate Termination without Prior Notice

This Agreement and all the Services shall end immediately (without any requirement for prior
notice) by reason of a deemed breach of this Agreement by the Provider on the insolvency or
liquidation of the Provider. (This shall not apply, however, in the case of a liquidation of the
Provider for the purpose of reconstruction or amalgamation where the terms have been approved
by the Purchasers.)

10.2 Termination Date without Prior Notice

The date the Provider is adjudicated bankrupt or the date of appointment of a liquidator in respect
of the Provider is the date upon which this Agreement and all the Services shall end (the relevant
date being the “Termination Date”).

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10.3 Immediate Termination on Notice

If an Insolvency Event has occurred in respect of the Provider and if, at any time thereafter, the
Purchasers give notice to the Provider of termination of this Agreement and all of the Services,
this Agreement and all the Services shall end immediately by reason of a deemed breach of this
Agreement by the Provider.

10.4 Termination Date on Notice

The date a notice given by the Purchasers in accordance with clause 10.3 is received by the
Provider is the date upon which this Agreement and all the Services shall end (the relevant date
being the “Termination Date”).

11 Termination for Breach

11.1 Notice of Breach

If either Party considers that the other has breached any provision of this Agreement, that Party
may give notice to the other specifying the breach and giving the other Party 10 Working Days for
the breach to cease and/or to remedy the breach if it is capable of remedy.

If the breach has not ceased or if the breach being capable of remedy has not been remedied
within the period of 10 Working Days, then the Party which gave the notice may forward to the
other Party a notice of termination of this Agreement and all of the Services.

11.2 Termination Date

This Agreement and all the Services shall terminate on the date of receipt by the other Party of
the notice of termination given under clause 9.1 or any later date specified for that purpose in the
notice (the relevant date being the “Termination Date”).

12 Cancellation or Expiry - Rights Preserved

12.1 Release from Cancellation Date or Date of Expiry

From the Cancellation Date for a particular Service Schedule or from the Date of Expiry of a
particular Service Schedule, the Provider is released from the obligation to further provide the
Service(s) described in that Service Schedule, and the Purchasers are released from the
obligation to pay for such Service(s) provided after that date.

12.2 Termination Cancellation or Expiry Without Prejudice to Rights

Termination of this Agreement or the cancellation or the expiry of any particular Service Schedule,
shall be without prejudice to the rights, other remedies and obligations of either Party under this
Agreement or under the Law which may have arisen before or on the Termination Date for this
Agreement or the Cancellation Date or the Date of Expiry for the particular Service Schedule, and
such rights, other remedies and obligations continue to have effect and may be enforced after the
relevant date. Termination or cancellation shall also be without prejudice to any other rights or
remedies of the Party who gave the notice of termination or cancellation. The Purchasers may
deduct any amount to which they are entitled as a result of the Provider being found to have
breached this Agreement and therefore has been funded for services which the Purchasers have
no legal entitlement to pay from moneys otherwise payable to the Provider.

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13 Indemnity
13.1 The Provider will indemnify, and will keep indemnified, the Purchasers against all claims, costs
(including solicitor and client costs), liabilities and losses suffered or incurred by that other party
as a result of any act or omission by the Provider in any way related to this Agreement or to any
alleged breach by the Provider of any Law, except to the extent that the same arises as a result of
any act or omission of the Purchasers. The Purchasers may deduct any amount to which they are
entitled to be so indemnified from moneys otherwise payable to the Provider once the amount to
be deducted has been agreed by the Provider or determined as provided in clause 14 (Disputes).

14 Disputes
14.1 Endeavour to Agree

If a dispute arises in any way related to this Agreement (other than any renewal of it or the fixing
of any prices upon any renewal), the Parties shall in good faith endeavour to resolve the dispute
by agreement.

14.2 Reference to Senior Executives

If the dispute is not promptly resolved, it shall be referred to the Manager, Claims Management
Health Procurement ACC, and the Director, National Health Purchasing, National Health Board
Ministry of Health and the chief executive of the Provider jointly to seek agreement upon a
resolution.

14.3 Mediation / Arbitration

If the dispute is unable to be resolved by agreement, either Party may, in writing, request that the
dispute be referred to mediation. If the other Party does not wish the dispute to be referred to
mediation or if it is not possible to agree on a mediator within 10 working days or to resolve the
dispute through mediation, either Party may refer the dispute for determination by arbitration of a
single arbitrator (to be appointed by the President of the NZ Law Society if not agreed within 10
working days of reference) under the Arbitration Act 1996.

14.4 Parties to Continue to Comply with Agreement

Notwithstanding the existence of a dispute, the Parties shall continue to fully comply with their
obligations under this Agreement in accordance with and subject to its provisions.

15 Notices
15.1 Sending

All notices and other communications provided for or permitted under this Agreement shall be
sent by email, mail with postage prepaid, or by hand delivery, or by facsimile as shown on the
relevant addresses set out in Part 1, Schedule 1 or to such other address or person as that Party
may specify by notice in writing to the others.

15.2 Deemed Time of Giving

All such notices or communications shall be deemed to have been duly given or made:

a Four days after being deposited in the mail by the sender with all postage prepaid;

b On delivery when delivered by hand or on behalf of the sender;

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 c If sent by facsimile, when a completed transmission report is received by the sender unless a
verifiable query as to material illegibility is promptly raised.

15.3 Deemed Time (delivery or fax)

Delivery by hand or transmission by facsimile prior to 5.00 p.m. on a Working Day shall be
deemed effected on the date of delivery or transmission, and delivery or transmission after 5.00
p.m. shall be deemed effected on the next Working Day.

16 Conflicts of Interest/Financial Incentives

16.1 The Provider will at all times during the Term of each relevant Service Schedule use its best
endeavours to ensure that no action is taken by itself, its personnel and sub-contractors which
could or might result in or give rise to the existence of conditions prejudicial to or in conflict with
the interests of the Purchasers if such action touches upon or relates to this Agreement or the
delivery of the Services.

16.2 If the Provider has a financial interest in an entity supplying, procuring or manufacturing products
or services, the Provider shall ensure that those products or services are not utilised in providing,
nor comprise, the Services described in the Service Schedules without prior approval from the
Purchasers

16.3 Where in order to provide the Services, the Provider procures products or services, the Provider
shall not accept or receive (or permit any person associated with the Provider to accept or
receive) any incentive or reward for providing those products or services, whether by way of any
gift, voucher, cash, trip or travel, merchandise or equipment or any discount, rebate or credit
towards such items or in any other form whatsoever.

16.4 The Provider shall under no circumstances accept or receive (or permit any person associated
with the Provider to accept or receive) any incentive or reward conditional upon, based on, or
linked to the recommendation or procurement of any products or services utilised in providing or
comprising the Services.

17 Cost and Volume Shifting

17.1 The Provider must not:

a act in such a way that increases cost to another provider,

b be party to any arrangement which results in the Purchasers effectively having to pay more
than once for the supply of the same Services or any component of them,

c act in such a way that shifts volumes relating to Services being provided separately by the
Provider where such volumes have been specifically related to that Service.

18 Other Arrangements
18.1 The Provider must not enter into any other contract or arrangement which might prejudice its
ability to meet its obligations in this Agreement. The Provider may (subject to its obligations in this
Agreement), agree to provide services for any other person.

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19 No Extension or Renewal
19.1 Unless otherwise stated in this Agreement, nothing in this Agreement shall be taken or read as
expressly or impliedly warranting that the provider is entitled to an extension or renewal of any of
the Service Schedules comprised in this Agreement at any time, or to any further agreement with
the Purchasers in respect of any or all the services described in the Service Schedules. The
Provider shall not have any claim against the Purchasers for any costs or expenses incurred in
anticipation of a further agreement or that any or all the services or the Service Schedules will be
extended or renewed, or for any anticipated income, profits or other sums whatsoever.

20 Multiple Providers
20.1 If this Agreement is signed by more than one provider, the liability of all providers under this
Agreement shall be joint and several.

21 Waiver
21.1 No failure or delay on the part of either Party to exercise any right, power or privilege under this
Agreement shall operate as a waiver nor shall any single or partial exercise or the exercise of any
other right or power or privilege whether arising under the law or this Agreement

22 Services for Injured Employees of Accredited Employers

22.1 Purchase of Services by Accredited Employers

The Provider agrees that Accredited Employers are permitted to purchase the Services for their
Injured Employees and that the Provider will provide Services to those Injured Employees, subject
to the provisions of clauses 22.2 to 22.4 below.

22.2 Information to Accredited Employers

ACC may, from time to time and for the purpose of facilitating purchase arrangements between
the Provider and Accredited Employers, release information about this Agreement including prices
to Accredited Employers, provided the Accredited Employer has first agreed in writing with ACC to
keep that information confidential and to use it only for the purpose of purchasing Services.

22.3 Access

During the period from the date of any Referral made or approved by an Accredited Employer,
until expiry of the Term of the applicable Service Schedule, the Provider will provide Services to
Injured Employees of such Accredited Employers on the same terms and prices as specified in
this Agreement (subject to any minor adjustments to this Agreement which may be necessary to
give effect to this clause 22, and to any changes in those terms and prices subsequently agreed
between the Provider and Accredited Employer) as if “ACC” in this Agreement was a reference to
the particular Accredited Employer. For the purposes of this clause any Injured Employee of an
Accredited Employer is deemed to be a “Claimant”.

22.4 ACC not Liable for Purchasing by Accredited Employers

ACC’s role is to bring the Provider and Accredited Employers together. The Provider agrees that
ACC and each Accredited Employer is only liable in respect of the individual purchases made by
ACC or that employer (as the case may be) and neither of them has any joint liability (except as
provided in section 187(3) of the AC Act). Accordingly, all communications, invoicing and

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 reporting about Injured Employees will go to the Accredited Employer of the Injured Employee or
Injured Employees who receives the Services.

