A paramedic from Victoria has written to me and asked:

… a question regarding the poisons & drugs legislation within Victoria.

Essentially it boils down to what, if any, medication may be carried and administered to patients by first aiders acting in a voluntary capacity in Victoria. Does this change between different qualifications of first aider? Does it change for an RN?

I’m especially curious as to the status of Paracetamol, Analgesics (Methoxyflurane or Nitrous Oxide), Salbutamol and Adrenaline auto injectors within the Victorian context.

I’ve heard so many different opinions as to what is legal that I’m thoroughly confused…

It’s not surprising your confused; the answer is confusing and will remain unclear at the end of this post.

The relevant Act is the Drugs, Poisons and Controlled Substances Act 1981 (Vic). This Act incorporates the Poisons Standards 2013 (made under the Therapeutic Goods Act 1989 (Cth)) into Victorian law; (Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 12D and Drugs, Poisons And Controlled Substances (Commonwealth Standard) Regulations 2011 (Vic). The Poisons Standard can be found online at http://www.comlaw.gov.au/Details/F2013L01607. It is under this standard that poisons are listed in the schedules 1 to 8.

The relevant schedules are:

Schedule 2. Pharmacy Medicine – Substances, the safe use of which may require advice from a pharmacist and which should be available from a pharmacy or, where a pharmacy service is not available, from a licensed person.

Schedule 3. Pharmacist Only Medicine – Substances, the safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription.

Schedule 4. Prescription Only Medicine, or Prescription Animal Remedy – Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription. (See Poisons Standard 2013, Introduction).

The drugs identified in the question are scheduled as follows:

• Methoxyflurane and Nitrous Oxide are both in Schedule 4:
• Paracetomol when in tablets of less than 500mg and in packets of less than 25, Schedule 2; otherwise Schedule 4:
• Salbutamol when it is the only therapeutically active substance in aerosols delivering 100 micrograms or less of salbutamol per metered dose or in dry powders for inhalation delivering 200 micrograms or less of salbutamol per dose, Schedule 3; otherwise Schedule 4:
• Adrenaline in preparations containing 1 per cent or less of adrenaline except in preparations containing 0.02 per cent or less of adrenaline unless packed and labelled for injection, Schedule 3; otherwise Schedule 4.

For the sake of this answer I will only consider the use of the schedule 4 drugs. It is an offence to possess or supply scheduled poisons except in accordance with the Act, however:

any nurse practitioner is … authorised to obtain and have in his or her possession and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in relation to the relevant category of nurse practitioner in the lawful practice of his or her profession as a nurse practitioner; and
any registered nurse whose registration is endorsed under section 94 of the Health Practitioner Regulation National Law is hereby authorised to obtain and have in his or her possession and to use, sell or supply any Schedule 2, 3, 4 or 8 poison approved by the Minister in relation to the relevant category of nurse in the lawful practice of his or her profession as a registered nurse; (s 13(ba) and (bb)).

(But the registered nurse or nurse practitioner cannot supply those drugs by retail in an open shop unless specifically licensed to do so; s 13(2AA) and (2AAB)).

The Minister may list drugs and poisons that can be used and supplied by practitioners including circumstances when the drug may be used (s 13). This is relevant for registered nurses and nurse practitioners (see http://www.health.vic.gov.au/dpcs/prescriber/nurse.htm). People may also apply for a warrant or permit to use poisons (s 20). This is relevant for say private paramedic service providers who need to gain permission to allow their staff to carry and use scheduled drugs.

The Regulations also give specific exemptions; importantly regulation 5 provides the following authorities;
• an operational staff member of Victoria Ambulance may carry and use ‘Those Schedule 4 poisons or Schedule 8 poisons listed in the health services permit held by that ambulance service within the meaning of the Ambulance Services Act 1986.
• A member of St John Ambulance Australia (Vic.) recognised by that organisation as qualified to Advanced First Aid level may carry and use “Those Schedule 4 poisons listed in the health services permit held by St John Ambulance Australia (Vic.).”
• An Australian Ski Patrol Association Inc. qualified ski patroller may carry and use “Those Schedule 4 poisons approved by the Secretary that are required in the performance of a ski patroller’s duties for the treatment of emergencies.” The website for the Department of Health says that the Secretary has approved the use of Methoxyflurane and Nitrous oxide by members of the ski patrol (see http://www.health.vic.gov.au/dpcs/approve.htm#skipatroller).

That doesn’t help us to understand what schedule 4 drugs can be used as we would need to see the permits issued to Ambulance Victoria and St John Ambulance (Vic) respectively. Whilst these exemptions or authorities are listed in the regulations, they don’t need to be; it follows that permits and warrants may have been issued authorising others to use various drugs.

Let me know return to the question which was “what, if any, medication may be carried and administered to patients by first aiders acting in a voluntary capacity in Victoria”?

Answer: it depends on their authority. A permit has been issued to St John Ambulance Australia (Vic) so to know the answer to that question one would have to see the permit. For first aiders outside St John it would also be necessary to see the terms of any authority that they had been granted.

“Does this change between different qualifications of first aider?”
Answer: Yes, for example the authorised St John first aiders are those ‘recognised by that organisation as qualified to Advanced First Aid level’. The same could and would be true for other organisations.

“Does it change for an RN?”
Answer: Yes, but the critical issue for RN’s is the terms of their registration or approval. As noted above the relevant provisions in Sections 13(ba) and (bb) refer to the use of drugs in the persons “lawful practice of his or her profession as a registered nurse”. If they are authorised by their registration to carry, use and supply scheduled drugs then they can in accordance with the terms of that registration; but whether that extends to volunteer work with volunteer first aid organisations one would have to look at the exact wording on their registration or authority.

So, as I said, having looked at the law the answer is no clearer – we can reach the conclusion that ‘first aiders acting in a voluntary capacity in Victoria’ can carry, use and administer whatever scheduled drugs they have been authorised to carry, use and administer by the Secretary and in accordance with the terms of any authorisation, warrant or permit.

Michael Eburn
2 January 2014