I received the following question:

I am a qualified paramedic; however, as I am currently engaged in full-time post graduate study, I am no longer working within EMS. What does the law state if I was to utilise my advanced life support skill in an emergency situation? and, what are the laws regarding the carry of emergency resuscitation drugs and equipment whilst volunteering with an organisation as an ALS paramedic?

I don’t know the jurisdiction this correspondent practices in but the answer is going to be much the same regardless of their state or territory. For the sake of the discussion I’ll refer to NSW law.

The real question is ‘in what sense are you a paramedic if you not employed in EMS?’ I guess you may hold some qualifications but they don’t actually authorise you to do anything.

In terms of life support skills they are unlikely to be regulated. If you have skills that go above and beyond the ordinary, skills that can be used in making a diagnosis and providing treatment then you can continue to use them, there is nothing to say you need a qualification or licence to use oxygen, perform external thoracic compressions (are they still used for extreme asthma?) or the like. It’s surprising how unregulated these things really are, but that is because no regulator could, or would want to, try and identify every treatment procedure and list who can perform the task.

The use of drugs is a very different matter. That is regulated. The Poisons and Therapeutic Goods Act 1966 (NSW) sets out the various schedules for drugs (in medical care the most relevant ones being Schedules 2, 4 and 8) and who can carry, use and dispense these drugs. The Poisons and Therapeutic Goods Regulation 2008 (NSW) fills in details including who can use the drugs as part of their duties. With respect to schedule 8 drugs, clause 101 of the Regulation says:

(1) The following persons are authorised to have possession of, and to supply, drugs of addiction:…
(g) a person:
(i) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and
(ii) who is approved for the time being by the Director-General for the purposes of this clause.

With respect to other scheduled drugs, clause 7 of Appendix C says:

A person:
(a) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and
(b) who is approved for the time being by the Director-General for the purposes of this clause,
is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Director-General for use by such persons in the carrying out of emergency medical treatment.

It is unquestionably clear that the authority to use and carry these drugs depends on the person being employed as an ambulance officer by the Ambulance Service of NSW and being authorised by the Director general. If they cease to be employed, they cease to have the authority to be in possession of or supply those drugs and they commit a criminal offence if they do. Carrying scheduled drugs in an ex ambulance officers first aid kit is prohibited. (Whether an off duty paramedic can carry those drugs in their private kit would depend on the wording of their authorisation but without seeing the specific wording, one would have to say that is also prohibited.)

As for carrying ’emergency resuscitation drugs and equipment whilst volunteering with an organisation as an ALS paramedic’ that again depends on the authorisation. Some drugs are authorised in appendix c so members of the ski patrol, people who hold an occupational first aid certificate, people who have done appropriate courses in asthma or anaphylaxsis first aid can carry the listed drugs for that purpose.

The Director General of Health may issue an authority to a person or to a class of people to allow them to carry and supply scheduled drugs (Poisons and Therapeutic Goods Regulation 2008 (NSW) s 170). Organisations that use volunteer paramedics may have obtained an authority to allow them to use their life saving drugs. If I was a volunteer paramedic, and in particular, one who was ‘no longer working within EMS’ I’d want to see the authority and read it carefully. It may say ‘if you have completed x, y or z course and have the approval of the chief officer you can carry drugs a, b and c’ or it may say ‘if you are employed as a level 5 ambulance officer by the state ambulance service you may carry and use all the drugs in accordance with the authorisation given by that service’. You can see the problem with either of those wordings, if you were an employed paramedic you may not have done course ‘a, b or c’ and no longer have state ambulance authority, in which case you could not carry any drugs!

The legal position is, absence paramedic registration, if you no longer work for your ambulance service, you are no longer a paramedic and your authority to use restricted substances goes. Of course you still have skills and knowledge that you should apply if called upon to do so.

Former employees of ambulance services would be well served by the move to paramedic registration. For more discussion on this topic see my earlier posts:

Treatment outside the protocol

Paramedic Registration (and the comments to that post) and

The paper written by Jason Bendall of NSW Ambulance and myself on ‘The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics’ (2010) Vol 8 Iss 4 Journal of Emergency Primary Health Care Article Number: 990414.

Michael Eburn