23 Where ACC Approval, Price or Cover is Uncertain

23.1 If prior to the commencement of a Service, the Provider is uncertain whether or not:

a a particular person or Claimant is eligible for the Service; or

b a person is a Claimant; or

c a price has been agreed for the Service; or

d the services required for the Claimant are within the scope of the Services that can be
provided under this Agreement

then the Provider will immediately request a written determination of the issue from ACC. ACC
will provide a written decision within 5 Working Days of receiving the request or will notify the
Provider if there will be a delay. ACC’s determination may include a direction that the person be
transferred to an appropriate facility at the relevant Purchaser’s cost. The Provider will provide the
service sought while cover is being determined. If ACC determines that the person is a Claimant
who is entitled to the Service, then retrospective payment will be arranged by ACC in accordance
with the relevant Service Schedule.

24 Definitions and Interpretation

24.1 In this Agreement, unless the context otherwise requires, the following terms have the meaning in
the corresponding definition:

Term Definition

AC Act Accident Compensation Act 2001

ACC Accident Compensation Corporation

Accredited An employer accredited by ACC under the Accredited Employer Programme in

Employer accordance with the framework established under section 183 of the AC Act
under which the employer and ACC may agree that the employer will provide
entitlements in relation to work-related personal injuries suffered by the
employer’s employees; and includes, where appropriate, any subcontractor
appointed in accordance with the accreditation agreement between ACC and the
Accredited Employer; and “Accredited Employers” has a corresponding meaning

Advanced An ambulance officer trained to the level of National Diploma in Ambulance

Paramedic (or Paramedic, or its equivalent, provided by an ambulance education provider
equivalent) recognised by Ambulance New Zealand.

Agreement and The agreement of which this provision forms part including all schedules
this Agreement (including service schedules), and appendices to it, as varied at any time

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 Ambulance Any motor vehicle, aircraft, or vessel:

(a) designed and used principally for the transport of sick or injured persons;
and

(b) operated by an ambulance operator.

Ambulance crew A crew member who has completed an appropriate ambulance/paramedic or first
member/staff aid qualification and who has met the standard set by the accrediting Education
member/officer Provider/Industry Training Organisation.

Attending ambulance personnel will have the skills, education, experience and
support (if necessary) to do an assessment and make a decision, based on the
assessment, with full documentation to support the decision made.

Ambulance A person who –

Operator
(a) (For the purposes of this Agreement) has a contract or arrangement
with ACC and the Ministry of Health for the emergency transport of
sick or injured persons; and

(b) is a member of Ambulance New Zealand.

Call A request for Service to be provided by the Emergency Ambulance Service or

Police or other dispatch service recognised in this Agreement

Claimant Any person who has been accepted by ACC as eligible for cover in respect of
personal injury under the Accident Compensation Act 2001.

Note the term “service user” includes a Claimant.

Commencement The date when the term for any Service described in a Service Schedule
Date commences as stated in that Service Schedule

Coverage Area Described in the Service Schedule for any particular Service (and in respect of
either Purchaser if relevant).

Crew One or more ambulance staff

Date of Expiry For any Service described in this Agreement has the meaning defined in the
Service Schedule for that particular Service

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 Emergency For medical cases, emergency means an ambulance response to a call from the
public indicating that a person is triaged as life threatening or potentially life
threatening by the EACC and services provided to a patient who requires medical
attention (not caused by trauma) from the time of the EAS being notified of the
need for services; to the time the patient arrives at a place of appropriate care, or
completion of care/attendance at the scene.

For ACC-related cases, emergency means an ambulance response to a call from

the public indicating that a person is triaged as life threatening or potentially life
threatening by the EACC and services provided to a patient who requires medical
attention as a result of a personal injury caused by accident. Medical attention will
be required from the time of the EAP being notified of the need for services to the
time the patient arrives at the place of definitive care, or completion of
care/attendance at the scene. EAS may start within 24 hours of suffering a
personal injury or within 24 hours of being found after suffering a personal injury
(whichever is the later).

Emergency A call-receiving centre provided by a Provider, which receives requests for the
Ambulance provision of Emergency Ambulance Services and which dispatches and co-
Communications ordinates the response to these requests.
Centre (EACC)

Emergency Inter- For the purposes of an ACC-related transport, this is an Emergency Transport
hospital transfer involving the transfer of a Claimant from one treatment facility to a higher level of
care within 24 hours of suffering a personal injury or within 24 hours of being
found after suffering a personal injury (whichever is the later)

Emergency For the purposes of an ACC-related transport, is transport by ambulance as

Transport defined under the IPRC (Ancillary Services) Regulations 2002 that:

(a) starts within 24 hours of a Claimant suffering a personal injury or being

found after suffering a personal injury, whichever is the later, and

(b) is necessary for the purposes of obtaining treatment urgently for the
Claimant’s personal injury, and

(c) is required to be provided under this Agreement to discharge ACC’s

liability for “Emergency Transport” under the IPRC (Ancillary
Services) Regulations, and that

(d) is by an ambulance that has been dispatched at the request of an

Emergency Ambulance Communications Centre.

GST Goods and services tax under the Goods and Services Tax Act 1985

Health Practitioner As defined at section 5 of the Health Practitioners Competence Assurance Act
2003.

Health Any authority or body that is empowered by or under any law, or the rules of any
Professional body or organisation, to exercise disciplinary powers in respect of any person who
Authority is involved in the supply of Health and Disability Services

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 Injured Employee A person who has suffered a work-related personal injury and who was, at the
time the work-related personal injury was suffered, an employee of an Accredited
Employer in that employment and “Injured Employees” has a corresponding
meaning.

Insolvency Event (a) the appointment of a receiver or receiver and manager or statutory
manager in respect of the whole or part of the activity or property of the provider;

(b) the Provider entering into; or resolving to enter into; a scheme of

arrangement or composition for the benefit of creditors or any class
of creditors; or

(c) the Provider suspending or stopping payment to its creditors

generally or ceasing to carry on business as normal; or threatening or
stating that it will do any of those things.

Inter-hospital A transfer of Claimants between publicly funded hospitals, for the purpose of
transfer accessing appropriate treatment that is not available at their existing facility.

IPRC (Ancillary The Injury Prevention, Rehabilitation, and Compensation (Ancillary Services)
Services) Regulations 2002.
Regulations

Job Cycle Time The total elapsed time from the receipt of a call until the patient arrives at a
medical facility.

Law Includes:

(a) any legislation; decree; judgement; order; regulation or by law; and

(b) any rule; protocol code of ethics or practice or conduct and other ethical
or standards guidelines and requirements of any relevant
professional authority; in effect at the relevant time

Material and In relation to any state of affairs, event or effect, anything which in a major way
materially affects or will affect the ability of a Party to perform or comply with the terms of
this Agreement.

Medical A person registered, or deemed to be registered, under the Health Practitioners

Practitioner Competence Assurance Act 2003 who provides primary and/or specialist and/or
continuing care to individuals, families, and to a practice population.

Non-Emergency A road ambulance service required to be provided under this Agreement to

Transport by discharge ACC’s liability under Regulation 10 of the IPRC (Ancillary Services)
Ambulance Regulations.
(NETBA)

Paramedic An ambulance officer who has successfully completed all the requirements of the
National Diploma IV/Cardiac (Paramedic), or its equivalent.

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 Parties The Provider and the Purchasers; and “Party” refers to either the Provider or the
Purchasers. For the avoidance of doubt, the Purchasers constitute one Party to
the Agreement and any reference to a Party means a reference to the Provider or
to the Ministry of Health and ACC together as the Purchasers.

Provider The Party whose reference name is “the Provider” in this Agreement and, where
the context requires, includes its employees, agents and permitted contractors,
and its successors and permitted assigns

The Purchasers The Accident Compensation Corporation continued under the Accident
and the purchaser Compensation Act 2001 and, where the context requires, includes its employees,
agents, consultants and contractors, and its successors and assigns, acting
together with Her Majesty the Queen in Right of New Zealand acting by and
through the Ministry of Health including, where the context requires, its permitted
consultants, subcontractors, agents, employees and assignees.

Registered Nurse A Registered Comprehensive, General and Obstetric, or General Nurse as

described under the Health Practitioners Competence Assurance Act 2003.

Required A response time as defined in the Schedules to this Agreement; this is a

Response Time component of the quality measurements of the Service to be provided.

Request point The geographical location at or to which an ambulance has been requested

Response Time The interval in time from when a call is received by the Emergency Ambulance
Communications Centre until the ambulance arrives at the patient scene.

Retrieval The organised transfer of a patient from one facility to a facility that is able to
provide a higher level of care.

Search and (a) any search for a lost person; or

Rescue
(b) any rescue operation for a person who is considered to be sick or
injured in a remote bush, mountain or close to shore setting where
there is or may be difficulty in locating the person; or

(c) any search or rescue operation where distance or location can be

affected by weather conditions (e.g. alpine terrain); and

(d) includes any operation mounted solely for the purpose of

recovering bodies from a remote location.

Services, service, The services (or some or all of them, as the context may require) that are to be
and the services provided by the Provider in accordance with the Service Schedules.

Service Level A performance requirement expressed as a minimum percentage of calls of a

particular category of call and particular Service area which meet the required
response time for calls of that particular category of call and particular Service
area as described in a Service Schedule.

Service Period The interval in time which commences and ends at a specific time during a day.

Service Schedule An individual service schedule contained in Part 2 of this Agreement.

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 Service User Any person who requires emergency road ambulance services as defined in the
service specifications.

Note the term “service user” includes a Claimant.

Shift An operational duty period.

Term The period described in a Service Schedule during which the Service(s) described
in that Service Schedule are to be provided.

Termination date The date that this Agreement and all the Services are terminated pursuant to
Schedule 2.

Triage A system of prioritising requests for medical or ambulance assistance or

attendance according to the severity of the trauma (or injury) suffered by a patient.

Working day A calendar day other than any Saturday or Sunday, any public holiday or any day
falling within the period 24 December to 5 January inclusive.

Urgent Treatment Where treatment is required for a life threatening or potentially life threatening
dispatch, or when a non emergency dispatch is found to be of higher acuity on
assessment, and the patient needs transport to treatment to address a life
threatening or potentially life threatening condition.

24.2 Interpretation

In this Agreement, unless the context otherwise requires:

a Expressions defined in this document bear that defined meaning in the whole of this
Agreement;

b A reference to one gender shall include the other;

c References to schedules, sections, clauses and subclauses are references to schedules,

sections, clauses and subclauses of this Agreement;

d The singular shall include the plural and vice versa;

e Clause and other headings shall be ignored in construing this Agreement;

f Any obligation not to do anything shall be deemed to include an obligation not to suffer,
permit or cause that thing to be done;

g References to statutes, regulations, ordinances, bylaws or other instruments include any

amendment, substitution or re-enactment;

h A person includes a company or other entity. Any reference to a person applies to his/her
personal representatives or to its legal successors.

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Schedule 3: Organisational Quality Standards

1 Introduction
These organisational quality standards outline the requirements that the Provider must meet in
providing all Services described in this Agreement. These standards are subject to audit but are
not subject to regular reporting unless stated elsewhere in this Agreement.

2 Written Policy, Procedures, Protocol, Guideline, Policy

Where a standard refers to the requirement for a written policy, procedure, programme,
information or plan, the Provider will provide the Purchasers with a copy on request.

3 All Staff Informed

The Provider will ensure that employees and sub-contractors are aware of their responsibilities
under these organisational quality standards and relevant Service Schedules as they relate to the
Services.

4 Philosophy
The Provider will provide Services:

a that promote the concept of best practice as an ongoing provider quality assurance
mechanism;

b that are necessary, appropriate, timely, of the required quality, and not excessive in number
or duration;

c that abide by all relevant legislation (for example Accident Compensation Act 2001, Privacy
Act 1993, Human Rights Act 1993, the Code of Health and Disability Consumers’ Rights);

d that demonstrate a commitment to the principles of the Treaty of Waitangi and promoting the
purchase of culturally appropriate services for Maori and other ethnic groups;

e that promote open communication, honesty and respect;

f which are accessible in a timely manner and promote the concepts of equity and fairness;

g which are organised and administered in a way that will provide an optimum service to
service users in accordance with the service requirements outlined in this Agreement;

h which are service user focused. Choices and service user responsibilities will be clearly
specified where appropriate;

i that comply with the Code of ACC Claimants’ Rights;

j that comply with the Health and Disability Commissioner Act 1994, and with all aspects of the
Health and Disability Commissioner (Code of Health and Disability Services Consumers
Rights) Regulations 1996 (H&DC Code).

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5 Quality Standards
5.1 Quality standards

The Purchasers are committed to purchasing Services from providers who can provide and
demonstrate a quality service. To this end, the Provider will:

a ensure that all timeframe requirements in this Agreement as more particularly described in
the Service Schedule for each Service in Part 2 are met;

b provide the Services in accordance with all current clinical, ethical and professional
standards and guidelines, including the Health and Disability (Safety) Act 2001, and with the
degree of professional skill, care and diligence expected of an appropriately qualified person
experienced in providing the same or similar services;

c ensure the stipulated time, cost and quality objectives of the Purchasers for each Service are
met;

d advise the Purchasers immediately if the Provider becomes aware of any matter which may
change or delay the performance of the Services. The advice must include detailed
particulars of the likely change or delay and recommendations to minimise any adverse effect
from it;

e when requested by the Purchasers, provide evidence that they have a system for ensuring
continued compliance with the Health and Disability Services (Safety) Act 2001;

f comply with all relevant provisions of the National Minimum Data Set, Dictionary (the current
version) published by New Zealand Health Information Service (available on Ministry of
Health website at www.health.govt.nz.

5.2 Quality systems

The Provider is required to:

a Have developed written and applied protocols and policies which outline the standards for
the Services.

b Have in place, and follow, written protocols, procedures and policies for the management of
the Services. This document needs to be kept up to date and made readily available for staff
to read. The document will include written procedures on the following:

i receiving and responding to complaints

ii systems to measure service user satisfaction with the Service

iii collection, privacy and storage of information

iv roles and responsibilities of those providing the Services

v systems for recording and reporting sentinel and serious events

vi culturally appropriate practices

vii rights and responsibilities of Service Users

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 viii compliance with relevant legislation, regulations, ethical standards and clinical
protocols.

c Ensure that records and documentation are maintained in a manner that is current, detailed
and organised and enables effective provision of Services.

d Comply with all reasonable instructions and directions of the Purchasers.

5.3 Service Providers

The Provider will:

a ensure the Services are performed by contractors and personnel who have the knowledge,
qualifications, skill base and experience appropriate for the provision of the Services, and
who have been trained and briefed appropriately to provide the Services;

b ensure that all registered health professionals providing the Services are registered or
enrolled with the appropriate professional body and have current practising certificates where
applicable; and

c ensure that assistants, volunteers and other support personnel receive adequate training to
allow them to provide the Services safely, and will work only under the supervision and
direction of appropriately qualified staff.

5.4 Facilities and equipment

The Provider shall ensure that:

a all facilities shall be accessible to people with disabilities;

b the service provider will provide the Services from safe, well-maintained, hygienic facilities
that are suitably designed and equipped for the Services;

c all equipment used in the Services shall be safe and maintained to comply with safety and
use standards.

5.5 Interpreting services

Where Service Users require interpreting services in order to communicate adequately with
service providers, the Provider will ensure that such Services will be supplied without additional
cost to the Service User as part of the Services.

6 Risk Management
The Purchaser will have in place well developed processes for:

a identifying key risks including risks to health and safety;

b evaluating and prioritising those risks based on their severity, the effectiveness of any
controls you have and the probability of occurrence;

c dealing with those risks and where possible reducing them.

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Schedule 4: Monitoring and Evaluation

1 Service Evaluation
1.1 The Purchasers’ rights to evaluate

As part of the ongoing management of this Agreement, the Purchasers may evaluate the
provision of the Services by the Provider. This is part of the evaluation requirements of the
Purchasers and contributes towards reporting to Ministers. The purpose of such evaluation is to
monitor progress and quality of delivery of Services under this Agreement in terms of results
against expected performance.

1.2 Scope of evaluation

The evaluation undertaken by the Purchasers may include (but shall not be restricted to):

a the processes outlined in this Agreement and used in the ongoing management of the
Services;

b the prices of the Services provided in relation to the outcomes;

c satisfaction of any referrer with the Provider and the quality of the Services;

d satisfaction of Service Users with the Provider; and

e any other matters reasonably considered to be relevant by the Purchasers.

1.3 Appointed person

An appropriately qualified person may be appointed and retained by the Purchasers to conduct an
evaluation of the Service. Prior to making the appointment, the Purchasers will consult with the
Provider as to the suitability of the appointee to conduct the evaluation. In conducting such
evaluations the appointee may (subject to the rights of Service Users or other persons receiving
Services) attend the provision of Services, talk with service users and/or any of the service
providers.

1.4 Notice

The Purchasers shall give the Provider at least 10 working days’ notice of intention to conduct an
evaluation.

1.5 Cost

The provision and initial cost of this evaluation is the responsibility of the Purchasers. However, if
the evaluation demonstrates that the Provider is not complying with the service requirements
contained in this Agreement or that any reports provided to the Purchasers pursuant to this
Agreement are not valid, and the Provider does not improve their service standards to the level
required by the Purchasers within a reasonable length of time, then any further evaluations which
are required in relation to the same performance issues may, at the Purchasers’ discretion,
become the cost of the Provider.

2 Service Review
2.1 Reviewing this Agreement

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 If either Party requests it, the Parties will meet annually (with the first meeting no earlier than the
anniversary of the Commencement Date) to review the Services and any business relationships
including without limitation, information flows, timeliness of service provision and prices payable
under this Agreement.

3 Audit Provisions
3.1 General right of the Purchasers to audit

The Purchasers shall have the general right under this Agreement, in addition to any audit and
evaluation rights expressed elsewhere in it, to undertake clinical and operational audits, at the
Purchasers’ expense, of the Services and compliance with this Agreement.

3.2 Notice

Notice will be given to the Provider of the proposed audit and its timing, at least 10 working days
before the audit is due to commence.

3.3 Access to records and premises

Subject to observance of the requirements of the law, the Provider will (and will ensure every one
of its subcontractors will) allow the Purchasers access to those records and premises of the
Provider and any relevant subcontractor retained by the Provider which are necessary for the
purposes of audit of quality, service delivery, performance requirements, organisational quality
standards or information standards and organisational reporting requirements as detailed in any
part of this Agreement. The Provider will (and will ensure every one of its subcontractors will)
provide the Purchasers with every reasonable facility for and assistance in obtaining access for
the purpose of such audits.

4 Reporting
4.1 Measures

This Agreement requires the Provider to provide results to the Purchasers against a number of
contract monitoring measures. The measures are specified in each Service Schedule.

4.2 Purpose

The purpose of these contract monitoring measures is to monitor progress and quality of delivery
of the Services in terms of results against expected performance.

4.3 Level of reporting

The reporting is to be at an individual Service User level. Sentinel events will be reported in
accordance with any relevant Service Schedule.

4.4 Results to relate only to Service Users

Results against the measures shall relate to only those Service Users who have received the
Services.

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Schedule 5: Prices and Payments

1 Prices
The prices payable by the Purchasers for the Services are the prices specified in each Service
Schedule.

2 No Additional Payments
Unless otherwise specified in each Service Schedule, the price for each Service is the entire
amount chargeable in relation to that Service, and no additional amount may be charged to the
Purchasers, any Service User or other person (whether by way of co-payment or part-charge or
otherwise) for that Service.

3 Billing and Payment

3.1 Invoicing and payment arrangements

Invoicing and payment arrangements for each Service are specified in the Service Schedule for
that Service.

3.2 GST invoice

Each invoice will constitute a GST invoice under the Goods and Services Tax Act 1985, and will
be in a format, and contain such information as reasonably requested by the purchasers from time
to time.

3.3 Payment terms

If the Provider has complied with its obligations under this Agreement the Purchasers will pay the
invoice into the Provider’s bank account as indicated in Part 1, Schedule 1, clause 1 of this
Agreement on or before the 20th day of the month following receipt of the invoice.

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Part 2: Individual Service Schedules

Service Schedule – Emergency Road Ambulance Services

1. This Service Schedule for Emergency Road Ambulance Services includes three parts:

Part A Terms and conditions specific to Ministry of Health (the Ministry) related Services;

Part B Terms and conditions specific to ACC-related Services;

Part C Service Specification applicable to all Services.

2. The Parties agree that in addition to the other terms and conditions of this Agreement, the
Provider will comply with the Service Specification and the relevant Purchaser-specific terms and
conditions set out in the Service Schedule which apply to the Services being provided (i.e. terms
and conditions specific to the Ministry when providing the Ministry related Services; and terms and
conditions specific to ACC when providing ACC related Services).

3. In this Service Schedule, unless the context otherwise requires, the following terms have the
meaning in the corresponding definition:

Term Definition

Adverse Event An event or circumstance which could have resulted in unintended or unnecessary
harm to a person and/or a complaint, loss or damage or failure of a mission

Alternative Care An Alternative Care Pathway includes triage, assessment and referral to an agreed
Pathway health provider appropriate to the patient’s needs, when the dispatch of an
Emergency Ambulance Resource is not required. The responsibility remains with the
EACC until a clinical pathway has been agreed and accepted by the other party, and
a warm handover has been completed, as per the developed protocols and/or
guidelines.

An Alternative Care Pathway may be regional or local, and may differ from area to
area, to meet the specific needs of that community. Alternative pathways of care are
based on agreed guidelines and best practice.

Ambulance Ambulance New Zealand is the organisation that represents the Ambulance sector in
New Zealand New Zealand. It was set up to promote common interests of ambulance services
providers in this country, Its goal is to make sure a safe, reliable and efficient
ambulance service meets the needs of New Zealanders.

Ambulance New Zealand is made up of representatives of all the major providers and
a paid executive director.

Ambulance and Standards for the operation of emergency ambulance services developed and
paramedical promulgated by Standards New Zealand (NZS 8156).
Services
Standard

Best An obligation to do what is reasonable in the circumstances known to the relevant

Endeavours party at the time of the performance.

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Term Definition

Delegated Under the requirements of the Medicines (Standing Order) Regulations 2002, the
Authority to delegated authority to practice is issued under the direction of the Medical Director,
Practice and processes are in place to monitor and assess delivery of services under the
delegated authority to practice. The authorising Medical Director remains responsible
for the service delivery under the delegated authority to practice.

District A geographical catchment area for which a District Health Board has responsibilities
as defined by the NZ Public Health and Disability Services Act.

EAP Emergency Ambulance Provider –emergency ambulance operators who hold

contracts with the Ministry and ACC to provide Emergency Ambulance Services.

EAS For the purpose of this Service Specification, Emergency Ambulance Services (EAS)
may include Emergency Ambulance Communication Centres, Emergency Road
Ambulance Providers, Emergency Air Ambulance Providers, and other services such
as PRIME and Water Ambulance when required.

Eligible Persons Eligibility refers to:

for ACC EAS
(a) People who have suffered personal injury in terms of the “Act” for which a
Services
claim for cover has been accepted, or is likely (in the EAP’s experience) to be
accepted.

(b) Eligible people are those for whom EAS starts within 24 hours of suffering a
personal injury or within 24 hours of being found after suffering a personal
injury (whichever is the later), and for whom the emergency transport is
necessary for the purpose of obtaining treatment urgently for the claimant’s
personal injury.

(c) Those eligible are all those resident in New Zealand and visitors to New
Zealand.

Eligible Persons Eligibility refers to:

for Ministry EAS
(a) conditions expressed in the latest ‘Eligibility Criteria’ published in the New
Services
Zealand Gazette, available from www.dia.govt.nz;

(b) overseas residents and visitors who are usually resident in countries with
which New Zealand has reciprocal health arrangements:

New Zealand has reciprocal agreements for healthcare with the United Kingdom.
However this is limited to citizens who are normally resident in the United Kingdom.
New Zealand has reciprocal agreements for healthcare with Australia, however this
excludes the provision of emergency ambulance services.

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Term Definition

Emergency Roadside to Bedside recommends that there should be five regional acute networks
Care made up of representatives of an emergency pre-hospital and hospital emergency
Coordination services based in Auckland, Hamilton, Wellington, Christchurch, and Dunedin. Each
Team (ECCT) region is funded to have an Emergency Care Coordination Team which acts in a
networking, monitoring and advisory role to the regional emergency care system.
Representation includes but is not limited to: EAPs, DHBs, General Practitioners,
PRIME providers, the Fire Service, Police etc.

The contracts for these services are managed by the DHBs (Auckland, Waikato, Hutt
valley, Canterbury and Otago or their designee) and ACC.

Events An attendance by the EAP at a function to supply first aid for individual organisations
in which the EAP enters into an individual agreement with the organisation.

Medical A registered medical practitioner who holds an appropriate post graduate specialist
Advisor/Medical qualification or relevant experience, appointed by an ambulance service to undertake
Director specified duties. These should include: overseeing and advising on patient care,
authorising (in writing) delegated medical procedures and drug regimes carried out by
ambulance officers, and being responsible for medical audit of patient care.

Medical Includes illness, injury or obstetric emergency that requires an emergency response.
Emergency

Non-emergency For the purpose of this service specification, non emergency refers to triage
assessment of the patient by the EACC where the patient does not require an
immediate or urgent response and may be suitable for an Alternative Care Pathways.

Patient Care Are a set of clinical guidelines for use by appropriately trained ambulance personnel
Protocols which are authorised by the Medical Director of the service.

Patient Report A record outlining the patient’s details, clinical status throughout the event and any
Form clinical interventions undertaken upon the patient through the event and up until
transfer of clinical responsibility to the receiving hospital. This may be paper or
electronic.

Performance Specific performance measures collected and reported regularly to enable monitoring
Indicators of service performance.

PRIME Primary Response In a Medical Emergency – a system using rural doctors and
nurses who are funded under contracts between those providers and ACC and the
EAPs.

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Term Definition

Place of For the purposes of Emergency Ambulance Services, a place of definitive care is a
Definitive Care receiving treatment facility which provides services and definitive care delivered by
the most suitably qualified and experienced staff able to deal effectively with the
patient’s presenting condition.

The place of definitive care may be determined by the EAS clinical personnel in
conjunction with the receiving treatment facility, and will always be dependent on the
patient’s condition and need for urgent care or stabilisation.

It may be deemed appropriate to transport the patient to a specialist facility, where

services available better meet the needs of the patient, rather than the nearest facility

Privately funded A commercial activity undertaken by the EAP in which they enter into an agreement
with individuals or organisations for the provision of non-emergency ambulance
services.

ProQA Is an internationally recognised emergency medical dispatch system and triage tool.

ProQA The level of severity indicated by ProQA: i.e. Echo, Delta, Charlie, Bravo, Alpha,
Determinant Omega. Each ProQA determinant has been given a response plan that includes the
Level prescribed crewing level and response priority.

ProQA Immediately life threatening – Allows for the early recognition of life threatening
Determinant: conditions and early dispatch of the closest resource, and provides links to pre-arrival
Echo instructions to callers to assist with best practice clinical outcomes - Dispatch occurs
at the beginning of the question sequence and is normally Advanced Life Support
Priority 1.

ProQA Critical but not immediately life threatening – Allows for early recognition of critical
Determinant: conditions less life threatening. Dispatch occurs at a given point during the Key
Delta Question sequence depending on severity and is usually either Advanced Life
Support or Intermediate Life Support Priority 1.

ProQA Serious but unstable – Allows for recognition of serious conditions not immediately
Determinant: Life threatening and Dispatch occurs at a given point during the Key Question
Charlie sequence depending on severity and is usually either Advanced Life Support or
Intermediate Life Support Priority 1 or 2.

ProQA Serious but stable – Allows for recognition of conditions not immediately critical and
Determinant: Dispatch occurs at a given point during the Key Question sequence depending on
Bravo severity and is usually either, Advanced Life Support, Intermediate Life Support or
Basic Life Support Priority 1 or 2.

ProQA Stable with the potential to deteriorate, – Allows for recognition of non critical
Determinant: conditions.
Alpha

ProQA Ambulance Response Not Required.

Determinant:
Omega

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Term Definition

Sentinel Event A sentinel event has led to an unanticipated death or major loss of function not
related to the course of the person’s injury, illness or underlying condition, and/or was
a life threatening event.

Serious Event A serious event has the potential to result in death or major loss of function, not
related to the natural course of the person’s injury, illness or underlying condition
and/or has resulted in significant harm and/or significant additional treatment.

Severity The Severity Assessment Code (SAC) is an agreed scoring system used to
Assessment determine the appropriate action to take following an incident.
Code Score

Service Means the BLS (Basic), ILS (Intermediate) and ALS (Advanced) levels of service for
Capability emergency road and air ambulance services.
Levels

Service Level A contractual agreement between the EACCs and the EAPs, which outlines the
Agreement operational aspects of their relationship.

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Part A: Terms and Conditions Specific to the Ministry related Services
[Include usual template info eg price and invoicing etc]

1 Payment Details
1.1 [Insert]

2 Invoicing
2.1 [Insert]

3 Payment Schedule
3.1 [Insert]

4 Coverage Area
4.1 The Provider is contracted to provide Emergency Ambulance Services in [enter coverage areas]

4.2 There may be instances where Emergency Ambulance Services may cross coverage boundaries
to ensure the patient is transported to the place of definitive care.

5 Service Specification
5.1 The service specifications for the following purchase units are contained within this agreement:

Emergency Road Ambulance Purchase Unit (TR0202)

6 Service Provision
6.1 The Ministry and the Provider agree that a total amount of [$XXXXXX] (GST excl) has been
allocated to the purchase of Emergency Road Ambulance Services for the period from [insert
date] to [insert date].

7 Payment of Services
7.1 In accordance with Part 1 of the Public Finance Act 1989, both parties acknowledge that payment
to the Provider beyond [insert financial year] is contingent upon the appropriation of adequate
levels of funding for services of the type covered by this Agreement under an Act of Parliament for
that financial year.

8 Part Charging
8.1 The Ministry recognises that the Provider may elect in some situations to levy a part charge on
individuals attended by a road ambulance crew.

8.2 Where the Provider elects to impose a part charge:

a the Provider will be entirely responsible for the enforcement of and any legal consequence
relating to the imposition of the charge, including on whom the charge is imposed and in what
circumstances.

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 b the Ministry accepts no legal or other responsibility in relation to the imposition of such a
charge.

8.3 Details to be developed

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Part B: Terms and Conditions Specific to ACC-related Services

1 Coverage Area
The Provider will provide Services to Claimants in [enter coverage areas]

Emergency Ambulance Services may cross coverage boundaries to ensure the Claimant is
transported to the place of definitive care.

2 Pricing
ACC agrees to pay the prices set out in [insert] for services to Claimants provided in accordance
with this Agreement.

Insert Pricing Schedule

Prices exclusive of GST. Services to match or exceed the minimum standards listed above.

3 Service Description
This Agreement between ACC and the Provider covers the provision of one or more of the types
of Service described in the attached Service Specification for the contracted Coverage Area. The
types of Service are listed below.

Where it is necessary and appropriate to transport an injured person by a specialised ambulance

vehicle with qualified ambulance crew, the Provider will provide Services in accordance with this
Agreement and ACC will pay for the following Services:

a Road Services – as outlined in the attached Service Specification

b Transfers

i Emergency Inter-hospital Transfer

An appropriate transportation road vehicle is dispatched by an Emergency Ambulance

Communications Centre (EACC), at the request of a DHB staff member, to collect a
Claimant from an originating medical facility and transport them to a destination medical
facility that can provide a higher level of specialist care; and

The following conditions apply:

A The emergency transport occurs within 24 hours of injury or of the injured person
being found (whichever is later); and

B The injured person’s condition deteriorates or the injuries are such that the
originating hospital is not able to provide the higher level of specialist service
required;

The Provider will ensure that suitably qualified escorts/crew accompany the Claimant in
order to provide inter-hospital treatment/care en route. Standards for transport, inter-
hospital treatment and reporting shall be in accordance with the standards stipulated in
this Agreement. The Emergency Inter-Hospital Transfer service, if provided by road

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 ambulance, will be delivered to one of the three service levels specified in this
agreement, as directed by the EACC.

Where the patient will be escorted by the hospital clinical team from bed (originating
hospital) to bed (receiving hospital), the appropriate handover of clinical notes and
transport documentation will take place with the clinicians taking over the duty of care at
the receiving hospital.

Exceptions

If the originating hospital should have been able to provide the service under normal
circumstances but is unable to do so (for example, the intensive care unit is full or there
is no specialist cover) then the costs of the emergency inter-hospital transfer are not
covered by ACC. In these circumstances ACC expects that the cost of the emergency
inter-hospital transfer is paid for either by the hospital requesting the transfer or under
the Ministry/District Health Board contract arrangements with providers of ambulance
services.

If for some reason the patient is not transported from bed to bed (e.g. a “tarmac”
handover takes place following an air transfer) this is to be reported to ACC within 24
hours of the event or on the first business day after the event occurs, outlining the
reasons why the criteria were not met.

ii Helipad/Airport to Hospital – Hospital to Helipad/Airport

An appropriate transportation vehicle is dispatched to meet an aircraft and transport the

Claimant to their destination hospital, or to transport the Claimant from their originating
hospital to a waiting aircraft. The crew will meet one of the service levels outlined in the
appropriate Service Specification depending on the requirements of the injured person.
The hospital clinical team will accompany the Claimant in order to provide
treatment/care enroute. Standards for transport, pre-hospital care and reporting shall be
in accordance with the standards stipulated in this Agreement.

iii Transport from a private facility to a public facility for Claimants who have undergone
elective procedures funded by ACC where the transfer is necessary for reasons of
clinical safety.

c Planned Non-Emergency Transport to Attend Treatment by Ambulance (NETBA)

i This service covers the provision of non-emergency transport to rehabilitation by

ambulance, by Emergency Ambulance Providers.

ii The objective of planned NETBA is to provide a means by which ACC claimants can
attend treatment and rehabilitation, when emergency transport is not needed.

iii The desired outcome of planned NETBA is that ACC claimants who require access to
non emergency ambulance transport in order to achieve a desirable rehabilitation
outcome, do so easily.

iv Services are to be provided to the standards in accordance with the principles of

Roadside to Bedside (Ministry of Health et al, 1999), that people receive “the right care
at the right time in the right place from the right people”. This specification relates only to
the road ambulance element of EAS.

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 v In addition, services are to be provided to meet the requirements of Regulation 10 of
the Injury Prevention, Rehabilitation and Compensation ( Ancillary Services) Regulations
2001

vi The crewing and qualification level for Planned NETBA is an ambulance or other vehicle
crewed and equipped at the basic Life Support level as specified in the Ambulance and
paramedical services standard (NZS 8156)

vii Service Provision

A Services are initiated where a Medical Practitioner, on behalf of a claimant,

requests ambulance transport to specified types of rehabilitation in relation to a
personal injury (for which ACC has accepted cover)

B Planned NETBA occurs when a claimant or their representative requests

ambulance transport and where ACC has given prior approval for the Planned
NETBA

C To apply for prior approval from ACC, the claimant or their representative must
provide a medical certificate that justifies use of an ambulance as opposed to other
forms of private or public transport. The medical certificate must provide the original
ACC45 or claim number.

D The ambulance transport is dispatched by an EACC

E The EAP is required to make all reasonable efforts to identify where planned
NETBA services are being utilised, and to invoice ACC appropriately

F The invoice submitted to ACC by the EAP must include the claimant’s ACC45 or
claim number, and the name of the doctor supplying the medical certificate.

G Planned NETBA services end when the claimant is delivered to the nominated
treatment provider, or when the claimant is returned to the place of residence/point
of departure following the scheduled rehabilitation treatment.

viii Access to Planned NETBA

A Planned NETBA is available to all eligible people who require the service and meet
the requirement in clause 3 c vii C.

B Access to planned NETBA will result from a call received and allocated by the
EACC.

ix Exclusions

A This service excludes inter-hospital transfer of patients and situations that meet the
criteria for emergency ambulance transport, as specified in the joint ACC and
Ministry of Health Service Specifications for emergency road ambulance services.

d Dispatch

i All requests for road ambulance assistance shall be made through the EACC regardless
of whether the request is for an emergency or non-emergency service.

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 ii All requests for road ambulance assistance and all dispatches shall be made in
accordance with the Injury Assessment Criteria attached as Appendix 1.

e Rescue/Retrieval

i Where the Provider receives a request to respond to a Search and Rescue (SAR)
incident the co-ordination of the operation is a Police responsibility. The Provider shall
liaise with both Police Communications and the EACC, who will work together to
dispatch the appropriate vehicle for the incident. Where the Provider is dispatched by
the EACC for that part of the SAR mission relating to emergency ambulance Services
(e.g. when an injured person has been found), the Provider will be paid for that part of
the Service by ACC.

ii The Provider shall develop working protocols with the Police SAR officer in their
Coverage Area. The protocols will include information regarding the availability of the
Provider’s services, the medical equipment and capabilities of the crew, and hand-over
procedures to facilitate the smooth running of any SAR operation.

iii Payment under this clause shall be in accordance with the requirements under clause g
below.

f Exceptions

This Agreement does not include the delivery and purchase of search services or the
recovery of bodies. “Search” means an attempt to locate a person who has been reported
and accepted as missing by the Police.

g Payment for Transport

ACC is only liable to pay for the provision of emergency and non-emergency transport of
Claimants under this Agreement where an ACC45 has been submitted and cover has been
granted and approved for payment, and/or an ACC claim number has been provided.

h Payment for accommodation

When a Provider transports a Claimant to a place of definitive care and is then unable to
return to their home base (e.g. when maximum driving hours have been reached or
deteriorating weather prevents the return trip) ACC agrees to pay the actual and reasonable
cost of overnight accommodation and meals to a maximum of $200 per night, per crew
member.

4 Completion and Turn-Over Of Forms

a Collection services

i For every collection Service where the Provider is the initial provider of services, they
shall complete (as far as possible) an Ambulance Patient Report Form and an ACC 45
form. The Service Provider shall not, however, sign the Medical Practitioner declaration
part of the form (Part F), unless a Medical Practitioner completed the form.

ii On each ACC45 form the Service Provider shall include the vehicle number (where
applicable), and Ambulance Officer, Medical Practitioner or Registered Nurse number
(where applicable) for each transport provided under this Agreement.

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 iii Within the Provider’s Coverage Area the Provider shall establish protocols with medical
facilities for the completion and forwarding of ACC 45 forms to ACC.

b Emergency Inter-hospital Transfer

To facilitate adequate hand-over for every emergency inter-hospital transfer, the Provider will
complete relevant forms to accompany the patient to the designated medical facility. The
Provider will develop protocols to ensure effective hand-over procedures are in place, and
will also ensure that all Ambulance Officers, Medical Practitioners and Registered Nurses
are aware of these procedures.

5 Invoicing and Payment

5.1 Service Item Codes

The following table represents service item codes used by ACC in the processing of Provider
invoices and schedules. The Provider must use these codes to identify individual service items on
Provider invoices and/or schedules submitted to ACC:

SERVICE ITEM CODE ITEM DESCRIPTION

Sundry

ACCOM1 Accommodation for Assessor or Service Provider

Road

ETR10 Road ambulance - Contracted Emergency Transport

ETRT01 Inter-hospital Transfer - Road - Basic Life Support

ETRT02 Inter-hospital Transfer - Road - Intermediate Life Support

ETRT03 Inter-hospital Transfer - Road - Advanced Life Support

ETRT04 Transfer to or from helipad/airport

Non-Emergency Transport

NETBAOP Planned Non-Emergency Transport by Ambulance - over 50km

NETBAUP Planned Non-Emergency Transport by Ambulance - under 50km

5.2 Basis of ACC Payments

a ACC will pay the relevant amount set out in Part B, clause 2 to the Provider on a fee-for-
Service basis for each Service provided to a Claimant for accident-related Services where:

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 i ACC is satisfied that the Service relates to a claim for cover accepted under the AC Act;
and

ii the invoice submitted has a valid and related ACC45 number (note that ACC may
determine the validity of an invoice by evaluating the information provided).

b Lodgement of ACC45

Where the Provider is the first provider of services to a Claimant, they must submit an
ACC45 claim registration form completed by an Ambulance Officer, Medical Practitioner or
Registered Nurse who is competent to complete the form, to the appropriate ACC Service
Centre for the region; alternatively there may be arrangement with the medical facilities in
their Coverage Area that ensures ACC receives a ACC45 claim registration form for all
Claimants within 24 hours of the date on which the Service was provided. This should be
submitted in electronic format where possible.

c The Provider will ensure that all mandatory fields in the ACC45 are completed accurately and
that the Claimant signs the form prior to lodgement with ACC.

d Where the Claimant is unable to sign the form due to their injuries, the Ambulance Officer,
Medical Practitioner or Registered Nurse may sign on their behalf clearly citing the reason
the Claimant could not sign.

e Where a claim relating to an invoice with an ACC45 number is not accepted under the AC
Act, ACC will inform the Provider. Where extra information is required to determine the
validity of the claim, the onus is on the Provider to provide that additional information.

5.3 Multiple Claimants/Patients for Emergency Transport In A Single Road Ambulance

a Where more than one Claimant is transported in the same ambulance, the EAP may invoice
for the transport of each claimant.

b For the avoidance of doubt, where a Claimant and a medical patient are transported in a
single ambulance, the EAP may submit an invoice to ACC the full price for transport for the
Claimant.

5.4 Bulk Billing

a The Provider will submit ACC40 (Bulk Billing Schedule) invoices electronically as soon as
possible following the date on which the ACC45 claim was lodged. This ACC40 must detail
all amounts payable for Services in accordance with Part B, clause 2 (Pricing grid) covering
the period since the close of the last Bulk Billing schedule.

b For invoices submitted in accordance with this Schedule ACC will pay the Provider the total
amount for all invoices that have a corresponding ACC45 number and that have been
accepted for cover by ACC and which meet all the terms and conditions of this Agreement.

c If an acceptable invoice is received ACC will lodge the payment amount in accordance with
Part B, Clause 2 (Pricing Grid) into the bank account nominated by the Provider within twelve
(12) working days of date of receipt of the invoice/schedule by ACC subject to the information
contained in the invoice/schedule being complete and accurate.

d Advice of payment will be forwarded separately by ACC detailing the individual invoices that
accounted for the total amount lodged.

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 e If an invoice cannot be approved for payment, ACC will advise the Provider, detailing the
reasons for the decline and the steps needed to be taken to obtain approval. Where ACC
requires further information in order to establish cover, ACC will advise what this process is.
If cover is subsequently granted, payment will then be made within ten (10) working days.

f Any queries regarding the non-payment of an invoice should initially be referred to the ACC
Provider Helpline (on 0800-222-070). If the issue remains unresolved it may then be referred
to National Ambulance Sector Office for investigation and resolution.

5.5 Submission Of Invoices

Providers will ensure invoices/schedules for Services are submitted to ACC within 90 days of the
Services being delivered. For the avoidance of doubt, the parties agree that ACC will not pay for a
Service where the invoice is submitted more than 12 months after the date the service was
provided.

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 Appendix 1: Injury Assessment Criteria
Decision-Making Tool for the assessment of the injured person with regard to Mechanism
of Injury and Physiological and Anatomical Assessment Criteria

Three methods may be used to assist in determining severity of major trauma or serious illness in
conjunction with Patient Status (as assessed by the ambulance crew). The three methods and the
criteria for each one are listed below:

 Mechanical

 Physiological

 Anatomical

a Mechanical criteria

The following mechanisms, which imply high energy transfer, would usually indicate a higher
level of care is required for the transport of the injured person, and accordingly will impact on
the decision of which ambulance and crew to use for collection, retrieval, transport and pre-
hospital care.

 Vehicle roll over

 Major deformation of the vehicle

 Fatality in the same vehicle

 Ejection from the vehicle

 Unrestrained child in a motor vehicle crash

 Cyclist or pedestrian hit by a motor vehicle

 Fall of over five metres

 Any mechanism that causes injuries to multiple body regions.

b Physiological criteria

Physiological triage is based on the present state of vital signs and level of consciousness.
Examples include:

 Respiratory rate < 10 or > 30 per minute (or assisted respiration)*

 Systolic blood pressure < 90mmHg*

 Pulse > 130 per minute or < 50 per minute*

 Difficulty of arousal or falling level of consciousness.

* In children and the elderly the same principles apply but physical criteria must be taken in
context of both age or size.

c Anatomical criteria

Specific examples of anatomical criteria include the following:

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  Deep penetrating injury to head, neck, chest, abdomen, peritoneum, or back

 Head injury with coma, a dilated pupil, open head injury, or severe facial injury

 Chest injury with flail segment or subcutaneous emphysema

 Abdominal injury with distension and/or rigidity

 Spinal injury with weakness and/or sensory loss

 Limb injury involving vascular injury with ischaemia of the limb; amputation; crush injury
of the limb or trunk; or bilateral fractures of the femur

 Burns (partial or full thickness) more than 20 percent in adults and more than 10 percent
in the elderly or children.

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Part C: Service Specification for emergency road ambulance services

1 Term
This Agreement will start on 1 April 2012 or when duly executed by the parties and will, subject to
Part 1, Schedule 2 clause 11 (Termination) or clause 16 (Conflict), continue for a period of 48
months to 31 March 2016 with a further right of renewal for a 24 month term. The right of renewal
is at the sole discretion of the Purchasers subject to the satisfactory performance of the Services

2 Purpose
Emergency Ambulance Providers (EAPs) provide Emergency Ambulance Services (EAS) to the
public. EAS includes timely, appropriate emergency care and where necessary, emergency
transport of patients to a place of definitive care.

3 Service Objectives
The objectives for this Service are:

a That it is essential that people get the right care, at the right time, in the right place from the
right person1.

b Emergency ambulance services ensure the care given facilitates the best possible outcomes,
for patients who access emergency ambulance services and complies with quality
requirements.

c Integration of EAS into the wider health sector.

4 Principles
4.1 The following are guiding principles for primary retrievals / treatment / transport:

a Treatment delivered is necessary, appropriate and of the required quality.

b Treatment is delivered by the staff with the appropriate skill level and support.

c Transport to treatment is undertaken only when necessary and appropriate and is related to
patient need.

5 Overview of Emergency Ambulance Services

5.1 Emergency Ambulance Services includes Emergency Ambulance Communication Centres
(EACCs) and Emergency Ambulance Providers.

5.2 EACCs:

a provide the telecommunication interface between the caller and the EAP;

b determine the patient need through an agreed telephone triage system;

c effectively manage ambulance resources to ensure emergency calls are appropriately

responded to.
1
Roadside to Bedside – A 24-hour Clinically Integrated Acute Management System for New Zealand; ACC/Health Funding
Authority/Ministry of Health and Council of Medical Colleges; 1999. Available from www.moh.govt.nz

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5.3 The types of resources available to the EACC for dispatch are:

a Emergency Road Ambulances including water ambulances2;

b Emergency Air Ambulances; and

c Primary Response in Medical Emergency (PRIME) doctors and nurses.

5.4 EAPs:

a provide road ambulance services across New Zealand, with a range of services and
capability levels to meet the needs of their communities within available resources;

b are dispatched by the EACCs;

c respond in a timely manner to calls for assistance made through the EACCs in order to
provide appropriate care and, where necessary, emergency transport of people requiring
urgent treatment as a result of one of the following medical emergencies: illness, injury or
obstetric emergency.

5.5 The Crown expects that the resource most appropriate to the patient’s triaged needs will be
utilised. This means an ambulance resource will be dispatched and/or referral to an alternative
care pathway.

5.6 It is expected, that if an ambulance has been dispatched and it is deemed clinically appropriate,
then the EAP shall refer the patient to an alternative care pathway rather than transport the patient
to a place of definitive care.

6 Background
6.1 Roadside to Bedside

a Roadside to Bedside outlines the framework necessary to provide the best possible
outcomes for people who need to access emergency services by ensuring that people get
‘the right care, at the right time, in the right place, from the right person’.

b EAPs must follow the Roadside to Bedside framework.

6.2 The New Zealand Ambulance Service Strategy

The New Zealand Ambulance Service Strategy3 (the Strategy) was announced in June 2009. The
Strategy was developed by the Accident Compensation Corporation (ACC) and the Ministry in
consultation with the ambulance sector and other stakeholders. The Strategy provides a
framework for future development and growth of emergency ambulance services, and ongoing
collaboration between Crown, sector and stakeholders. The 10 initiatives from the Strategy were
developed taking into consideration advice and recommendations following several reviews of the
Ambulance Sector. These initiatives have been prioritised and are being implemented over time.

2
Services usually organised through EAPs and provided by Coast Guard services
3
The New Zealand Ambulance Service Strategy – The first line of mobile emergency intervention in the continuum of health care. 4
June 2009. Available from www.naso.govt.nz.

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6.3 Integration into the wider health sector

The integration of Emergency Ambulance Services into the wider Health Sector may contribute to
more services being delivered in local communities. Thereby potentially reducing the demand on
secondary and tertiary services. This may lead to providing better care for patients, closer to
home.

6.4 Obligations for response to major emergencies

EAPs must comply with the following:

a The National Civil Defence Emergency Management Plan Order 2005.

b The Ambulance New Zealand Ambulance National Major Incident Plan (AMPLANZ)
framework.

c The New Zealand Standard, Ambulance and paramedical services standard (NZS 8156).

6.5 EAP and EACC Interface

a The EACCs dispatch EAP resources to the scene of the medical emergency, as appropriate,
based upon information received from the caller. Allocation and dispatch of resources is
based on patient need, within available resources. EAPs are responsible for the supply of the
EAS resources.

b EAPs are required to have a formal, signed Service Level Agreement (SLA) with EACCs that
describes the operational relationship, including location finding responsibilities.
Communication between the EAP and EACCs is paramount at all times and this will be
reflected in the SLA. A copy of the signed SLA will be provided to the National Ambulance
Sector Office (NASO). Any subsequent changes will be formally agreed and signed by the
EAP and EACCs, and then advised to NASO.

c The EAP will be a participating member of the Emergency Ambulance Communication

Centre User Group. The Terms of Reference4 should be revised at least every two years with
EACCs leading the process with involvement of all EAPs and NASO.

6.6 Emergency Care Coordination Teams

EAPs must be participating members of the appropriate regional Emergency Care Coordination
Team (ECCT), where they exist.

6.7 Interface Between the Ministry and ACC

a The NASO is a joint ACC and Ministry team which manages all EAS contracts, including
EACC and EAP contracts, on behalf of the two Crown Agencies.

b ACC and the Ministry have different funding models for EAS; these will continue until such
time as a joint funding model has been agreed and approved for implementation. Any
changes to the funding model will be recorded in a contract variation.

4
EACC User Group Terms of Reference are approved by NASO, Ambulance New Zealand and the EACC Oversight Committee.
Current ToR are available from Ambulance New Zealand

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6.8 ACC Responsibilities

ACC is responsible for the funding of EAS for certain eligible people 5 who have suffered personal
injury in terms of the ‘Act’ for which a claim for cover has been accepted, or is likely (in the EAP’s
experience) to be accepted. Eligible people are those for whom the EAS starts within 24 hours of
suffering a personal injury or within 24 hours of being found after suffering a personal injury
(whichever is the later), and for whom the emergency transport is necessary for the purpose of
obtaining treatment urgently for the claimant’s personal injury. Those eligible are all those resident
in New Zealand and visitors to New Zealand.

6.9 Ministry Responsibilities

a The Ministry funds EAS for all Eligible People6 who have a need for emergency medical
attention. For the purposes of this service specification emergency medical attention means
services provided to a patient who requires medical attention (not caused by trauma) from
the time of the EAS being notified (via the EACC) of the need for services; to the time the
patient arrives at a place of definitive care.

b Transport between public hospital emergency departments within three hours of arriving by
ambulance is included in the service provided under this Agreement.

c In this specification, “emergency” means those cases triaged as life threatened or potentially
life threatened as determined by the Triage system used in the EACC.

d The EAS is capacity funded to meet this urgent demand and may be used to respond to non
emergency situations but non emergency volumes are not considered a basis for change in
funding levels.

e The use of funded capacity to respond to non-emergency situations must not impact on the
ability to respond to emergency situations.

7 Service Description
7.1 General

The Emergency Ambulance Provider must:

a Comply with NZS 8156 (including but not limited to clinical governance) and relevant
legislation outlined in NZS 8156.

b Be a member of Ambulance New Zealand.

c Comply with International Organisation for Standardization 9001: 2001 (ISO 9001:2001).

d Use best endeavours to meet the required response time targets (refer Appendix 2).

e Respond and supply an emergency road ambulance service for people requiring assistance
as a result of a medical emergency when required and dispatched by the EACC.

f Be available 24 hours a day, 7 days a week inclusive of statutory and public holidays, and
have contingency services in place for back-up in the event of their inability to provide the
Services for any reason.
5
Refer to Part Two, Service Schedule – Emergency Road Ambulance Services for the definition of Eligible Persons for ACC EAS
Services.
6
Refer to Part Two, Service Schedule – Emergency Road Ambulance Services for the definition of Eligible Persons for Ministry EAS
Services.

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 g Respond to requests by the EACC to transport a treatment provider(s) to the scene of an
incident where it is clinically appropriate (eg where the patient is not able to be moved), and
where it is reasonable, to return that treatment provider to town or residence, (e.g.
emergency physician, anaesthetist, lead maternity carer).

h Crew road ambulances with appropriately skilled staff (refer Appendix 1).

i Meet service delivery requirements described in this service specification.

j Send the most appropriate, closest/fastest resource regardless of geographical boundary.

7.2 Clinical Governance

a The EAP must have an established Clinical Governance Framework within their organisation,
and must be able to demonstrate both the framework, and application of the framework to
daily business, if requested by NASO.

b The EAP will be a participating member of the ambulance sector’s National Clinical
Leadership Group (NCLG)7.

c The EAP shall implement policies and procedures directly relating to clinical issues which
have been promoted by the NCLG.

7.3 Training and Education

The EAP will have a continuing clinical education programme to ensure that ambulance personnel
maintain clinical competence and currency.

7.4 Staff and Service Capability Levels

a The Service Capability Levels (refer Appendix 1) describes the crewing required of the EAP.

b If Ambulance Personnel become regulated and registered health professionals under the
Health Practitioners Competence Assurance Act (HPCA Act) 2003, then each Ambulance
crew member/staff member/officer will hold an annual practicing certificate and will work
within their scope of practice (if any).

c The EAP will be responsible to ensure staff meet the registration requirements under the
HPCA Act, in a timeframe agreed by the EAP and NASO (on behalf of ACC and the
Ministry).

7.5 At the Scene of a medical emergency

The EAP must:

a ensure Services provided comply with NZS 8156;

b ensure all Ambulance Personnel are appropriately trained and work within the current
authorised patient care protocols issued by the responsible Medical Advisor/Medical Director;
and

c co-ordinate with other emergency services present at the scene (e.g. Police and Fire).

7
The purpose of the NCLG is to provide a consistent approach to all clinical issues across the New Zealand Ambulance Sector.

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7.6 Patient Handover

The EAP must ensure continuity of care for the patient is maintained by :

a The seamless transfer of care to the accepting treatment facility.

b Handover by both a verbal report, and a properly documented copy of the Patient Report
Form (PRF), and, where appropriate, the ACC45, to the receiving treatment facility

Where it is appropriate, the ACC45 must be signed by the patient wherever possible; if the patient
is unable to sign, the reason for this must be documented on the PRF.

The responsibility remains with the EAP until an alternative clinical pathway has been agreed and
accepted by the other party, and a warm handover has been completed, as per the developed
protocols and/or guidelines.

8 Maori Health and Cultural Requirements

8.1 EAPs will provide services in a culturally appropriate way and will comply with relevant cultural
requirements as prescribed by the Ministry and ACC from time to time.

9 Exclusions
9.1 EAS services for the following incidents are excluded from this Agreement:

a for the Ministry:

i the inter-hospital transfer of patients with the exception of those medical patients
transferred between facilities within three hours of arrival at that facility; and

ii non emergency attendances including attendance at public events, standby in support of

other emergency services and any transports privately funded.

b for ACC:

i patients transferred more than 24 hours after suffering their personal injury;

ii non-emergency transport unless the transport meets the Planned Non Emergency
Transport by Ambulance (NETBA) service descriptions. Prior approval must be obtained
for Planned NETBA

iii any time spent in the search for a Claimant; and costs incurred if the Claimant dies
before the EAS arrives; and

iv patients, where the location of the patient is outside New Zealand’s territorial waters. 8

10 Service Linkages
10.1 The purpose of key linkages is to maintain a working relationship of communication, consultation
and inclusion. Those organisations identified in clause 10.2 are not exclusive and the EAP is
encouraged to explore opportunities to develop and maintain key linkages with other
organisations nationally, or within the region that enable and/or promote effective service delivery
and achievement of the objectives of this service specification.

8
Territorial Sea, Contiguous Zone and Exclusive Economic Zone Act 1977 and Injury Prevention, Rehabilitation, and Compensation
Act 2001.

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10.2 The EAP must maintain key linkages with the following organisations or entities in order to provide
an efficient and effective emergency ambulance service:

a other EAPs (road and air) in the region and neighbouring regions;

b PRIME providers;

c EACCs;

d receiving District Health Boards which have an involvement in emergency care as well as
DHBs which provide specialist services on a national or sub national basis (e.g burns, spinal
injury);

e the ECCT for the region;

f the Ministry;

g ACC;

h NASO;

i other emergency services including New Zealand Police, Fire, Search and Rescue;

j relevant national Sector and Stakeholder groups eg Ambulance New Zealand;

k other local organisations with a direct interest in the provision of emergency care including
Primary Health Organisations and private emergency medical clinics.

11 Quality Requirements
11.1 General Quality Requirements

The EAP will:

a comply with the quality requirements in the overarching Agreement(s); and

b be certified as compliant with the current version of NZS 8156.

Response time targets are defined in Appendix 2 (Response Time Targets).

11.2 Data Quality

a The EAP must work with EACCs to ensure that the data stored by EACC is accurate and
reliable.

b The EAPs will work with EACCs to ensure that the classifications (ie Urban, Rural and
Remote) that are applied to each Service Area are aligned with the latest Census data
available.

c Agreement is required by the EAP, the EACC and NASO to apply a classification to a
Service Area(s) that is not in line with the latest census data available. The reason for the
change must be documented by the EACC and reported in the next Quarterly Report.

12 Reporting
12.1 The EAP will provide reports electronically to NASO, in an agreed format.

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12.2 The EAP will provide reports to NASO as per the following table. Data should be provided in
Microsoft Excel spreadsheet format where appropriate. Appendix 3 contains indicative templates
for data required.

Reporting Requirement Frequency/Period Due

1. Response Time Performance (Latest month and 24
20th calendar
months history)
day of the
Performance against response time targets as defined in Monthly
following
appendix 2 month

2. Volume Data (Latest month and 24 months history)

a. Volume of incidents attended where there was no 20th calendar
patient transported day of the
Monthly
following
b. Volume of incidents attended where there was at month
least one patient transported (by life threatening,
potentially life threatening and non emergency)

3. Frontline Staffing
Staff establishment Full Time Equivalent (FTE) numbers
by Skill level for Six-monthly:
a. FTE paid establishment July-December 20th January
January to June 20th July
b. FTE vacancies for paid positions
c. Headcount of Volunteers

4. Clinical outcomes:
The EAP will to report on clinical outcome measures for at
least one medical condition and one trauma related Six-monthly:
July-December 20th January
condition.. This report must also be sent to the NCLG. January to June 20th July
The conditions and reporting requirements are determined
by the NCLG with NASO and may be reviewed annually.

5. Quality
a. Copy of Annual Patient Experience Survey
Annual As available
b. Copy of the NZS8156 audit summary with any
corrective actions

12.3 The EACC service providers may provide data to NASO. Where the data represents an individual
EAP the data will first be sent to the EAP for the opportunity to verify the data and provide
commentary.

13 Incident reporting
All incidents will be assigned a Severity Assessment Code (SAC) rating for the actual and
potential outcome of the incident. Ratings shall be in accordance with the New Zealand Incident
Management System (NZIMS). See Appendix 4 for details.

13.1 Incident Reporting - Serious and Sentinel Events

a Specific Event Reporting

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 Serious and Sentinel events with a SAC 1 or SAC 2 rating of the outcome of the incident
must be reported as per NZIMS.

i NASO must be notified of SAC 1 and SAC 2 events no later than five working days from
identification of the event. The EAP will provide NASO with a copy of the NZIMS report.

b The EAP will provide NASO with updates of any developments regarding the investigation
including:

i Progress of investigation

ii Findings of the investigation

iii Media releases/responses

iv Mitigation strategies.

c Media

The EAP will immediately advise NASO if it becomes aware of a serious or sentinel event
which in the EAP’s opinion has or may have media or public interest. This may be provided
orally in the first instance, and followed up in writing.

d Quarterly Reporting

i The EAP must provide NASO with quarterly reports summarising Serious and Sentinel
events.

ii These reports should be from the same data source as the NZIMS reports.

iii The minimum data required is shown in the template in Appendix 5 (Serious and
sentinel events quarterly report). This data may either be entered into the template or in
an alternative format.

13.2 Incident Reporting - Adverse Events and Complaints

a Media

The EAP will immediately advise NASO if it becomes aware of an adverse event or complaint
which in the EAP’s opinion has or may have media or public interest. This may be provided
orally in the first instance, and followed up in writing.

NASO will be informed of the following information, following internal investigation:

i Cause of incident

ii Impact/Potential Impact

iii Mitigation Strategies

iv Outcome.

b Quarterly Reporting

The EAP must report to NASO, volumes of adverse event, using the template in Appendix 6
(Volume Template – Adverse Events). This will be used to monitor trends.

13.3 Other Reporting

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 NASO may make reasonable requests for ad-hoc information relating to the provision of EAS and
the EAPs must provide any such requested information within an agreed timeframe that is
reasonable for the information requested.

14 Monitoring and Evaluation

14.1 Representatives from NASO will meet quarterly with the representative from the EAP to review
and discuss the reports received by NASO and any performance issues.

14.2 All reports that are provided to NASO from both the EAP and EACCs will form the basis for
quantitative measurement of performance of that EAP.

14.3 Prior to the regular performance monitoring meetings as detailed in clause Error: Reference
source not found4.1, the EAP will provide NASO with written commentary/explanations regarding

a changing trends and exceptions identified in the reports

b regional/district performance issues

c activities planned and being undertaken to improve performance

14.4 The EAP will participate in the EACC User Groups as per clause 6.5c.

14.5 Upon reasonable notice (not less than 10 working days), the EAP will collate and provide
information for audit to the Ministry and ACC.

14.6 NASO retains the right to evaluate any aspect of the EAP’s performance. At least 10 days notice
will be given of any evaluation audit.

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Appendix 1: Service Capability Levels as per NZS 8156
Service Capability Levels Road

Basic Life Support All emergency Basic Life Support capable ambulances must be
crewed with at least one crew member who holds at a minimum: the
(BLS) Ambulance New Zealand recognised National Diploma in Ambulance
Practice (NZQA Level 5) or equivalent.

Intermediate Life Support All emergency Intermediate Life Support capable ambulances must be
(ILS) crewed with at least two crew members who hold an Ambulance New
Zealand recognised ambulance qualification. One must hold a
minimum: the Ambulance New Zealand recognised Bachelor of Health
Science, ILS Pathway (WFA/OSJ) or equivalent.

Advanced Life Support All emergency Advanced Life Support capable ambulances must be
crewed with at least two crew members who hold an Ambulance New
(ALS)
Zealand recognised ambulance qualification. One must hold a
minimum of Post Graduate Certificate in Speciality Care – Advance
Paramedic Practice or equivalent as recognised by Ambulance New
Zealand.

OTHER SERVICE CAPABILITY LEVELS

Service Capability Levels Road

First Responder A response which may have a qualification of less than BLS
and is the first resource available to respond to an incident.
This may or may not be a response in a vehicle with patient
carrying capability. This may include the fire service.

Rapid Response Unit A response is a non transport capable vehicle. This response
is designed for early arrival at cases where immediate
intervention is required and can also be used for back up for
lower skilled crew levels.

Urgent Community Care A response with a skill level of ECP/UCC who are trained to
(UCC)/Extended Care assess patients conditions to determine the best patient care
Paramedics (ECP) pathway, which may be typically involve treatment at home or
referral to other care pathways, rather than direct transport to
ED.

PRIME PRIME is a co-response with ambulance services, for medical

emergencies in identified PRIME locations. PRIME
Practitioners are Doctors and Nurses who are PRIME trained.

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Appendix 2: Response Time Targets
Response times will be reported for the following types of incident:

1 Immediately Life Threatening Incidents

2 Potentially Life Threatening Incidents, and

3 Non Emergency Incidents

ProQA is an internationally recognised medical dispatch system and triage tool. The definitions for the various ProQA determinant levels are in the Service
Schedule glossary. The determinant level assigned to each incident will form the basis of classifying the type of incident.

Urban service area Rural service area Remote rural service area

Type of Incident (Main urban centres > 15,000 population – responses (Rural areas surrounding urban cities, or non-remote (Very rural and remote locations as specified on
within city boundary as specified on service area map) rural areas, or minor urban/provincial town centres < service area map)
15,000 population as specified on service area map)

Immediately Life Arrive at request point
Threatening within 8 minutes from
Emergency time of sufficient
Incidents information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 20 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls
Arrive at request point
within 12 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 30 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls
Arrive at request point
within 25 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 60 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls

Potentially Life Arrive at request point within 20 minutes from the time Arrive at request point within 30 minutes from the time Arrive at request point within 60 minutes from the time
Threatening of sufficient information collected for the call to be of sufficient information collected for the call to be of sufficient information collected for the call to be
Emergency entered into the queue for 80% of calls entered into the queue for 80% of calls entered into the queue for 80% of calls
Incidents

Non Emergency Time out as requested or specified by control and Time out as requested or specified by control and Time out as requested or specified by control and
Incidents within normal road restrictions within normal road restrictions within normal road restrictions

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Time intervals

The following diagram shows the intervals that are used for time based reports

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Appendix 3: Reporting Templates
Response Time Performance

Provider
Period
Date

Urban Rural Remote

Potentially life Potentially life Potentially life
Immediately Life threatening threatening Immediately Life threatening threatening Immediately Life threatening threatening
emergency incidents emergency emergency incidents emergency emergency incidents emergency
incidents incidents incidents
50% 95% 80% 50% 95% 80% 50% 95% 80%
8 minutes 20 minutes 20 mintues 12 minutes 30 minutes 30 minutes 25 minutes 60 minutes 60 minutes
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11

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Volume Reporting

Provider
Period
Date

Volume of incidents attended where there was at least one patient transported
Volume of incidents attended where
there was no patient transported
Immediately life threatening Potentially life threatening Non-emergency

Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11

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Front Line Staffing

Provider
Period
Date

ALS ILS BLS Total

Full Time Equivalent Paid Establishment

Full time Equivalent vacancies for paid

positions

Headcount of volunteers

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Appendix 4: Allocating the Severity Assessment Code (SAC Score)

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Source: http://www.moh.govt.nz/moh.nsf/indexmh/improvingquality-reportableevents-resources
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Appendix 5: Serious and Sentinel Events Quarterly Reporting Template

Incidents - Quarterly Report

Reported by: (name)
Operator: (select)
Date Reported: (date)
Year: 2010/11
Quarter: (select)

Required fields Required for SAC1 and SAC2 events (not required for SAC3 & SAC4) If known:

Serious, Sentinel or

Assessment Code
Date Reported to

Actual / Potential

Actual Severity

Final SAC Score

Incident Number
Type of Incident

Date of incident

investigation /
(SAC) Score
Organisation

(Near Miss)

Complaint?
mitigation)
Event Ref

(following
Description of what

Adverse
Region
NASO

Findings/Outcome of Mitigation (Investigation /

Incident Category happened and immediate Recommendations Media coverage (if any) Media Story (if any)
Investigation Response / Actions)
actions taken

(select) (select) (select) (select) (select) (select) (select)

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Appendix 6: Volume Template – Adverse Events
This template relates to clause 13.2.b
Reported by: (name)
Operator: (select)
Date Reported: (date)
Year: 2010/11
Quarter: (select)

Categories
Adverse Events
Attitude The attitude of the attending member(s)

Late Late arrival

Driving Any issues around the driving of the ambulance

Payment Specific issues involving payment

Refusal of patient to transport or the member believes there is no

Refusal
need to transport

Equipment Specific equipment issues - maybe safety related

Where the patient is injured as a direct result of transporting to

Injury
destination

Treatment Medical treatment - suitability thereof etc.

Whether there may have been a breakdown in Communication with

Communication
crew and RCC or even hospital / patient

Cultural Any issues around cultural matters

Privacy Issues involving privacy concerns

Other Where complaint does not neatly fit into any of the other categories

Total 0

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